Association of total cholesterol variability with risk of venous thromboembolism: A nationwide cohort study

Hyungjong Park; Yoonkyung Chang; Heajung Lee; Iksun Hong; Tae-Jin Song

doi:10.1371/journal.pone.0289743

Association of total cholesterol variability with risk of venous thromboembolism: A nationwide cohort study

PLoS One. 2023 Aug 17;18(8):e0289743. doi: 10.1371/journal.pone.0289743. eCollection 2023.

Authors

Hyungjong Park¹, Yoonkyung Chang², Heajung Lee³, Iksun Hong³, Tae-Jin Song³

Affiliations

¹ Department of Neurology, Keimyung University, School of Medicine, Deagu, Republic of Korea.
² Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
³ Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.

Abstract

Background: The effects of total cholesterol (TC) on coagulation and hemostatic systems could contribute to the development of venous thromboembolism (VTE). We investigated this possible association using TC variability.

Methods: From the Korean NHIS-HEALS database, 1,236,589 participants with health screenings between 2003 and 2008 were included. TC variability was assessed using various parameters, including the coefficient of variation (CV), standard deviation (SD), and variability independent of mean (VIM). Occurrence of VTE was established by identifying at least two medical claims with a diagnostic code including various types of VTE: deep vein thrombosis (DVT) (I80.2-80.3), pulmonary embolism (PE) (I26, I26.0, I26.9), intraabdominal VTE (I81, I82, I82.2-82.3), and other VTE (I82.8-82.9).

Results: Throughout the study's median follow-up period of 12.4 years (interquartile range 12.2-12.6) years, TC levels were assessed a total of 5,702,800 times. VTE occurred in 11,769 (1.08%) patients (DVT (4,708 (0.43%)), PE (3,109 (0.29%)), intraabdominal VTE (5,215 (0.48%)), and other VTE (4,794, (0.44%)). As a result, there was gradual association was observed between higher TC variability and occurrence of VTE. Multivariable analysis showed that quartile of TC variability using CV showed a positive correlation with the occurrence of VTE (adjusted hazard ratio (the highest versus lowest quartile), 1.14, 95% confidence interval, 1.08-1.20, p < 0.001). This result remained consistent applying to SD and VIM. In addition, higher quartile of TC variability was consistently associated with the development of various types of VTE in subgroup analysis.

Conclusions: Increased TC variability may be associated with increased VTE risk. This analysis highlights the importance of maintaining stable TC levels to prevent the development of VTE.

Copyright: © 2023 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abdominal Cavity*
Asian People
Cholesterol
Cohort Studies
Humans
Pulmonary Embolism* / epidemiology
Venous Thromboembolism* / epidemiology

Substances

Cholesterol

Grants and funding

This project was supported by a grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2021R1F1A1048113 to T-JS). This work was supported by the Institute of Information & Communications Technology Planning & Evaluation (IITP) grant funded by the Korean government (MSIT) (2022-0-00621 to TJS, Development of artificial intelligence technology that provides dialog-based multi-modal explainability). This research supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI22C073600, RS-2023-00262087 to TJS). The funding source had no role in the design, conduct, or reporting of this study.