Total cholesterol variability and risk of atrial fibrillation: A nationwide population-based cohort study

High-Density Lipoprotein Cholesterol Levels and the Risk of Acromegaly: A Nationwide Cohort Study

OBJECTIVE

Large-scale population-based data on the association between low high-density lipoprotein cholesterol (HDL-C) levels and the development of acromegaly are lacking. We aimed to investigate the association between different HDL-C levels and incident acromegaly.

DESIGN

Retrospective Cohort study.

PATIENTS AND MEASUREMENTS

Using data from the National Health Insurance Services in Korea, we enroled adults without pre-existing acromegaly, who participated in the national health screening in 2009, were enroled and followed up until 2019. Participants were classified based on baseline HDL-C levels. Low HDL-C level was defined as HDL-C value < 40 mg/dL for men or < 50 mg/dL for women. The risk of acromegaly was also examined according to HDL-C levels in 10 mg/dL intervals.

RESULTS

Among a total 9,876,423 adults without acromegaly, 459 (4.6 cases per 100,000 people) participants developed acromegaly during the median follow-up period of 9.2 years. The risk of acromegaly was significantly higher in patients with low HDL-C (HR 1.45, 95% CI 1.19-1.78) compared to normal HDL-C group after adjusting for potential confounding variables, including total cholesterol levels and the use of lipid-lowering medication. Furthermore, when HDL-C levels were categorised into four groups at 10 mg/dL intervals, a dose-dependent association with acromegaly risk was observed, with the highest risk found in the low HDL-C group (grade 4, HR 1.78, 95% CI 1.30-2.43).

CONCLUSION

Low HDL-C levels were independently associated with an increased risk of acromegaly.

Unveiling Atrial Fibrillation: The Risk Factors, Prediction, and Primary Prevention

Atrial fibrillation (AF) is a highly prevalent, progressive cardiac arrhythmia that significantly impacts the patient's health-related quality of life. AF is linked to a 5-fold and 2-fold higher risk of stroke and cognitive dysfunction, respectively. With advancements in cardiac electrophysiology, many risk factors have been identified, which increase the risk for the development of AF. These risk factors encompassing age, hypertension, smoking, diabetes mellitus, male gender, obesity, alcohol intake, obstructive sleep apnea and so on, can be categorized into 3 major groups: modifiable, non-modifiable, and cardiac. Multiple AF prediction models have been successfully validated to identify people at high risk of AF development using these risk factors. These prediction models, such as CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) and HARMS2-AF score can be used in clinical practice because of their easy applicability. It is crucial to address modifiable risk factors in individuals with a high risk of developing AF. Furthermore, the implementation of primary AF prevention in individuals at high risk can contribute to improved long-term outcomes. This review aims to provide the most recent, concise explanation of the risk factors linked to AF, the prediction of AF, and strategies for the primary prevention of AF.

Association between glycaemic status and the risk of acromegaly: a nationwide population-based cohort study

OBJECTIVES

Although evidence suggests that the overall prevalence of type 2 diabetes mellitus (T2DM) was already higher in the acromegaly group than in the general population several years before diagnosis, the effect of glycaemic status on the risk of developing acromegaly remains unclear.

DESIGN

Retrospective cohort study.

SETTING

Data were obtained from the National Health Insurance Services in Korea. Baseline glycaemic status was defined based on fasting plasma glucose levels and prescription records, and it was classified into three categories: normal fasting glucose (NFG), impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM) or five categories: NFG, IFG, new-onset T2DM, well-controlled T2DM and poorly controlled T2DM.

PARTICIPANTS

A total of 9 707 487 adults without acromegaly participated in the national health screening programme in 2009 and were followed up until 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

The main outcome of interest was the diagnosis of incident acromegaly.

RESULTS

Over a median follow-up period of 9.2 years, 434 people (4.5 cases per 100 000 people) developed acromegaly at least 1 year after enrolment. Participants with IFG and T2DM exhibited an increased risk of acromegaly, with hazard ratios (HR) of 2.27 (95% CI 1.84 to 2.80) and 2.45 (95% CI 1.78 to 3.39), respectively, compared with those with NFG. When participants were categorised into five glycaemic status groups, an increased risk of acromegaly was observed in those with new-onset T2DM (HR 2.18, 95% CI 1.38 to 3.43) and well-controlled T2DM (HR 2.29, 95% CI 1.28 to 4.09), similar to individuals with IFG, with the highest risk found in individuals with poorly controlled T2DM (HR 3.07, 95% CI 1.88 to 5.01). These associations are persistent across various subgroups, regardless of age, sex, lifestyle factors and the presence of comorbidities.

CONCLUSIONS

The results of this study supported that alterations in glucose metabolism, including IFG and T2DM, are associated with an increased risk of acromegaly.

Association between fluctuations in blood cholesterol levels and the risk of suicide death in the general population

OBJECTIVE

Suicide is a pressing global public health issue. While recent studies have explored the association between serum cholesterol levels and suicide risk, the association between cholesterol variability and suicide risk is not well characterized.

METHODS

This was a nationwide population-based cohort study using data from the Korean National Health Insurance Service database. A total of 1,983,701 patients with at least three measurements of TC between 2004 and 2009 were included. Participants were followed until death by suicide or the study's end in December 2021. Participants were categorized based on baseline TC or TC variability. TC variability was assessed using coefficient of variation (CV), variability independent of the mean (VIM), and average successive variability (ASV).

RESULTS

Over a median follow-up of 11 years, 5883 (0.3 %) patients died by suicide. Compared to subjects with TC <200 mg/dL, those with TC ≥240 mg/dL had a lower risk of suicide death (hazard ratio [HR]: 0.85, 95 % confidence interval [95 % CI]: 0.78-0.93). In the unadjusted model, the HR for suicide death in the highest quartile (Q4) compared to the lowest quartile (Q1) of TC variability was 1.36 (95 % CI: 1.26-1.46). After adjusting for potential confounders, high variability in TC levels was associated with a higher risk of suicide death (HR 1.27, 95 % CI: 1.18-1.37). When analyzed based on the combination of TC baseline and variability, the highest quartile of TC variability showed a higher rate of suicide death compared to the lowest quartile, regardless of baseline TC level.

CONCLUSION

High TC variability and low TC levels were associated with an increased risk of suicide.

Cholecystectomy Increases the Risk of Chronic Kidney Disease: A Nationwide Longitudinal Cohort Study

Background/Objectives: Growing evidence suggests that cholecystectomy is associated with adverse health outcomes, including the development of metabolic diseases. However, data on the association between cholecystectomy and kidney disease are limited. The present study aimed to investigate the association between cholecystectomy and chronic kidney disease (CKD) using a nationwide longitudinal cohort. Methods: Participants aged ≥20 years with cholecystectomy between 2010 and 2014 (n = 116,748) and age- and sex-matched control participants without cholecystectomy (n = 116,748) were analyzed using the Korea National Health Insurance Service data. The adjusted hazard ratios (aHRs) were calculated for incident CKD in the cholecystectomy group compared with the nonoperative controls. Results: A total of 233,496 participants were included (mean age, 54.7 ± 12.7 years; 52.6% men). During the mean follow-up period of 4.8 ± 1.7 years, 6450 patients (5.5%) were newly diagnosed with CKD in the cholecystectomy group. Cholecystectomy was an independent risk factor for the development of CKD after adjustment for confounders, including age, sex, income, health behaviors, and comorbidities. The risk of CKD was 21% higher in the cholecystectomy group compared to the non-cholecystectomy group (aHR, 1.21; 95% CI, 1.17-1.26). The increased risk of CKD in the cholecystectomy group was consistently significant when a stratified analysis by age, sex, and presence or absence of comorbidities was conducted. Conclusions: Cholecystectomy was independently associated with an increased risk of developing CKD in a nationwide population-based study. Therefore, careful and long-term monitoring of the risk of CKD after cholecystectomy is necessary.

Assessment of the efficacy of the electrocardiographic P-wave peak time in predicting atrial high rate episode in patients with cardiac implantable electronic devices

INTRODUCTION & OBJECTIVE

The incidence of atrial high-rate episode (AHRE) is high among patients with cardiac implantable electronic devices (CIEDs). In this context, the objective of this study is to evaluate the efficacies of P-wave indices (PWIs) obtained from the surface electrocardiography (ECG) in predicting future AHRE development.

MATERIAL & METHOD

The study sample consisted of 158 patients with CIEDs. The study group was divided into two subgroups according to the presence of AHRE during device interrogation. PWIs were calculated using the surface ECG.

RESULTS

There was no significant difference between the groups in the P-wave indices (PWIs), i.e., minimum P-wave duration (PWDmin), maximum P-wave duration (PWDmax) and P-wave dispersion (PWDIS). On the other hand, P-wave peak time in V1 lead (PWTV1) and P-wave peak time in D2 lead (PWPTD2) were significantly higher in the AHRE group than in the non-AHRE group.

CONCLUSION

The study findings revealed that novel ECG parameters PWPTV1 and PWPTD2 had high prognostic value in predicting patients likely to develop AHRE.

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

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.

Prediction of cardiovascular disease risk based on major contributing features

The risk of cardiovascular disease (CVD) is a serious health threat to human society worldwide. The use of machine learning methods to predict the risk of CVD is of great relevance to identify high-risk patients and take timely interventions. In this study, we propose the XGBH machine learning model, which is a CVD risk prediction model based on key contributing features. In this paper, the generalisation of the model was enhanced by adding retrospective data of 14,832 Chinese Shanxi CVD patients to the kaggle dataset. The XGBH risk prediction model proposed in this paper was validated to be highly accurate (AUC = 0.81) compared to the baseline risk score (AUC = 0.65), and the accuracy of the model for CVD risk prediction was improved with the inclusion of the conventional biometric BMI variable. To increase the clinical application of the model, a simpler diagnostic model was designed in this paper, which requires only three characteristics from the patient (age, value of systolic blood pressure and whether cholesterol is normal or not) to enable early intervention in the treatment of high-risk patients with a slight reduction in accuracy (AUC = 0.79). Ultimately, a CVD risk score model with few features and high accuracy will be established based on the main contributing features. Of course, further prospective studies, as well as studies with other populations, are needed to assess the actual clinical effectiveness of the XGBH risk prediction model.

Total Cholesterol Variability and the Risk of Osteoporotic Fractures: A Nationwide Population-Based Cohort Study

Several risk factors for osteoporotic fractures have been identified but reports of the association of lipid parameters with the occurrence of osteoporotic fractures have been limited. We aimed to examine whether serum total cholesterol (TC) variability is associated with osteoporotic fractures. The study included 3,00,326 subjects who had undergone three or more health examinations between 2003 and 2008. The primary endpoint was the incidence of osteoporotic fractures, including vertebral, hip, distal radius, and humerus fractures. TC variability was evaluated based on the following three parameters: coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM). A total of 29,044 osteoporotic fracture events (9.67%) were identified during a median of 11.6 years of follow-up. The risk of osteoporotic fractures in the highest quartile was significantly higher compared with the lowest quartile according to the three indices of TC variability with adjusted hazard ratios (HR) and 95% confidence intervals (CI) as follows: CV (HR 1.11, 95% CI [1.08–1.15]), SD (HR 1.07, 95% CI [1.04–1.11]) and VIM (HR 1.07, 95% CI [1.04–1.11]). The Kaplan–Meier curves showed a significantly positive relationship between the higher quartile of TC variability and overall osteoporotic fractures. The association remained significant in subgroup analyses of vertebral and hip fractures, regardless of the indices of TC variability. Our study showed that visit-to-visit TC variability was found to be associated with osteoporotic fracture risk. Maintaining TC levels stable may help attenuate the osteoporotic fracture risk in the future.

Lipid Variability and Risk of Cardiovascular Diseases and All-Cause Mortality: A Systematic Review and Meta-Analysis of Cohort Studies

No consensus has yet been reached on the associations of lipid variability (LV) with cardiovascular diseases (CVDs) and all-cause mortality. We aimed to quantify the associations of different types and metrics of LV with CVDs and all-cause mortality. PubMed, Medline, and Embase databases were searched for eligible cohort studies published until 14 December 2021. Lipids included total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). Metrics of variability included standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM). The primary outcomes were CVDs and all-cause mortality. Random-effects meta-analysis was used to generate a summary of the relative risks (SRRs). Sources of heterogeneity were explored by subgroup analysis and meta-regression. A total of 11 articles based on seven cohorts were included. Participants in the top quartile of TC variability had an increased risk of CVDs (vs. bottom quartile: TC-CV: SRR 1.29, 95% CI 1.15-1.45; TC-SD: 1.28, 1.15-1.43; TC-VIM: 1.26, 1.13-1.41, respectively) and all-cause mortality (vs. bottom quartile: TC-CV: 1.28, 1.15-1.42; TC-SD: 1.32, 1.22-1.44; TC-VIM: 1.32, 1.25-1.40, respectively). Participants in the top quartile of HDL-C variability had an increased risk of CVDs (vs. bottom quartile: HDL-C-CV: 1.11, 1.07-1.15; HDL-C-SD: 1.18, 1.02-1.38; HDL-C-VIM: 1.18, 1.09-1.27, respectively) and all-cause mortality (vs. bottom quartile: HDL-C-CV: 1.29, 1.27-1.31; HDL-C-SD: 1.24, 1.09-1.41; HDL-C-VIM: 1.25, 1.22-1.27, respectively). LDL-C variability was also associated with an increased risk of CVDs (for top vs. bottom quartile; LDL-C-SD: 1.09, 1.02-1.17; LDL-C-VIM: 1.16, 1.02-1.32, respectively) and all-cause mortality (for top vs. bottom quartile; LDL-C-CV: 1.19, 1.04-1.36; LDL-C-SD: 1.17, 1.09-1.26, respectively). The relationships of TG variability with the risk of CVDs and all-cause mortality were inconclusive across different metrics. The effects of SRR became stronger when analyses were restricted to studies that adjusted for lipid-lowering medication and unadjusted for mean lipid levels. These findings indicate that the measurement and surveillance of lipid variability might have important clinical implications for risk assessment of CVDs and all-cause mortality.

Association between Variability of Metabolic Risk Factors and Cardiometabolic Outcomes

Despite strenuous efforts to reduce cardiovascular disease (CVD) risk by improving cardiometabolic risk factors, such as glucose and cholesterol levels, and blood pressure, there is still residual risk even in patients reaching treatment targets. Recently, researchers have begun to focus on the variability of metabolic variables to remove residual risks. Several clinical trials and cohort studies have reported a relationship between the variability of metabolic parameters and CVDs. Herein, we review the literature regarding the effect of metabolic factor variability and CVD risk, and describe possible mechanisms and potential treatment perspectives for reducing cardiometabolic risk factor variability.

3D printed enzymatic microchip for multiplexed electrochemical biosensing

The low-cost e-fabrication of specialized multianalyte biosensors within the point-of-care (POC) settings in a few minutes remains a great challenge. Unlike prefabricated biosensors, 3D printing seems to be able to meet this challenge, empowering the end user with the freedom to create on-demand devices adapted to immediate bioanalytical need. Here, we describe a novel miniature all-3D-printed 4-electrode biochip, capable of the simultaneous determination of different biomarkers in a single assay. The chip is utterly fabricated via an one-step 3D printing process and it is connected to a mini portable bi-potentiostant, permitting simultaneous measurements. The bioanalytical capability of the microchip is demonstrated through the simultaneous amperometric determination of two cardiac biomarkers (cholesterol and choline) in the same blood droplet, via enzymatic assays developed on its two tiny integrated electrodes. The simultaneous determination of cholesterol and choline is free from cross-talk phenomena and interferences offering limits of detection much lower than the cut-off levels of these biomarkers in blood for coronary syndromes. The biodevice is an easy-constructed, low-cost, sensitive and e-transferable POC chip with wide scope of applicability to other enzymatic bioassays.

Myocardial bridging of the left anterior descending coronary artery as a risk factor for atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy: a matched case-control study

BACKGROUND

Myocardial bridging (MB) is associated with various forms of arrhythmia. However, whether MB is a risk factor for atrial fibrillation (AF) in patients with hypertrophic obstructive cardiomyopathy (HOCM) remains unknown. This study aimed to identify the relationship between myocardial bridging of the left anterior descending coronary artery (MB-LAD) and AF in patients with HOCM.

METHODS

We reviewed the medical records of 1925 patients diagnosed with HOCM at Fuwai Hospital from January 2012 to March 2019. Patients with coronary artery disease, a history of heart surgery, and those who had not been subjected to angiography were excluded. Finally, 105 patients with AF were included in this study. The control group was matched in a ratio of 3:1 based on age and gender.

RESULTS

Forty-three patients were diagnosed with MB-LAD in this study. The presence of MB was significantly higher in patients with AF than in those without AF (19.0% vs. 7.3%; p = 0.001), although MB compression and MB length did not differ between the two groups. In conditional multivariate logistic analysis, MB (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.08-5.01; p = 0.03), pulmonary arterial hypertension (OR 2.63; 95% CI 1.26-5.47; p = 0.01), hyperlipidemia (OR 1.83; 95% CI 1.12-3.00; p = 0.016), left atrial diameter (OR 1.09; 95% CI 1.05-1.13; p < 0.001), and interventricular septal thickness (OR 1.06; 95% CI 1.003-1.12; p = 0.037) were independent risk factors for AF in patients with HOCM.

CONCLUSIONS

The presence of MB is an independent risk factor for AF in patients with HOCM. The potential mechanistic link between MB and the development of AF warrants further investigation.

P wave dispersion and ventricular repolarization changes in children with familial hypercholesterolemia

BACKGROUND

Familial hypercholesterolemia is a genetic disease with plasma total cholesterol especially low-density lipoprotein-cholesterol elevation. In this study, we aimed to examine the changes in the electrocardiographies of children with familial hypercholesterolemia.

MATERIALS AND METHODS

Electrocardiography of 85 patients with a diagnosis of familial hypercholesterolemia, followed up from the Pediatric Metabolism and Pediatric Cardiology outpatient clinic was examined. Electrocardiography of 83 children from the control group who did not have hypercholesterolemia in a similar gender and age range were examined. Heart rate, P wave, PR interval, P wave dispersion, QRS wave, QT interval, corrected QT (calculated with Bazett formula), Tpeak-end interval, QT dispersion, corrected QT dispersion, JT interval, corrected JT (calculated with Bazett formula) were statistically compared.

RESULTS

P wave, PR interval, and P wave dispersion values were significantly higher (p < 0.05) in the children with familial hypercholesterolemia. Corrected QT, QT dispersion, corrected QT dispersion, JT interval, corrected JT, Tpeak-end interval were significantly higher than the control group (p < 0.05) in children with familial hypercholesterolemia. These statistical differences in electrocardiography parameters support the risk of atrial and/or ventricular arrhythmia in children with familial hypercholesterolemia.

CONCLUSION

We found that high total cholesterol and low-density lipoprotein-cholesterol variables are associated with an increased risk of cardiac atrial and/or ventricular arrhythmia. The findings suggest that total cholesterol and low-density lipoprotein-cholesterol variability can be used as a new marker for the risk of cardiac arrhythmia. In this case, decreasing total cholesterol and low-density lipoprotein-cholesterol variability below certain thresholds may decrease the risk of cardiac arrhythmia.

Greater variability in lipid measurements associated with cardiovascular disease and mortality: A 10-year diabetes cohort study

AIM

To examine the associations between variability in lipids and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes based on low-density lipoprotein-cholesterol (LDL-C), the total cholesterol (TC) to high-density lipoprotein-cholesterol (HDL-C) ratio and triglycerides (TG).

MATERIALS AND METHODS

A retrospective cohort study included 125 047 primary care patients with type 2 diabetes aged 45-84 years without CVD during 2008-2012. The variability of LDL-C, TC to HDL-C and TG was determined using the standard deviation of variables in a mixed effects model to minimize regression dilution bias. The associations between variability in lipids and CVD and mortality risk were assessed by Cox regression. Subgroup analyses based on patients' baseline characteristics were also conducted.

RESULTS

A total of 19 913 CVD events and 15 329 mortalities were recorded after a median follow-up period of 77.5 months (0.8 million person-years), suggesting a positive linear relationship between variability in lipids and the risk of CVD and mortality. Each unit increase in the variability of LDL-C (mmol/L), the TC to HDL-C ratio and TG (mmol/L) was associated with a 27% (HR: 1.27 [95% CI: 1.20-1.34]), 31% (HR:1.31 [95% CI: 1.25-1.38]) and 9% (HR: 1.09 [95% CI: 1.04-1.15]) increase in the risk of composite endpoint of CVD and mortality, respectively. Age-specific effects were also found when comparing LDL-C variability, with patients aged 45-54 years (HR: 1.70 [95% CI: 1.42-2.02]) exhibiting a 53% increased risk for the composite endpoints than those aged 75-84 years (HR: 1.11 [95% CI: 1.01-1.23]). Similar age effects were observed for both the TC to HDL-C ratio and TG variability. Significant associations remained consistent among most of the subgroups.

CONCLUSIONS

Variability in respective lipids are significant factors in predicting CVD and mortality in primary care patients with type 2 diabetes, with the strongest effects related to LDL-C and the TC to HDL-C ratio and most significant in the younger age group of patients aged 45-54 years. Further study is warranted to confirm these findings.

Higher visit-to-visit total cholesterol variability is associated with lower cognitive function among middle-aged and elderly Chinese men

To examine the prospective associations between total cholesterol (TC) variability and cognitive function in a large sample of Chinese participants aged 45 years and above. A total of 6,377 people who participated in the China Health and Retirement Longitudinal Study (CHARLS) were included. TC variability was defined as the intra-individual standard deviation over two blood tests in CHARLS 2011 and 2015 (Wave 1 and Wave 3). Cognitive function was assessed by a global cognition score, which included three tests: episodic memory, figure drawing and Telephone Interview of Cognitive Status (TICS). Multivariate linear regression models (MRLMs) and generalized estimating equation (GEE) were used to investigate associations between TC variability and cognitive scores. After adjusting for potential confounders, male participants with higher visit-to-visit TC variability showed lower global cognition scores (β = - 0.71, P < 0.001). After further adjustment for baseline cognition, the association remained statistically significant (β = - 0.68, P < 0.001). The domains with declines were focused on episodic memory (β = - 0.22, P = 0.026) and TICS (β = - 0.44, P = 0.004). However, these associations were not found in women (β = - 0.10, P = 0.623). For men, the rates of decline in global cognition increased by 0.14 (β = - 0.14, P = 0.009) units per year while TC variability increased by 1 mmol/L. For males, higher visit-to-visit TC variability correlated with lower cognitive function and an increased rate of decreases in memory. More attention should be paid to cognitive decline in males with high TC variability, and particularly, on decreases in memory, calculation, attention and orientation.