{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T01:18:52Z","timestamp":1766971132445,"version":"3.48.0"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Fund of Seoul St. Mary\u2019s Hospital, The Catholic University of Korea"},{"name":"Korea Health Technology R&D Project through the Korea Health Industry Development Institute"},{"DOI":"10.13039\/501100003710","name":"Ministry of Health & Welfare, Republic of Korea","doi-asserted-by":"publisher","award":["HI22C1529"],"award-info":[{"award-number":["HI22C1529"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The aim of this study was to stratify cardiovascular risk based on the mean and variability of non-high-density lipoprotein cholesterol (non-HDL-C) in patients undergoing hemodialysis. Methods: Data were analyzed for 453 hemodialysis patients without a history of myocardial infarction (MI) or stroke, who underwent at least five lipid profile measurements at any one of seven university hospitals in the Republic of Korea between March 2009 and December 2020. Visit-to-visit non-HDL-C variability was calculated using the coefficient of variation. The endpoints of the study were newly diagnosed MI, stroke, or all-cause death. Patients were divided into four groups according to quartiles of the mean and variability of non-HDL-C. Results: During a median follow-up of 97.0 months, there were 39 cases of MI, 99 cases of stroke, and 96 deaths. The cumulative incidence rate of MI was significantly highest in the low mean\/high variability group (log-rank p = 0.0296). However, there were no significant differences between groups in the incidence rates of stroke (log-rank p = 0.9939) or all-cause mortality (log-rank p = 0.9373). In the multivariable Cox regression analysis, age and low mean\/high variability (HR: 3.311, 95% CI: 1.380\u20137.944) were identified as independent risk factors for MI. However, for stroke and all-cause mortality, age was the only independent risk factor. Moreover, neither the mean nor the variability of non-HDL-C alone was associated with MI, stroke, or all-cause mortality. Conclusions: Our results suggest that the coexistence of low mean non-HDL-C and high variability is associated with an elevated risk of MI in hemodialysis patients.<\/jats:p>","DOI":"10.3390\/jcm15010242","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:50:42Z","timestamp":1766969442000},"page":"242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Impact of Mean and Variability of Non-HDL Cholesterol on Myocardial Infarction in Hemodialysis Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7326-0602","authenticated-orcid":false,"given":"Hanbi","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6295-8095","authenticated-orcid":false,"given":"Ji Won","family":"Min","sequence":"additional","affiliation":[{"name":"Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"Department of Internal Medicine, Bucheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2884-4948","authenticated-orcid":false,"given":"Tae Hyun","family":"Ban","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Eunpyeong St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1282-7876","authenticated-orcid":false,"given":"Eun Sil","family":"Koh","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6347-7282","authenticated-orcid":false,"given":"Hye Eun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Uijeongbu St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyung Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, St. Vincent\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0048-5717","authenticated-orcid":false,"given":"Byung Ha","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"},{"name":"Transplantation Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1053\/j.ajkd.2015.06.028","article-title":"Cholesterol Metabolism in CKD","volume":"66","author":"Reiss","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1056\/NEJMoa043545","article-title":"Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis","volume":"353","author":"Wanner","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa0810177","article-title":"Rosuvastatin and cardiovascular events in patients undergoing hemodialysis","volume":"360","author":"Fellstrom","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1016\/S0140-6736(11)60739-3","article-title":"The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): A randomised placebo-controlled trial","volume":"377","author":"Baigent","year":"2011","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Abidor, E., Achkar, M., Al Saidi, I., Lather, T., Jdaidani, J., Agarwal, A., and El-Sayegh, S. (2025). Comprehensive Review of Lipid Management in Chronic Kidney Disease and Hemodialysis Patients: Conventional Approaches, and Challenges for Cardiovascular Risk Reduction. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020643"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S315","DOI":"10.1097\/01.ASN.0000081698.10331.83","article-title":"Impact of dyslipidemia in end-stage renal disease","volume":"14","author":"Prichard","year":"2003","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Echefu, G., Stowe, I., Burka, S., Basu-Ray, I., and Kumbala, D. (2023). Pathophysiological concepts and screening of cardiovascular disease in dialysis patients. Front. Nephrol., 3.","DOI":"10.3389\/fneph.2023.1198560"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"iii28","DOI":"10.1093\/ndt\/gfy174","article-title":"Cardiovascular disease in dialysis patients","volume":"33","author":"Cozzolino","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jacc.2009.07.057","article-title":"Beyond low-density lipoprotein cholesterol: Respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol\/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women","volume":"55","author":"Arsenault","year":"2009","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/S0140-6736(19)32519-X","article-title":"Application of non-HDL cholesterol for population-based cardiovascular risk stratification: Results from the Multinational Cardiovascular Risk Consortium","volume":"394","author":"Brunner","year":"2019","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1093\/eurheartj\/ehy209","article-title":"Visit-to-visit cholesterol variability correlates with coronary atheroma progression and clinical outcomes","volume":"39","author":"Clark","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100774","DOI":"10.1016\/j.lanepe.2023.100774","article-title":"Non-HDL cholesterol and residual risk of cardiovascular events in patients with ischemic heart disease and well-controlled LDL cholesterol: A cohort study","volume":"36","author":"Hansen","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.jacc.2021.01.027","article-title":"Apolipoprotein B and Non-HDL Cholesterol Better Reflect Residual Risk Than LDL Cholesterol in Statin-Treated Patients","volume":"77","author":"Johannesen","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1002\/ana.26425","article-title":"ApoB and Non-HDL Cholesterol Versus LDL Cholesterol for Ischemic Stroke Risk","volume":"92","author":"Johannesen","year":"2022","journal-title":"Ann. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1161\/CIRCULATIONAHA.117.032318","article-title":"Triglyceride-Rich Lipoprotein Cholesterol and Risk of Cardiovascular Events Among Patients Receiving Statin Therapy in the TNT Trial","volume":"138","author":"Fayyad","year":"2018","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1001\/jama.2012.366","article-title":"Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: A meta-analysis","volume":"307","author":"Boekholdt","year":"2012","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2879","DOI":"10.1161\/STROKEAHA.125.051754","article-title":"Aging and Sex Modify the Risk of Carotid Plaque Thrombosis Related to Dyslipidemic Profile","volume":"56","author":"Servadei","year":"2025","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ijcard.2007.05.026","article-title":"Cholesterol--a marker of nutritional status in mild to moderate heart failure","volume":"129","author":"Araujo","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/0036933016681913","article-title":"Statins and the cholesterol mortality paradox","volume":"62","author":"Nunes","year":"2017","journal-title":"Scott. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1016\/S0140-6736(07)61751-6","article-title":"The paradox of cholesterol and stroke","volume":"370","author":"Amarenco","year":"2007","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1001\/jama.291.4.451","article-title":"Association between cholesterol level and mortality in\u2014Role of inflammation dialysis patients and malnutrition","volume":"291","author":"Liu","year":"2004","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/0002-8703(94)90393-X","article-title":"Long-term intraindividual cholesterol variability: Natural course and adverse impact on morbidity and mortality\u2014The Framingham Study","volume":"127","author":"Kreger","year":"1994","journal-title":"Am. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3560","DOI":"10.1093\/eurheartj\/ehx585","article-title":"Cholesterol variability and the risk of mortality, myocardial infarction, and stroke: A nationwide population-based study","volume":"38","author":"Kim","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1161\/CIRCULATIONAHA.118.034978","article-title":"Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index with Mortality and Cardiovascular Outcomes in the General Population","volume":"138","author":"Kim","year":"2018","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.atherosclerosis.2020.09.003","article-title":"Visit-to-visit variability of lipid measurements and the risk of myocardial infarction and all-cause mortality: A prospective cohort study","volume":"312","author":"Liu","year":"2020","journal-title":"Atherosclerosis"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e027639","DOI":"10.1161\/JAHA.122.027639","article-title":"Variability in Lipid Levels and Risk for Cardiovascular Disease: An Electronic Health Record-Based Population Cohort Study","volume":"12","author":"Manemann","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Chen, Y., Zhang, S., Tao, Y., Hu, W., Li, D., Shen, X., Li, Y., Lin, M., Zhang, W., and Liu, X. (2023). Association between the variability of non-high-density lipoprotein cholesterol and the neutrophil-to-lymphocyte ratio in patients with coronary heart disease. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1254125"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1093\/eurheartj\/ehy348","article-title":"Variability in atherogenic lipoproteins and coronary artery disease progression","volume":"39","author":"Alfonso","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1161\/ATVBAHA.117.309803","article-title":"Variability in Total Cholesterol Is Associated with the Risk of End-Stage Renal Disease: A Nationwide Population-Based Study","volume":"37","author":"Kim","year":"2017","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1681\/ASN.2007101128","article-title":"Lipid abnormalities and cardiovascular risk in renal disease","volume":"19","author":"Ritz","year":"2008","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s11883-025-01290-2","article-title":"Managing Dyslipidemia in Chronic Kidney Disease: Implications for Cardiovascular and Renal Risk","volume":"27","author":"Theofilis","year":"2025","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1046\/j.1523-1755.2002.00324.x","article-title":"Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients","volume":"61","author":"Iseki","year":"2002","journal-title":"Kidney Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1053\/j.ajkd.2003.09.012","article-title":"The effect of long-term aggressive lipid lowering on ischemic and atherosclerotic burden in patients with chronic kidney disease","volume":"43","author":"Fathi","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/sdi.12375","article-title":"Dyslipidemia in Dialysis Patients","volume":"28","author":"Qunibi","year":"2015","journal-title":"Semin. Dial."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T01:14:50Z","timestamp":1766970890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,28]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010242"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010242","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,28]]}}}