#121 Can I get my cholesterol checked fast (without fasting)?
CLINICAL QUESTION
Can non-fasting lipid levels be used to predict future cardiovascular disease (CVD) risk?
BOTTOM LINE
Minimal differences exist between fasting and non-fasting HDL, LDL, and total cholesterol (TC). Also, non-fasting HDL and non-HDL levels correlate with future CVD events. Therefore, fasting for lipid testing is not required.
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EVIDENCE
Surrogate Outcomes: Lipid results:
- Cross sectional study of >200,000 Canadians (mean age 52.8 years, 53.1% female) examined fasting intervals (1-16 hours) on lipids.1 Fasting changed lipid levels by:
- <2% for TC and high density lipoprotein (HDL).
- ~10% for low density lipoprotein (LDL).
- ~20% for triglycerides.
- Cross sectional study of 33,391 Danish patients (mean age 60, 53% women) found maximal changes between lipid levels collected 0 to >8 hours post-fasting were:2
- -0.2mmol/L for LDL and TC.
- -0.1mmol/L for HDL.
- +0.3mmol/L for triglycerides.
- Smaller studies where fasting and non-fasting lipids were done on the same patients found similar results:
- Small changes in TC, HDL,3,4 and LDL.4-7
- Larger changes in triglycerides4 especially after a high fat meal.5-7
- Theses small changes are unlikely to significantly effect cardiovascular risk prediction and are less than the within person variation of repeat lipids.8
- A large compilation of prospective cohort studies examined 302,430 individual patient records, (mean age 59 years, 43% women) with 2.8 million person-years of follow-up demonstrated:9
- Non-fasting and fasting HDL and non-HDL cholesterol similarly predicted CVD risk.
- After adjusting for HDL and non-HDL, triglycerides did not predict CVD risk.
- Restricting patients to fasting before laboratory testing may contribute to:
- Testing non-adherence.
- Fluctuations in laboratory demand and wait times.
- Hypoglycemia in diabetic patients.10
- Guidelines differ regarding lipid testing: some recommend11 or prefer12 fasting, while others do not require fasting.13
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