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#121 Can I get my cholesterol checked fast (without fasting)?


CLINICAL QUESTION
QUESTION CLINIQUE
Can non-fasting lipid levels be used to predict future cardiovascular disease (CVD) risk?


BOTTOM LINE
RÉSULTAT FINAL
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
DONNÉES PROBANTES
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  
Clinical Outcomes: Cardiovascular events:  
  • 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-HDLtriglycerides did not predict CVD risk.   
Context:  
  • 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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Author(s)
Auteur(s)
  • Adrienne J Lindblad BSP ACPR PharmD
  • Michael R Kolber BSc MD CCFP MSc

1. Sidhu D, Naugler C. Arch Intern Med. 2012; 172:1707-1710.

2. Langsted A, Freiberg JJ, Nordestgaard BG. Circulation. 2008; 118: 2047-56.

3. Craig SR, Amin RV, Russell DW, et al. J Gen Intern Med. 2000; 15:395-9.

4. Wilder LB, Bachorik PS, Finney CA, et al. Am J Med. 1995; 99:374-7.

5. Schaefer EJ, Audelin MC, McNamara JR, et al. Am J Cardiol. 2001; 88:1129-33.

6. Lund SS, Petersen M, Frandsen M, et al. Clin Chem. 2011; 57:298-308.

7. Cohn JS, McNamara JR, Schaefer EJ. Clin Chem. 1988; 34:2456-9.

8. Glasziou PP, Irwig L, Heritier S, et al. Ann Intern Med. 2008; 148:656-61.

9. The Emerging Risk Factors Collaboration. JAMA. 2009; 302:1993-2000.

10. Aldasouqi S, Sheikh A, Klosterman A, et al. Diabetes Care 2011; 34:e52.

11. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2011; 32:1769-1818.

12. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation. 2014; 129(25 suppl 2):S1-S45.

13. National Institute for Health and Care Excellence. Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. July 2014. Available at http://www.nice.org.uk/Guidance/CG181. Accessed May 25, 2014.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.