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Measurement of fasting lipids unnecessary for cardiovascular risk prediction

Circulation 2008; Advance online publication



Lipid levels change only minimally in response to food intake and are still predictive of increased risk for cardiovascular events, report investigators.

“Lipid profiles are usually measured after fasting; however, it would be much simpler for patients if a random nonfasting sample could be used,” say Børge Nordestgaard (Copenhagen University Hospital, Denmark) and colleagues.

Hypothesizing that nonfasting lipid samples would not differ significantly from fasting samples, and that they would be equally predictive for cardiovascular events, the researchers measured changes in lipids after eating in 33,391 people from the Copenhagen General Population Study.

They also measured the predictive ability of baseline nonfasting lipids in 9319 individuals from the Copenhagen City Heart study over a 14-year period, during which time 1166 cardiovascular events (627 myocardial infarctions and 539 ischemic strokes) occurred.

As reported in the journal Circulation, the authors found that total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol were reduced by an average of 0.2 mmol/l, 0.1 mmol/l, and 0.1 mmol/l, respectively, for a period of 3 to 5 hours.

In contrast, triglycerides increased by an average of 0.3 mmol/l for up to 6 hours after eating.

In the Copenhagen City Heart study group, a 1.7–2.4-fold increased risk for cardiovascular events was predicted by comparing the highest compared with the lowest tertiles for nonfasting total, non-HDL, and LDL cholesterol, apolipoprotein (apo)B, triglycerides, total cholesterol-to-HDL cholesterol ratio, and ratio of apoB-to-apoA-I, as well as the lowest versus the highest tertiles of nonfasting HDL cholesterol and apoA-I.

“Because we detected only minimal changes in levels of lipids, lipoproteins, and apolipoproteins in response to normal food intake in the general population, changes that are clinically unimportant, and because nonfasting levels predict cardiovascular events, our data challenge the necessity for asking patients to fast before measurement of lipid profiles for cardiovascular risk prediction,” conclude Nordestgaard et al.

Read the abstract