Nonfasting Lipid Levels Adequate for Assessing Cardiovascular Risk

Fasting before a cholesterol test is not necessary when evaluating risk for cardiovascular events, according to a study published in JAMA Internal Medicine.

Samia Mora, M.D., from Brigham and Women's Hospital in Boston, and colleagues used data from 8,270 participants (82.1 percent male) from the lipid-lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (1998 through 2002) who had nonfasting and fasting lipid levels measured four weeks apart. The cohort included 6,855 participants with no prior vascular disease. Median follow-up was 3.3 years.

The researchers found that nonfasting samples had modestly higher triglyceride levels and similar cholesterol levels versus fasting samples. The two groups were found to be similar in terms of associations between lipid levels and coronary events. For example, per 40 mg/dL of low-density lipoprotein cholesterol, the adjusted hazard ratios were 1.32 for nonfasting levels and 1.28 for fasting levels. Similarly, in the primary prevention group, for nonfasting levels, the adjusted hazard ratio was 1.42 compared with 1.37 for fasting levels. Results were similar regardless of randomized treatment arm (atorvastatin calcium, 10 mg/day, or placebo) and similar for atherosclerotic cardiovascular disease (ASCVD) events. There was high concordance (94.8 percent) between fasting and nonfasting lipid levels for classifying participants into appropriate ASCVD risk categories.

"These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy," the authors write.

Several authors disclosed financial ties to Pfizer, Amgen, Quest Diagnostics, and/or Atherotech Diagnostics Lab.

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