CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

August 19th, 2014

Do Patients Really Have to Fast Before Lipid Testing?

CardioExchange’s Harlan M. Krumholz interviews Sripal Bangalore about his research group’s study of the prognostic value of non-fasting lipid panels. The study is published in Circulation.

Krumholz: Please briefly describe the high points of your article.


Bangalore: We questioned the value of “fasting” lipid panel measurement, given that people spend very little of their everyday lives fasting. Using NHANES-III data, we found that in terms of predicting long-term all-cause and cardiovascular mortality, fasting LDL was no better than non-fasting LDL. This also held true for total cholesterol and for triglycerides, thereby challenging the age-old practice of requiring people to fast before a lipid panel.

Krumholz: How does what you found align with prior reports?


Bangalore: Our report is aligned with prior reports that show similar results for triglycerides. Our findings confirm the data on triglycerides and expand the evidence base to LDL cholesterol and total cholesterol.

Krumholz: Non-fasting LDL may be predictive — but how should we think about it with regard to risk scores? Does it matter?

Bangalore: If one were to base it on the 2013 ACCF–AHA guidelines, the definition of 3 out of the 4 statin-benefit groups is based on LDL cholesterol levels. Risk scores are important, but the baseline LDL cholesterol level is also important.

Krumholz: What are you doing with your patients?

Bangalore: I am comfortable using a non-fasting lipid panel to make treatment decisions. It is convenient for the patient, and the prognostic value, as we show, is no different than that of the fasting lipid panel.

Krumholz: Finally, for non-fasting LDL, are there any calibration issues?

Bangalore: Prior studies have shown that LDL-cholesterol variability between fasting and non-fasting status is minimal, usually less than 10%. One would therefore not expect fasting lipid status to yield a significant reclassification of patients.

JOIN THE DISCUSSION

Do you think the age-old practice of making patients fast for a lipid panel is on its way out?

Categories: Prevention
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3 Responses to “Do Patients Really Have to Fast Before Lipid Testing?”

  1. H Robert Silverstein, MD says:
    August 21, 2014 at 10:13 pm

    This is old, old news. I have been ordering non-fasting lipids, etc for over 10 years or even more. Welcome aboard! Lab slips even have sites so that you can check for it being fasting OR NON-FASTING. HRS, MD, FACC

  2. Carlos Cuneo, MD says:
    August 22, 2014 at 7:03 am

    I’m not sure.
    All the evidence about lipid risk and lipid lowering benefit is based on trials that used fasting lipid panels.
    This small differences between fasting and non fasting have any significant clinical effect ?
    Are there trials comparing these different strategies ?

  3. Jean-Pierre Usdin, MD says:
    August 22, 2014 at 1:47 pm

    Where do you rank milestone?

    Thank you for this intersting discussion but I do not agree.
    I understand, specially for diabetics, old people, frail patients… how difficult it can be to stay 12 hours fasting and eventually going to the laboratory in the winter coldness.

    However LDL-C is (in France and many countries) calculated via triglycérides, altered by meals…two errors in the same sample!

    An example:
    When I check the weight of my patients suffering from cadiac failure I ask them to be undressed.
    How would I compare their weights if not?
    Winter and summer weights will be different without salt water retention.

    This is the reason why I will keep milestones and continue to check LDL -C and triglycérides: fasting