Fasting for eight to 12 hours before having blood drawn for a Lipid Profile Test was thought to give a more accurate assessment of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. One problem with fasting is that we spend most of the day in the nonfasting state, so the way cholesterol tests are currently done doesn’t necessarily give a clear picture of “normal” levels. Salient points are
In a pooled analysis of 20 studies comprising 103,353 subjects who didn’t fast and 48 studies with a combined 199,076 subjects who did. In those studies, the ability to predic using nonfasting lipid tests was 31 percent greater (hazard ratio 1.72 vs. 1.41) than in fasting lipid tests.
- As a matter of fact fasting for >8 h, as previously required for lipid profiles, normally only occurs a few hours before breakfast and by contrast, the nonfasting state predominates most of a 24-h cycle and better captures atherogenic lipoprotein levels.
- Plasma contains atherogenic lipoproteins of hepatic origin in the fasting state and additionally those of intestinal origin in the nonfasting state.
- Maximal mean changes for random, nonfasting versus fasting levels are +26 mg/dl for triglycerides, −8 mg/dl for total cholesterol, −8 mg/dl for low-density lipoprotein cholesterol, +8 mg/dl for remnant cholesterol, and −8 mg/dl for non–high-density lipoprotein cholesterol;
- lipoprotein(a), apolipoprotein B, and high-density lipoprotein cholesterol are largely unaffected.
Fasting is a hassle for everyone concerned — patients, clinicians, and even lab workers therefore For patients, laboratories, and clinicians alike, nonfasting lipid profiles represent a simplification without negative implications for prognostic, diagnostic, and therapeutic options for cardiovascular disease prevention. Keeping this in view several societies’ guidelines and statements in Denmark, the United Kingdom, Europe, Canada, Brazil, and the United States endorse nonfasting lipid profiles.
Nonfasting cholesterol testing is more accurate lipid profile for individual patients switching to it shall be path of least resistance for patients and clinicians.
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