Dear Friends,
I have seen patients are put into unnecessary strain when we ask for their lipids profile. More often than not they are asked to come on fasting state. That means they have to come on another day and forego one man-day. Coming in a fasting state of about 8 to 10 hours and some, if not most of them, have to travel long distance to reach the labs. Most of the labs are open late in the morning. Years ago I had come across a study in which it was stated that most of the values in the lipids profile do not show any change except triglycerides which also show a raise after a fatty meal and that too not very significant. In another study I had seen that postprandial hypertriglyceridemia is a risk factor for cardiovascular diseases. Since then I have been asking for lipid profile in a non-fasting state. Of course many times I have to take pains to explain to the patients why I am not asking for a fasting blood test. Recently I had come across an updated version in BMJ Blog and I reproduce the relevant portions below. I only hope that our colleagues would shed this obsession of ordering fasting lipid profiles without sacrificing the accuracy of the tests in question and at the same time obviating an avoidable inconvenience:
By Dr. Geoffrey Modest
There was a recent review summarizing the data and strongly suggesting that we use nonfasting lipid testing (see Mora S. JAMA Internal Medicine; published online April 27, 2016).
Details for these recommendations:
• There was a recent consensus statement from the European Atherosclerosis Society comparing nonfasting with fasting lipids, finding that there was not more than an 8 mg/dl difference in total cholesterol, calculated LDL, non-HDL cholesterol, and up to a 26 mg/dl difference for triglycerides, with no difference in HDL, apo A or B (see Nordestgaard BG. Eur Heart J in press with doi:10.1093/eurheartj/ehw152). They go on to suggest we “consider” a fasting sample if the non-fasting triglycerides are >440 mg/dl.
• Several studies have found pretty consistently that nonfasting lipids are appropriate for general cardiovascular screening, including the impressive large study by Mora from 2008 mentioned in last blog below. Also there was a meta-analysis of 68 studies which found no diminution of the association between lipids and CVD when using nonfasting measurements
• Studies that have specifically included both fasting and nonfasting lipid determinations have found similar and sometimes stronger cardiovascular disease associations with nonfasting vs fasting determinations (including LDL and triglycerides)
• Although many intervention studies have used fasting lipids, 3 large clinical trials with 43000 patients used nonfasting lipid determinations
• Current recommendations are quite mixed: NCEP suggests fasting lipids, USPSTF recommendations are for either fasting or non-fasting cholesterol and HDL (which is the same as the 2015 NICE recommendations). Even the 2013 ACC/AHA cholesterol guidelines, which suggested that initial screening be with fasting lipids, does allow for nonfasting total and HDL cholesterol (in order to calculate the chol/HDL ratio, or the non-HDL levels)
A few comments from the author:
• I personally have been only using nonfasting lipid measurements for the past 20+ years after I saw a study from the Boston VA hospital which showed very small differences (<10%) between fasting and nonfasting values, with the huge benefit of ordering nonfasting blood work being that I could get the lab test when I was seeing the patient (i.e., the patient did not have to return in a fasting state, the test would get done more reliably, and with diabetics it seemed a mixed message to say that one needs to regularize their eating patterns as much as possible but come in tomorrow am before breakfast to get your blood test…). Since then, there have been a variety of studies confirming the utility and some suggesting the superiority of nonfasting levels.
• Even the data on triglycerides, which have the most variation with eating, find that nonfasting triglycerides are a better predictor of cardiovascular events than fasting (there were several articles in a single issue of JAMA in 2007 finding this, including Bansal S. JAMA 2007; 298: 309). Perhaps this should not be surprising, since we do seem to eat pretty regularly/perhaps too often and our bodies are more exposed to nonfasting than fasting lipids. And there are even studies showing that the role of triglycerides is even more important in those with larger areas under the curve after eating: given the same meal, some people have more profound and longer lasting increases in triglycerides, which seems to correlate with more clinical disease).

http://blogs.bmj.com/ebm/2016/05/19/pri ... t-so-fast/
Hope this would be a useful piece of information.

UA Mohammed