Fasting versus non-fasting lipid profile.

With update from ACC 20161 need to measure serum lipids has become more important than 2013 ACC guidelines2.  This has made clinician to order lipid profile more frequently. Getting lipid profile in the fasting state is inconvenient to the patient as he or she has to reach the lab in fasting state. So, in this article, I decided to relook into non-fasting state lipid profile. Is it worth it? What is the difference between non-fasting state and fasting lipid profile?

 Fasting state starts from 8 hours after last meal, but such a state is very limited in humans, because humans have a meal, 4 times a day. Thus our vessels are exposed to non-fasting lipid levels for prolonged time compared to fasting lipid levels.
Variation between fasting and non-fasting states deferred very little in a study published in JAMA. Total and HDL cholesterol did not very much, calculated LDL varied by 10% but triglyceride varied by 20%3.
In a study published in circulation compared with fasting lipid levels, total cholesterol, LDL-C and HDL-C levels were reduced up to 3 to 5 hours after the last meal; triglycerides levels were increased up to 6 hours after the last meal; and non-HDL cholesterol level, apolipoprotein A1 level, apolipoprotein B level, ratio of total cholesterol to HDL cholesterol, and ratio of apolipoprotein B to apolipoprotein A1 did not change in response to normal food intake4.
An important  difference between fasting and non-fasting lipid profile is triglyceride levels. In the non-fasting state, its value is more than the fasting state, other lipoproteins do not change. Increase in Triglyceride level increase is by 18 to 36mg/dl in non-fasting state5
Higher nonfasting triglyceride levels are representing remnant lipoproteins. composed primarily of very low-density lipoproteins (VLDL) and intermediate density lipoproteins (IDL).   which is associated with increased association of IHD, MI and death6.
Indian lipid guidelines weigh non-HDL  cholesterol  equal to LDL cholesterol5, as the difference between fasting and nonfasting non-HDL cholesterol is not significant, one can safely resort to non-fasting lipid cholesterol. This increases the compliance of patient and thus better management of lipids.
References

1.Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Daly DD, DePalma SM, et al. 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Clinical Expert Cons. J Am Coll Cardiol [Internet]. 2016;68(1):92–125. Available from: http://www.sciencedirect.com/science/article/pii/S0735109716323981
2.Bilagi U. Lipid and hypertensive guidelines of 2013. | LearnOnly Heart [Internet]. Available from: http://bilagi.org/2014/05/lipid-and-hypertensive-guidelines-of.html
3.Sidhu D, Naugler C. Fasting time and lipid levels in a community-based population: a cross-sectional  study. Arch Intern Med. 2012 Dec;172(22):1707–10.
4.Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and nonfasting lipid levels: influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction. Circulation. 2008 Nov;118(20):2047–56.
5.Consensus E, Ss P, Puri R, Narasingan SN, Wangnoo SK, Mohan V, et al. Lipid Association of India Expert Consensus Statement on Management of Dyslipidemia in Indians 2016 : Part 1. JAPI [Internet]. 2016;7–52. Available from: http://lipid.net.in/wp-content/uploads/2016/03/01_lipid_association_of.pdf
6.Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A. Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA. 2007 Jul;298(3):299–308.

Dr Umesh Bilagi

MBBS, MD, DM (cardiology). I am Interventional cardiologist. Blogging is my passion. Associate professor of cardiology KIMS Hubli. Director and consultant at Tatwadarsha Hospital Hubli. Owner of Jeevan Jyoti Hospital Hubli. Mobile +91 9343403620.

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