Are Fasting Lipid Determinations Really Necessary?

Summary and Comment |
August 14, 2014

Are Fasting Lipid Determinations Really Necessary?

  1. Kirsten E. Fleischmann, MD, MPH

The prognostic value of fasting versus nonfasting LDL cholesterol levels was similar for all-cause and cardiovascular-related mortality.

  1. Kirsten E. Fleischmann, MD, MPH

Current guidelines on treating patients with high cholesterol to prevent adverse cardiovascular (CV) events support risk stratification of patients on the basis of fasting lipid panels (NEJM JW Gen Med Nov 12 2013). But does a fasting lipid determination allow better prognostication of all-cause and CV-related mortality than do nonfasting results? To answer this question, researchers used data from the National Health and Nutrition Survey and National Death Index on 16,000 middle-aged adults who were followed for 14 years. Propensity score matching was used to create fasting and nonfasting cohorts with similar characteristics. Fasting was defined as not eating for ≥8 hours before blood draw.

For the primary outcome of all-cause mortality, fasting versus nonfasting LDL cholesterol determinations (estimated via the Friedewald equation) yielded similar prognostic values. Results were similar for the secondary outcome of CV-related mortality.


In this analysis, nonfasting and fasting LDL cholesterol determinations yielded similar prognostic information, leading the authors to call for reassessment of current guidelines and practices. These researchers did not evaluate the effect of fasting on the prognostic value of triglyceride measurements, but an editorialist points out that we lack good evidence that lowering triglyceride levels apart from lowering LDL cholesterol levels prevents adverse CV events. Clearly, nonfasting lipid determinations are attractive logistically, although more data probably are needed before the recommendation to obtain fasting lipid determinations will be changed.

  • Disclosures for Kirsten E. Fleischmann, MD, MPH at time of publication Grant / Research support NIH/NHLBI; Bluefield Project to Cure Frontotemporal Dementia Leadership positions in professional societies American College of Cardiology and American Heart Association (Vice Chair, Writing Committee for Guidance on Cardiovascular Evaluation and Care for Noncardiac Surgery)


Reader Comments (4)

JOSE GROS-AYMERICH Physician, Oncology, INSS -Retired

Hi!: TriGlycerides levels may be the ones most affected by the duration of fasting before sample drawing; although TG are an added Risk Factor, the issue may remain that not all of those who have high TG after a too short fasting period are the same as those having high TG on a regular fasting. TG are no longer considered a marker of CarboHydrate Metabolism impairment, but CH Metabolism alterations are present in two thirds of patients not known as Diabetics having an Ischemic Heart Disease, the subject may be more complex that it looks at first sight. Thanks. Salut †

DINAKER MANJUNATH Physician, Internal Medicine, Sunshine Hospitals, Hyderabad, INDIA

Finally a fairly robust data regarding the lack of advantage of fasting (Vs non-fasting) lipids. If this is widely accepted, community screening for 'prevalence of metabolic syndrome' will overcome several logistic issues, especially in a vast and remotely located population in a country like INDIA.

ANDREW WELLS Physician, Family Medicine/General Practice

been doing this for years non fasting-good non fasting better fasting. Why tell diabetics to only test when fasting?

CAROL VASSAR private practice, Vermont

Is this a change?
Hasn't LDL always been considered stable? The triglycerides and total cholesterol if the trigycerides are high are what is affected by the fatty meal.
Wasn't the fasting period supposed to be 16 hours? nothing after dinner?

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