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Am Fam Physician. 2020;101(1):53

Clinical Question

Are fasting lipid levels more predictive of cardiovascular outcomes than nonfasting lipid levels?

Bottom Line

Guidelines recommend checking lipid levels in nonfasting patients. They are easier to obtain and are equally predictive of subsequent cardiac events. Although triglyceride levels may be higher in nonfasting patients, cholesterol levels will be similar whether the patient was fasting or not. (Level of Evidence = 2c)

Synopsis

This study looked at 8,270 patients enrolled in a clinical trial of cholesterol lowering. The patients were between 40 and 79 years of age with hypertension and a total untreated cholesterol level of less than 250 mg per dL (6.47 mmol per L) with three additional risk factors for cardiovascular disease. Nonfasting and fasting lipid levels were obtained four weeks apart during the baseline period of the study. The average fasting and nonfasting total cholesterol and high-density lipoprotein cholesterol levels were similar. Triglyceride levels were modestly higher (25 mg per dL [0.3 mmol per L]) when measured in nonfasting patients. The hazard ratios, which in this case measured the cumulative risk of having a major coronary event within 3.3 years, were similarly associated with fasting and nonfasting cholesterol levels. Results were similar for patients with and without previous cardiovascular disease and in treated and nontreated patients.

Study design: Cohort (retrospective)

Funding source: Industry and government

Setting: Outpatient (any)

Reference: MoraSChangCLMoorthyMVet alAssociation of nonfasting vs fasting lipid levels with risk of major coronary events in the Anglo-Scandinavian cardiac outcomes trial-lipid lowering arm. JAMA Intern Med2019;179(7):898–905.

Editor's Note: Dr. Ebell is deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell. Dr. Shaughnessy is an assistant medical editor for AFP.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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