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Fasting lipid levels not more accurate in predicting cardiovascular risk

Nonfasting and fasting lipid levels from the same patients had similar results for associations with incident coronary and atherosclerotic cardiovascular disease, according to results published in JAMA Internal Medicine.

“We live most of our lives in the nonfasting state, which is the most representative of our physiology,” Samia Mora, MD, MHS, of the Center for Lipid Metabolomics and the divisions of preventive medicine and cardiovascular medicine in Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Nonetheless, fasting samples have been the standard for measurement of lipid profiles, which are typically measured after an 8- to 12-hour fast. Recent studies suggest that post prandial effects do not weaken, and even may strengthen, the risk associations of lipids with atherosclerotic cardiovascular disease (ASCVD).”

The study was a post hoc prospective follow-up of the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA), a randomized, double-blinded, placebo-controlled clinical trial designed to test whether atorvastatin calcium 10 mg per day or placebo would reduce the risk of incident coronary events in patients with ASCVD.

The trial included adults aged 40 to 79 years who had hypertension and a total cholesterol concentration of 250 mg/dL or lower who did not take a statin or fibrate and had at least three other ASCVD factors. Those included in the study had nonfasting and fasting lipid measurements taken at least 4 weeks apart.

A total of 8,270 patients out of 10,305 from ASCOT-LLA were included in the study. The mean age of participants was 63.4 years, and 82.1% were male. Compared with fasting samples, nonfasting samples had slightly higher triglyceride and cholesterol levels.

Coronary events were similarly associated in nonfasting and fasting lipid levels. For instance, the adjusted HR per 40-mg/dL of low-density lipoprotein cholesterol for nonfasting lipid levels was 1.32 (95% CI, 1.08-1.61) and the adjusted HR for fasting lipid levels was 1.28 (95% CI, 1.07-1.55).

In the primary prevention group, nonfasting lipid levels had an adjusted HR of 1.42 (95% CI, 1.13-1.78) and fasting lipid levels had an adjusted HR of 1.37 (95% CI, 1.11-1.69).

The randomized treatment arm of the study comparing atorvastatin calcium therapy (10 mg per day) with placebo found that the association of nonfasting and fasting lipid levels with coronary events were similar and consistent with the overall study. Fasting and nonfasting lipid levels had very high agreement (94.8%) in ASCVD risk classification categories.

“These results are consistent with prior population-level studies that examined fasting and nonfasting lipid levels and support the recent change in U.S. guidelines to more broadly adopt nonfasting lipids for routine cardiovascular risk assessment,” Mora and colleagues wrote. “The results of this study suggest that such a strategy would be highly effective and offer many advantages for cardiovascular risk screening and treatment decisions, including for initiating statin or antihypertensive therapy.” – by Erin Michael

Disclosures: Mora reports receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung, and Blood Institute and Pfizer during the conduct of the study; personal fees from Amgen, Pfizer, and Quest Diagnostics, and grants from Atherotech Diagnostics Lab outside the submitted work. Please see study for all other authors’ relevant financial disclosures.