Document Detail

Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events.
MedLine Citation:
PMID:  18711012     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although guidelines recommend measuring fasting lipids for initial screening of adults without cardiovascular disease (CVD), recent studies suggest that nonfasting triglycerides may be superior to fasting. Whether fasting status alters associations of nontriglyceride lipids with CVD is unclear.
METHODS AND RESULTS: In a prospective study of 26 330 healthy women (19 983 fasting; 6347 nonfasting), associations of baseline lipids with incident CVD (754 fasting; 207 nonfasting) were examined over an 11-year follow-up. Except for triglycerides, lipid concentrations differed minimally (<5%) for fasting versus nonfasting. However, stronger associations with CVD were noted for fasting total cholesterol (adjusted fasting hazard ratio [HR], 1.22 per 1-SD increment; 95% CI, 1.14 to 1.30; nonfasting HR, 1.07; 95% CI, 0.93 to 1.21), low-density lipoprotein (LDL) cholesterol (fasting HR, 1.21; 95% CI, 1.13 to 1.29; nonfasting HR, 1.00; 95% CI, 0.87 to 1.15), apolipoprotein B-100 (fasting HR, 1.36; 95% CI, 1.27 to 1.45; nonfasting HR, 1.20; 95% CI, 1.05 to 1.36), non-high-density lipoprotein (HDL) cholesterol (fasting HR, 1.29; 95% CI, 1.21 to 1.38; nonfasting HR, 1.15; 95% CI, 1.01 to 1.31), and apolipoprotein B-100/A-1 ratio (fasting HR, 1.39; 95% CI, 1.30 to 1.48; nonfasting HR, 1.18; 95% CI, 1.09 to 1.27). Compared with fasting levels, nonfasting HDL cholesterol, apolipoprotein A-1, and total/HDL cholesterol ratio had similar associations, and triglycerides had a stronger association, with CVD. Significant interactions were seen for LDL cholesterol and apolipoprotein B-100/A-1 ratio with fasting status (P for interaction=0.03 and <0.001, respectively).
CONCLUSIONS: This study demonstrates that HDL cholesterol, triglycerides, total/HDL cholesterol ratio, and apolipoprotein A-1 predict CVD when measured nonfasting. By contrast, total, LDL, and non-HDL cholesterol, in addition to apolipoprotein B-100 and B-100/A-1 ratio, provide less useful CVD risk information when nonfasting, despite small changes in their concentrations. Guidelines for lipid screening may need to consider these differences.
Samia Mora; Nader Rifai; Julie E Buring; Paul M Ridker
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2008-08-18
Journal Detail:
Title:  Circulation     Volume:  118     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-03     Completed Date:  2008-09-23     Revised Date:  2013-02-28    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  993-1001     Citation Subset:  AIM; IM    
Donald W. Reynolds Center for Cardiovascular Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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MeSH Terms
Apolipoproteins / blood*
Cardiovascular Diseases / blood*
Cholesterol, HDL / blood*
Cholesterol, LDL / blood*
Double-Blind Method
Fasting / blood*
Follow-Up Studies
Guidelines as Topic
Middle Aged
Predictive Value of Tests
Prospective Studies
Randomized Controlled Trials as Topic
Grant Support
CA-47988/CA/NCI NIH HHS; HL-43851/HL/NHLBI NIH HHS; R01 CA047988/CA/NCI NIH HHS; R01 CA047988-09/CA/NCI NIH HHS; R01 CA047988-10/CA/NCI NIH HHS; R01 CA047988-11/CA/NCI NIH HHS; R01 CA047988-12/CA/NCI NIH HHS; R01 CA047988-13/CA/NCI NIH HHS; R01 CA047988-14/CA/NCI NIH HHS; R01 CA047988-15/CA/NCI NIH HHS; R01 CA047988-16/CA/NCI NIH HHS; R01 CA047988-17/CA/NCI NIH HHS; R01 CA047988-18/CA/NCI NIH HHS; R01 HL043851/HL/NHLBI NIH HHS; R01 HL043851-09/HL/NHLBI NIH HHS; R01 HL043851-10/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Apolipoproteins; 0/Cholesterol, HDL; 0/Cholesterol, LDL
Comment In:
Circulation. 2009 Apr 7;119(13):e384; author reply e385   [PMID:  19349329 ]

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