Cited by 445Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsLipid metabolism and disorders

Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events

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Mora, Samia, Rifai, Nader, Buring, Julie E., Ridker, Paul M·2008·Circulation

Abstract

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.

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Crossref · 10.1161/circulationaha.108.777334

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  • Nonfasting lipid profiles can potentially be more relevant to the estimation of an individual's cardiovascular risk than fasting lipids since in real life the postprandial state predominates most of the 24-h cycle.

    “Nonfasting lipid profiles, therefore, can potentially be more relevant to the estimation of an individual's cardiovascular risk than fasting lipids since in real life the postprandial state predominates most of our 24-h cycle [15,16].”

    From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [15]

    The Discussion (page unavailable) reports that several lipids predict cardiovascular events when measured nonfasting, supporting the possibility that nonfasting measurements are useful. It also says total, LDL, and non-HDL cholesterol may provide less useful risk information when measured nonfasting. The paper does not establish that nonfasting lipid profiles are generally more relevant because the postprandial state predominates over a 24-hour cycle. (LLM, conf=0.86)

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  • Nonfasting serum triglyceride levels may be a better or similar predictor of CVD events in the general population compared with fasting levels.

    “Prospective studies have indicated that, compared with fasting levels, nonfasting serum triglyceride levels may be a better or similar predictor of CVD events in the general population (15-18).”
  • Lp(a) concentration is reported as molar or mass by various assays, and conversion between molar and mass concentrations is size- and concentration-dependent.

    “Furthermore, the concentration of Lp(a) is reported as either a molar concentration (nmol/L) or as a mass (mg/dL) by the various assays, and conversion between molar and mass concentrations has been found to be both size- and concentration-dependent [91-93].”

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Research works printed but not linked: 1

  1. [4]Rifai N Dufour DR Cooper GR Rifai N Warnick GR Dominiczak MH Preanalytical variation in lipid, lipoprotein, and apolipoprotein testing. Handbook of lipoprotein testing 2000 161 187 AACC Press Washington, DC 2nd ed.

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Authors
Mora, S., Rifai, N., Buring, J. E., & Ridker, P. M.
Affiliations
Brigham and Women's Hospital (US)
Venue
Circulation
Published
2008-09-02
Volume
118
Issue
10
Pages
993-1001
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W2108018713
Cited by
445
References
29
Citations by year
2026: 8 · 2025: 9 · 2024: 8 · 2023: 32 · 2022: 23 · 2021: 29 · 2020: 29 · 2019: 21 · 2018: 33 · 2017: 27 · 2016: 33 · 2015: 15 · 2014: 34 · 2013: 28 · 2012: 30
FWCI
30.21
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5r01hl043851-10)
  • National Heart, Lung, and Blood Institute (R01‐HL043851)
  • National Cancer Institute (CA-47988, R01CA047988)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords
fasting state, cardiovascular risk prediction, incident cardiovascular events, triglycerides, total cholesterol, LDL cholesterol, apolipoprotein B-100, apolipoprotein A-I, HDL cholesterol, non-HDL cholesterol, TC/HDL-C ratio, women, healthy adults, lipid screening
MeSH terms
Apolipoproteins, Cardiovascular Diseases, Double-Blind Method, Fasting, Female, Follow-Up Studies, Humans, Cholesterol, HDL, Cholesterol, LDL, Middle Aged, Predictive Value of Tests, Prospective Studies, Randomized Controlled Trials as Topic, Guidelines as Topic

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