Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: ATP III guidelines suggest a 9- to 12-hour fast before obtaining lipid levels. Various publications have challenged this practice citing postprandial hypertriglyceridemia as a risk for cardiovascular events. Although this association is not entirely certain, it does raise into question the requirement for obtaining fasting lipoprotein measurements.

Method: Exhaustive literature search was conducted using multiple search engines, with keywords related to lipids, postprandial time and cardiovascular events. Relevant studies were assessed for quality of evidence using GRADE.

Results: Three prospective cohort studies met inclusion criteria. All studies included fasting and nonfasting plasma triglycerides, which were about ~15% higher in the nonfasting group. First study had 19 983 fasting and 6347 nonfasting female participants. Cardiovascular events HR for postprandial hypertriglyceridemia was 1.22 (95% CI 1.12-1.33) and 1.23 (95% CI 1.16-1.30) in the fasting. Further adjusting for total and HDL-cholesterol, showed an HR 1.17 (95% CI 1.04-1.31) and 1.07 (95% CI 1.00-1.15), respectively. Second study included 20 118 fasting and 6391 nonfasting female participants. When adjusted for all possible variables, the nonfasting group showed an HR of 1.98 (95% CI 1.21-3.25) and 1.09 (95% CI 0.85-1.41) for the fasting group. Third study included 2809 men, who, at baseline, had both fasting and nonfasting triglycerides measured. At an 8-year follow-up, cardiovascular event HR was 1.64 (95% CI 1.17-2.29) and 1.46 (95% CI 1.03-2.07) for fasting and nonfasting triglycerides ≥200 mg/dL, respectively. At 18-year follow-up, HR for cardiovascular-associated death in the fasting cohort was 0.93 (95% CI 0.61-1.41) versus 1.60 (95% CI 1.05-2.45) for nonfasting.

Conclusion: All of the studies reviewed showed nonfasting triglycerides to be an independent risk factor for cardiovascular events. However, risk with fasting levels was not as consistent. At this time, fasting is standard practice, but in certain patients, checking nonfasting lipids may be appropriate.

Keywords: Lipid, lipoprotein, triglyceride, fasting, nonfasting, cardiovascular events

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