Abstract 5529: Fasting Compared with Nonfasting Lipids and Apolipoproteins for Predicting Incident Cardiovascular Events
Background While 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 non-triglyceride lipids with CVD is unclear.
Methods and Results In a prospective study of 26,330 healthy women (19,983 fasting; 6,347 nonfasting), associations of baseline lipids with incident CVD (754 fasting; 207 nonfasting) were examined over 11-year follow-up. Except for triglycerides, lipid concentrations differed minimally (<5%) fasting versus nonfasting. However, compared with nonfasting measurements, stronger associations with CVD were noted (Table⇓) for fasting measurements of total cholesterol, LDL cholesterol, non-HDL cholesterol, apolipoprotein B100, and apolipoprotein B100/A-1 ratio. By contrast, nonfasting HDL cholesterol, apolipoprotein A-1, and total/HDL cholesterol ratio had similar associations, and triglycerides had stronger association with CVD compared with fasting measurements. Significant interactions were seen for LDL cholesterol and apolipoprotein B100/A-1 ratio with fasting status (P for interaction=0.03 and <0.001, respectively).
Conclusion This study demonstrates that HDL cholesterol, triglycerides, total/HDL cholesterol ratio, and apolipoprotein A-1 predict CVD when measured nonfasting. By contrast, total cholesterol, LDL cholesterol, non-HDL cholesterol, in addition to apolipoprotein B100 and B100/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.
This research has received full or partial funding support from the American Heart Association, AHA National Center.