Abstract 17662: Nonfasting Compared With Fasting Lipids for Predicting Major Coronary Events in ASCOT-LLA
Background: Recent European guidlelines have recommended nonfasting for routine lipid testing, while US guidelines prefer fasting. No study to date has examined the cardiovascular predictive value of lipids measured both fasting and nonfasting on the same individuals, and evidence from randomized studies is lacking.
Methods: In 8270 participants from ASCOT-LLA, we measured both fasting and nonfasting lipids from the same individuals prior to randomization. LDL cholesterol was calculated using the Friedewald equation. We evaluated prospective associations with the trial primary endpoint of major coronary events (212 events; median follow-up 3.3 years) and an expanded ASCVD endpoint (315 events) using Cox models adjusted for risk factors.
Results: Compared with fasting samples, nonfasting samples obtained from the same individuals had modestly higher triglycerides and slightly lower total and LDL cholesterol, with no differences in HDL cholesterol. Nonfasting lipid associations with incident coronary events were better or similar to fasting lipids (Table). Results were consistent by randomized treatment arm (atorvastatin 10 mg/day or placebo) and unchanged after excluding individuals with elevated triglycerides. Overall concordance of fasting and nonfasting lipids for classifying participants into appropriate risk categories was high (95% for the 2013 ACC/AHA Pooled Cohorts equations).
Conclusions: In ASCOT-LLA, nonfasting lipids were better than or equivalent to fasting lipids measured from the same individuals for predicting incident vascular events, with high concordance of cardiovascular risk categories regardless of whether fasting or nonfasting samples were tested. These results support recent guideline recommendations to routinely measure nonfasting lipids, a strategy that could be highly effective and offer many advantages for cardiovascular risk screening and treatment.
Author Disclosures: S. Mora: Research Grant; Significant; Atherotech Diagnostics. Consultant/Advisory Board; Modest; Pfizer, Amgen, Lilly, Quest Diagnostics, Cerenis Therapeutics. C. Chang: None. M. Moorthy: None. P.S. Sever: Consultant/Advisory Board; Modest; Pfizer. Consultant/Advisory Board; Significant; Pfizer investigator initiated research grant.
- © 2016 by American Heart Association, Inc.