Study Finds You Don’t Have To Fast Before Getting Your Lipids Measured Interview with:

Samia Mora, MD, MHSAssociate Physician, Brigham and Women's HospitalAssociate Professor of Medicine, Harvard Medical SchoolBrigham and Women's HospitalDepartment of MedicinePreventive MedicineBoston, MA 02115 

Dr. Mora

Samia Mora, MD, MHS
Associate Physician, Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
Brigham and Women’s Hospital
Department of Medicine
Preventive Medicine
Boston, MA 02115 What is the background for this study? What are the main findings? 

Response: Lipid testing plays a major role in cardiovascular disease (CVD) risk screening, prediction, and treatment. In the past decade, several pivotal studies (including the Women’s Health Study, the Copenhagen City Heart Study, and the Copenhagen General Population Study) compared populations of individuals who had fasting lipid testing with populations of individuals who had nonfasting lipid testing, and found that non-fasting lipids were at least as good as fasting lipids in cardiovascular risk screening and predicting CVD risk.

To date, however, no study has examined the cardiovascular predictive value of lipids measured on the same individuals who had both fasting and nonfasting lipid testing. This is important because individual-level variability in fasting versus nonfasting lipids may not be captured when looking at population-level risk associations, and evidence from randomized studies is lacking. Furthermore, it is unclear whether substituting nonfasting lipids would misclassify cardiovascular risk for individuals who may be eligible for statin therapy. What is the background for this study? What are the main findings? 

Response: In the randomized clinical trial of the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA), both fasting and nonfasting lipids were measured on the same individuals (N=8270) done four weeks apart with no intervention in between. Compared with fasting samples, nonfasting samples obtained from the same individuals had modestly higher triglycerides and similar cholesterol levels. Notably, associations with incident coronary events were also similar whether the lipids were fasting or nonfasting.  Results were consistent by randomized treatment arm (atorvastatin 10 mg/day or placebo).

In addition, overall concordance of fasting and nonfasting lipids for classifying participants into appropriate CVD risk categories was high (95% concordance for risk categories according to the 2013 ACC/AHA Pooled Cohorts equations). What should readers take away from your report?

Response: These results should reassure healthcare providers that fasting prior to a lipid test is not necessary, regardless of whether the lipid test is done prior to or during statin treatment.  Indeed, recent guideline recommendations that have shifted towards allowing routine measurement of nonfasting lipids.  Such a strategy would be highly effective and offer many advantages for cardiovascular risk screening and treatment. What recommendations do you have for future research as a result of this work?

Response: The study was composed predominantly of whites, and it would be important for future studies to confirm similar results for nonfasting samples among other ethnic/racial groups. Is there anything else you would like to add? 

Response: Sometimes clinicians ask what cutpoint for nonfasting triglycerides would be considered elevated or abnormal (since nonfasting triglycerides are usually somewhat higher than fasting triglycerides).  We conducted a prior study in the Women’s Health Study and found that a cutpoint of 175 mg/dL for nonfasting triglycerides was the best cutpoint to define elevated nonfasting triglycerides (corresponding to a fasting triglyceride cupoint of 150 mg/dL). This cutpoint (175 mg/dL for abnormal nonfasting triglycerides) has since been adopted by guidelines.

Any disclosures? 

Dr Mora has received institutional research grant support from Pfizer, NHLBI and NIDDK, and Atherotech Diagnostics, and received personal fees for scientific advisory board participation from Pfizer, Amgen, and Quest Diagnostics during the conduct of the study.  Dr. Sever has research grant support and personal fees from Pfizer and Amgen. The other authors reported no disclosures.

Citation: Mora S, Chang CL, Moorthy MV, Sever PS. Association of Nonfasting vs Fasting Lipid Levels With Risk of Major Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm. JAMA Intern Med. Published online May 28, 2019. doi:10.1001/jamainternmed.2019.0392

May 28, 2019 @ 11:12 pm

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