National and international guidelines recommend fasting lipid panel measurement for risk stratification of patients for prevention of cardiovascular events. Yet, the prognostic value of fasting versus non-fasting low density lipoprotein cholesterol ( LDL-C ) is uncertain.
Patients enrolled in the National Health and Nutrition Survey III ( NHANES-III ), a nationally representative cross-sectional survey performed between 1988 to 1994, were stratified based on fasting status ( greater than or equal to 8 hours or less than 8 hours ) and followed for a mean of 14.0 years.
Propensity score matching was used to assemble fasting and non-fasting cohorts with similar baseline characteristics.
The risk of outcomes as a function of LDL-C and fasting status was assessed using receiver operating characteristic ( ROC ) curves and bootstrapping methods.
The interaction between fasting status and LDL-C was assessed using Cox proportional hazards modeling.
Primary outcome was all-cause mortality. Secondary outcome was cardiovascular mortality.
One-to-one matching based on propensity score yielded 4,299 pairs of fasting and non-fasting individuals.
For the primary outcome, fasting LDL-C yielded similar prognostic value as non-fasting LDL-C [ C-statistics=0.59 vs 0.58; P=0.73 ], and LDL-C by fasting status interaction term in the Cox proportional hazard model was not significant ( Pinteraction=0.11 ).
Similar results were seen for the secondary outcome [ fasting vs non-fasting C-statistics=0.62 vs 0.62; P=0.96; and Pinteraction=0.34 ].
In conclusion, non-fasting LDL-C has similar prognostic value as that of fasting LDL-C. ( Xagena )
Doran B et al, Circulation 2014; Published online before