No overnight fast needed for dyslipidaemia management

Nonfasting lipid profiles may be used in the management of Singaporean patients with dyslipidaemia, according to a recent study, suggesting that the recently established Western guidelines may be applied to a multi-ethnic Asian population as well.

“[T]he impact on the patients and the laboratory services will be significant if random lipids were systematized. The morning wait time and congestion at the laboratory will be reduced as patients can be scheduled to use its service throughout its operational hours. Their discomfort, inconvenience, and potential adverse effects of fasting can also be mitigated,” the researchers said.

A total of 470 adult patients (mean age 62.5±9.1 years, 51.7 percent male) with type 2 diabetes mellitus (T2DM) and dyslipidaemia participated in the study. Nonfasting blood samples were collected within 6 hours after a meal, and profiles were compared against fasting specimens; both collections occurred within 14 days of each other.

Paired t-test analysis showed that total cholesterol (TC) measurements were significantly higher in the nonfasting vs fasting blood samples (mean difference, 0.043, 95 percent confidence interval [CI], 0.001–0.085; p=0.045), as were triglyceride levels (mean difference, 0.484, 95 percent CI, 0.422–0.545; p<0.001). [Sci Rep 2021;11:6478]

On the other hand, levels of low-density lipoprotein cholesterol (LDL-C; mean difference, –0.154, 95 percent CI, –0.194 to –0.114; p<0.001) were significantly lowered in nonfasting samples. No such difference was reported for high-density lipoprotein cholesterol (HDL-C) levels.

“Despite the paired t-test showing significant differences in all lipid components except the HDL-C, the absolute difference other than TG was very small,” the researchers explained, suggesting that these may not be too clinically impactful.

Moreover, two-way mixed effects intra-class correlation coefficients (ICC) revealed that measurements conducted on both samples strongly agreed with each other.

For instance, the ICC for fasting and nonfasting TC was 0.82 (95 percent CI, 0.79–0.85), which indicated good correlation between measurements. The same was true for HDL-C (ICC, 0.87, 95 percent CI, 0.85–0.89) and LDL-C (ICC, 0.76, 95 percent Ci, 0.72–0.80).

As in the t-test, ICC analysis revealed that TG measurements showed the most discrepancy between fasting and nonfasting blood samples, with an ICC of 0.58 (95 percent CI, 0.52–0.64), which corresponded to a moderate agreement.

In Singapore, the management of dyslipidaemia is based on LDL-C thresholds or targets, the researchers said. “In view of the insignificant difference between the fasting and nonfasting LDL-C result, treatment decision to titrate statin dose is unlikely to change if random lipids were used, thus not changing clinical practice.”

In addition, it could also make work more efficient, as medical technicians need not verify if patients had indeed fasted. Nevertheless, “the implementation and cost-effectiveness of introducing nonfasting lipid panels routinely in polyclinics need to be further evaluated in future study,” they added.