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Long-term mortality: non-fasting LDL cholesterol has similar prognostic value as that of fasting LDL cholesterol


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

XagenaMedicine_2014



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