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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 4  |  Page : 190-193

Comparison of the nonfasting and fasting lipid profiles of the patients admitted in the cardiology department of a tertiary hospital in Bangladesh


1 Department of Cardiology, Sheikh Hasina Medical College, Jamalpur, Bangladesh
2 Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh
3 Department of Cardiology, Mymensingh Medical College, Mymensingh, Bangladesh
4 Department of Cardiology, National Heart Foundation, Dhaka, Bangladesh
5 Department of Gynecology and Obstetrics, Upazila Health Complex, Ishwarganj, Mymensingh, Bangladesh

Date of Submission04-Mar-2020
Date of Decision24-Mar-2020
Date of Acceptance08-Apr-2020
Date of Web Publication23-Oct-2020

Correspondence Address:
Dr. A B. M. Kamrul-Hasan
Department of Endocrinology, Mymensingh Medical College, Mymensingh 2200
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJIM.AJIM_14_20

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  Abstract 


Background: Evidence relaxes the obligation of fasting for a lipid profile test. There is a scarcity of data comparing the fasting and nonfasting lipid profiles in our setting. Objectives: We conducted this study to observe the differences in the components of the lipid profile between the nonfasting and fasting states. Materials and Methods: In this cross-sectional study, 275 patients admitted in the cardiology department of a tertiary hospital in Bangladesh were evaluated; the study participants were categorized as having an acute myocardial infarction (AMI), unstable angina (UA), and no acute coronary syndrome (non-ACS). Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were measured in both nonfasting and fasting states in all. Results: All the measured components of the lipid profile, e.g., serum TC, HDL-C, LDL-C, and TG, were higher in the nonfasting state than the fasting state in the study participants with AMI. However, those with UA and those without ACS (non-ACS) had no significant differences in fasting and nonfasting levels of TC, HDL-C, and LDL-C through their TG level was significantly higher in the nonfasting state. Conclusion: Nonfasting blood sample, which is more convenient, may be used for assessing the lipid profile in the majority of the patients advised for the test.

Keywords: Acute coronary syndrome, fasting lipid profile, lipid profile, non-fasting lipid profile


How to cite this article:
Sarker KK, Kamrul-Hasan A B, Bari MA, Islam MM, Chowdhury S, Pramanik LR. Comparison of the nonfasting and fasting lipid profiles of the patients admitted in the cardiology department of a tertiary hospital in Bangladesh. APIK J Int Med 2020;8:190-3

How to cite this URL:
Sarker KK, Kamrul-Hasan A B, Bari MA, Islam MM, Chowdhury S, Pramanik LR. Comparison of the nonfasting and fasting lipid profiles of the patients admitted in the cardiology department of a tertiary hospital in Bangladesh. APIK J Int Med [serial online] 2020 [cited 2020 Nov 24];8:190-3. Available from: https://www.ajim.in/text.asp?2020/8/4/190/298932




  Introduction Top


Serum lipid profile is measured for cardiovascular risk assessment and has now become almost a routine test. The test includes four basic parameters: total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TG). Conventionally, this test is done in a fasting serum specimen. Fasting refers to at least 8 hours overnight complete dietary restriction except for water and medication, which may not be convenient for a good number of the patients who are advised for the test.[1] As most individuals consume several meals a day and consuming snacks between meals is also common, the postprandial state predominates over 24 h. Therefore, the fasting state may not reflect the daily average plasma lipid and lipoprotein concentrations and may not quantify the associated cardiovascular risk accurately.[2] Comparing with fasting and nonfasting measurements, TC, HDL, and LDL cholesterol measurements are slightly high in fasting state than the nonfasting state, in contrast, TG measurements are high in a nonfasting state.[3] There is poor evidence that fasting is superior to nonfasting when evaluating the lipid profile for cardiovascular risk assessment; moreover, there are advantages of using nonfasting samples rather than fasting samples for measuring the lipid profile.[1],[3],[4],[5]

There is a lack of data comparing the components of the fasting and nonfasting lipid profiles in Bangladesh. The current study was intended to compare the lipid profile in fasting and nonfasting states in the setting of the cardiology inpatient department.


  Materials and Methods Top


This cross-sectional study was conducted in the cardiology inpatient department of Mymensingh Medical College hospital in Bangladesh from September 2016 to August 2017; the Institutional Review Board approved the study protocol. All patients aging 25–75 years got admitted to the cardiology inpatient department with chest pain were included in the study population. Patients having a major cardiovascular disorder to whom keeping 8 hours fasting is not justifiable; patients with severe illness for any cause who unable to give 8 hours fasting blood sample; patients of diabetes mellitus who is on insulin therapy, TG ≥400 mg/dL; and patients not willing to enroll in the study were excluded from the study. With the assumption of the prevalence of dyslipidemia 50% in the population and 5% margin of error, the estimated sample size was 384. For this study, 275 samples were selected by purposive sampling due to time and budget constraints. The study participants were categorized into three groups: those having an acute myocardial infarction (AMI), those having unstable angina (UA), and those having noncardiac chest pain, that is, having no acute coronary syndrome (ACS). The categorization was done based on history, physical examination, 12-lead electrocardiogram, and plasma level of troponin I. Data were collected from all respondents by the direct interview; informed written consent was obtained from all. Blood samples collected after admission were sent to the cardiology laboratory of the hospital for the estimation of lipid profile, serum creatinine, random blood sugar, and troponin I level. The lipid profile was measured again on the next day morning after overnight fasting of at least 8 hours. The measurement of TC, TG, and HDL-cholesterol (HDL-C) was carried out by the semi-auto chemistry analyzer MF-808A (Medfuture LLC, USA); LDL-C was calculated from TC, HDL-C, and TG using the Friedewald equation (LDL-C = TC − HDL-C − TG/5).[6]

Statistical analysis

The data were analyzed by the Statistical Package for Social Science Version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) software. The categorical variables were represented as percentages, and measurable variables were represented as mean ± standard deviation. The Student's t -test was performed for comparing the lipid parameters in fasting and nonfasting states. P ≤ 0.05 was considered statistically significant.


  Results Top


In the present study, we measured fasting and nonfasting lipid profiles in 275 patients presenting with chest pain; among them, 118 had AMI, 75 had UA, and the remaining 82 had noncardiac chest pain (non-ACS).

[Table 1] summarizes the demographic and clinical characteristics of the study participants; 62.18% were male, the mean age was 52.85 (±11.45) years, the majority aged >50 years, 31.3% were smokers, 26.2% were hypertensive, and 13.8% had diabetes mellitus. Their mean body mass index was 25.43 (±11.98) kg/m2, and the majority of them (68.7%) were overweight or obese.
Table 1: Demographic and clinical characteristics of the study participants (n =275)

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The comparison of lipid profiles of the study participants as a whole and in different subgroups is summarized in [Table 2]. All the components of the lipid profile (TC, LDL-C, HDL-C, and TG) were significantly higher in the nonfasting state in comparison to the fasting state when the study participants were analyzed as a whole. Similar observations were found in the patients having AMI. The patients with UA and those having no ACS were found to have similar TC, LDL-C, and HDLC levels in fasting and nonfasting states though the TG level was higher in the nonfasting state in this subgroup of the study participants.
Table 2: Mean fasting and nonfasting lipid profile of study population (n =275)

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  Discussion Top


The current study conducted at the cardiology inpatient department of a tertiary hospital in Bangladesh, demonstrated no differences among the fasting and nonfasting levels of TC, LDL-C, and HDL-C in patients with UA and those without ACS through the nonfasting TG levels were higher than the fasting TG in these patients. On the other hand, all these lipid parameters were higher in the nonfasting state than the fasting state in the study participants having MI.

In recent years, efforts have been made to simplify blood sampling by replacing fasting lipid profile with nonfasting lipid profile, as it has been found that lipids, lipoproteins, and apolipoproteins were not much different in fasting and nonfasting states except for TGs which were higher in a nonfasting state.[7] The maximal mean changes as measured in random, nonfasting versus fasting blood samples were found to be +26 mg/dL (0.3 mmol/L) for TG, −8 mg/dL (0.2 mmol/L) for TC, −8 mg/dL (0.2 mmol/L) for LDL-C, +8 mg/dL (0.2 mmol/L) for remnant cholesterol, and −8 mg/dL (0.2 mmol/L) for non-HDL cholesterol. Lipoprotein(a), apoB, HDL-C, and apoA1 levels are found largely unaffected by random, nonfasting sampling. Importantly, in individual patients, the change in TGs will depend on baseline TG levels, fat intake, and time since the last meal.[8]

Many studies have been conducted worldwide in different groups of the population to compare the fasting and nonfasting lipid profiles in them. Dipankar and Pawar found no significant difference between fasting and nonfasting levels of TC, HDL, LDL, very LDL, and TG in young, healthy Indian adults.[9] Craig et al . observed a clinically insignificant difference in fasting and nonfasting TC in healthy individuals; nonfasting HDL levels were also similar to fasting HDL.[10] Abdel-Azizaa et al . found no significant difference between fasting and nonfasting levels of TC, HDL, LDL, and HDL in dyslipidemic patients receiving statin through nonfasting TG was high in them.[11] Difference between nonfasting and fasting values of TC, HDL cholesterol, LDL cholesterol, and non-HDL cholesterol in patients with diabetes was statistically insignificant in the study done by Gupta et al ., although TGs values were higher in the nonfasting state.[12] The above observations support the rationality of the use of nonfasting random samples for lipid measurement in the majority of patients with diverse clinical entities.

AMI is associated with profound alterations in the plasma lipoprotein profile. The mechanism of these alterations is not clear, and both cholesterol biosynthesis up- and down-regulation could be a consequence of AMI. Lipids change after AMI may persist for several weeks.[13] That is why it is better to do a lipid profile in such patients during the first 48 h after AMI, and the test may be repeated after 3 months.[13],[14] We measured the lipid profile in myocardial infarction patients after hospital admission and again the next day morning at a fasting state. Higher values of all the components of the lipid profile measured (TC, HDL-C, LDLC-C, and TG) were observed in the nonfasting state when compared to fasting values in these patients. Ryder et al . observed no significant difference between random and fasting TG levels though TC, LDL-C, and HDL-C showed significant falls in the fasting state.[15]

Doing random lipid test is not a new phenomenon; it has been followed up by Denmark since 2009. Several societies' guidelines and statements in Denmark, the United Kingdom, Europe, Canada, Brazil, and the United States endorse and recommend that nonfasting blood samples can be used for the assessment of lipid profiles.[8],[16] However, we need to be aware of other indications for fasting lipid profile tests such as nonfasting TGs >0.5 mmol/L (440 mg/dL), known hypertriglyceridemia followed in lipid clinic, recovering from hypertriglyceridemic pancreatitis, starting medications that may cause severe hypertriglyceridemia and require additional laboratory tests that entail fasting or morning samples, such as fasting glucose and therapeutic drug monitoring.[17] Nonfasting and fasting measurements should be complementary but not mutually exclusive.[16],[18]


  Conclusion Top


The current study found indifferent TC, LDL-C, and HDL-C levels in fasting and nonfasting states in the patients with UA and the patients having no ACS; the patients with AMI had higher levels of all the lipid parameters in the nonfasting state. Further, large scale researches involving more diverse clinical groups of patients may be done to justify the utility of nonfasting random lipid profile tests in our population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nigam PK. Serum lipid profile: Fasting or non-fasting? Indian J Clin Biochem 2011;26:96-7.  Back to cited text no. 1
    
2.
Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M. Standardization of collection requirements for fasting samples: For the Working Group on Preanalytical Phase (WG-PA) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Clin Chim Acta 2014;432:33-7.  Back to cited text no. 2
    
3.
Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and nonfasting lipid levels: Influence of normal food intake on lipids, lipoproteins, apolipoproteins, and cardiovascular risk prediction. Circu 2008;118:2047-56.  Back to cited text no. 3
    
4.
Mora S, Rifai N, Buring JE, Ridker PM. Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events. Circu 2008;118:993-1001.  Back to cited text no. 4
    
5.
Khera AV, Mora S. Fasting for lipid testing: Is it worth the trouble? Arch Intern Med 2012;172:1710-12.  Back to cited text no. 5
    
6.
Bachorik PS, Ross JW. National cholesterol education program recommendations for measurement of low-density lipoprotein cholesterol: Executive summary. The National Cholesterol Education Program Working Group on Lipoprotein Measurement. Clin Chem 1995;41:1414-20.  Back to cited text no. 6
    
7.
Nordestgaard BG, Langsted A, Freiberg JJ. Non-fasting hyperlipidemia and cardiovascular disease. Curr Drug Targets 2009;10:54-61.  Back to cited text no. 7
    
8.
Nordestgaard BG. A test in context: Lipid profile, fasting versus nonfasting. J Am Coll Cardiol 2017;70:1637-46.  Back to cited text no. 8
    
9.
Dipankar S, Pawar S. Comparison of fasting and non-fasting lipid profile in young healthy adults. Int J Clin Exp Physiol 2019;6:8-10.  Back to cited text no. 9
    
10.
Craig SR, Amin RV, Russell DW, Paradise NF. Blood cholesterol screening influence of fasting state on cholesterol results and management decisions. J Gen Intern Med 2000;15:395-9.  Back to cited text no. 10
    
11.
Abdel-Azizaa WF, Soltanaa GM, Amer AM. Comparison between fasting and non-fasting lipid profile in patients receiving treatment with statin therapy. Menoufia Med J 2017;30:614-18.  Back to cited text no. 11
    
12.
Gupta L, Goyal VK, Baweja A. A study to establish the validity of non-fasting lipid profile against fasting lipid profile for making treatment decision in diabetes mellitus 2012-2014. J Med Sci Clin Res 2016;4:1432-43.  Back to cited text no. 12
    
13.
Pfohl M, Schreiber I, Liebich HM, Häring HU, Hoffmeister HM. Upregulation of cholesterol synthesis after acute myocardial infarction – Is cholesterol a positive acute phase reactant? Atherosclerosis 1999;142:389-93.  Back to cited text no. 13
    
14.
Nigam PK, Narain VS, Hasan M. Serum lipid profile in patients with acute myocardial infarction. Indian J Clin Biochem 2004;19:67-70.  Back to cited text no. 14
    
15.
Ryder RE, Hayes TM, Mulligan JP, Kingswood JC, Williams S, Owens DR. How soon after myocardial infarction should plasma lipid values be assessed? Br Med J 1984;289:1651-53.  Back to cited text no. 15
    
16.
Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, et al . Fasting is not routinely required for determination of a lipid profile: Clinical and laboratory implications including flagging at desirable concentration cutpoints-a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Clin Chem 2016;62:930-46.  Back to cited text no. 16
    
17.
Umakanth M. Fasting versus non-fasting lipid profile in the clinical practice. Sri Lanka J Diabetes Endocrinol Metab 2018;8:32-38.  Back to cited text no. 17
    
18.
Pati SS, Singh AK. Can non-fasting and fasting lipid profile be mutually exclusive? An Indian perspective. J Investig Med 2017;65:e3.  Back to cited text no. 18
    



 
 
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