Lots of news coverage of an interesting study and accompanying commentary in this week’s “online first” edition of the Archives of Internal Medicine – suggesting that fasting may not be necessary before cholesterol tests. From the banks of the Charles, Harold DeMonaco, MS, one of our expert story reviewers on HealthNewsReview.org, weighs in with his own lab analysis below.
The study documents the effects of fasting on serum the serum lipid profiles of 209,180 patients who had blood drawn at a Calgary Canada laboratory. I should point out that this was an observational study and has all of the liabilities as such. However, the conclusions are of interest to those of us who have a hard time arriving to our physician’s office for a 3:00 pm appointment in the fasting state. Here is there conclusion: “Fasting times showed little association with lipid subclass levels in a community-based population, which suggests that fasting for routine lipid levels is largely unnecessary.”
As has been pointed out on numerous occasions, a single study rarely provides the definitive answer to a medical question. However, this study does shake up the time honored practice of only obtaining blood for laboratory studies in fasting patients, regardless of the testing. While the study is interesting, the accompanying commentary clarifies the importance of the findings. The commentary is a good reminder to journalists that accompanying editorials and commentaries provide additional insight into study conclusions and help put the results into perspective.
Boston.com’s The Daily Dose went a step further in its reporting and included comments by Dr. J. Michael Gaziano, the author of an accompanying editorial. In his editorial, Graziano concludes, “Therefore, in practice, you can begin with a nonfasting lipid profile, and it is possible to use nonfasting levels for risk assessment, decisions about initiating treatment, and monitoring the effects of treatment. If you want to monitor triglyceride levels, then doing some sample fasting may useful. With this approach, most of our lipid profiles can be obtained in the nonfasting state, increasing convenience for our patients and ourselves and decreasing the burden on the laboratory, with no real adverse effect on clinical decision making.”
But I was much more interested in Dr. Gaziano’s comments in his interview with Deborah Kotz in the Globe’s Daily Dose. Here’s the statement that got my attention, “Doctors can use the Framingham risk score calculation — based on total cholesterol, HDL, smoking status, blood pressure, and age — to calculate a person’s 10-year heart disease risk and determine whether cholesterol-lowering drugs or lifestyle modifications, such as increased exercise and a lower-fat diet, are warranted. “We don’t absolutely need an exact LDL measurement to make these decisions,” he said.
Bravo to Ms. Kotz for not only providing a wonderful overview of the study and placing the results in context but also this wonderful quote from a thoughtful clinician. Contrary to what the pharmaceutical industry might have us believe, cardiovascular risk is indeed multivariate and not solely dependent on our lipid profiles, fasting or not.