Fasting Before Lipid Panel Deemed Unnecessary

A new study claims that requiring patients to fast for 8–12 hours before a lipid panel blood draw adds no clinical value and is an unnecessary burden.

Researchers at New York University (NYU, NY, USA) and Stanford University (CA, USA) conducted a study involving 16,161 patients enrolled in the National Health and Nutrition Survey III (NHANES-III), who were stratified based on fasting status (8 hour cut-off point) before blood draw and followed for a mean of 14 years. Risk outcomes as a function of low density lipoprotein cholesterol (LDL-C) and fasting status was assessed, with the primary outcome all-cause mortality. The secondary outcome was cardiovascular (CV) mortality.

In all, 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, and LDL-C by fasting status interaction term in the Cox proportional hazard model was not significant; similar results were seen for the secondary outcome. In a separate unmatched cohort, the researchers found that triglyceride levels in fasting versus non-fasting groups for CV mortality were also not significantly different. The study was published ahead of print on July 11, 2014, in Circulation.

“Fasting is inconvenient for the patient, and doing away with it could simplify the process of assessing patient risk,” said senior author associate professor of medicine Sripal Bangalore, MD, of NYU. “During a 24-hour period people spend most of their time in a nonfasting state; when we ask them to fast it is an artificial situation. To me it's like studying for an exam to do well on a test; it is an artificial situation.”

“This (study) along with a few others that have been published is compelling enough to change clinical practice,” added Dr. Bangalore. “I would say, yes, research is needed, but research is needed only to show that fasting is a better prognostic indicator.... If we want to do what we have been doing, we need research to actually prove that it is more efficacious.”


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