Prognostic Value of Fasting Versus Nonfasting Low-Density Lipoprotein Cholesterol Levels on Long-Term Mortality Insight From the National Health and Nutrition Examination Survey III (NHANES-III)

被引:108
作者
Doran, Bethany [1 ]
Guo, Yu [1 ]
Xu, Jinfeng [1 ]
Weintraub, Howard [1 ]
Mora, Samia [2 ]
Maron, David J. [3 ]
Bangalore, Sripal [1 ]
机构
[1] NYU, Sch Med, New York, NY 10016 USA
[2] Brigham & Womens Hosp, Boston, MA 02115 USA
[3] Stanford Univ, Dept Med, Sch Med, Stanford, CA 94305 USA
关键词
cholesterol; mortality; CORONARY-HEART-DISEASE; POSTPRANDIAL BLOOD-GLUCOSE; CARDIOVASCULAR-DISEASE; LDL-CHOLESTEROL; CLINICAL-RELEVANCE; RISK-FACTORS; LIPID-LEVELS; TRIGLYCERIDES; APOLIPOPROTEINS; EVENTS;
D O I
10.1161/CIRCULATIONAHA.114.010001
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-National and international guidelines recommend fasting lipid panel measurement for risk stratification of patients for prevention of cardiovascular events. However, the prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol (LDL-C) is uncertain. Methods and Results-Patients enrolled in the National Health and Nutrition Examination Survey III (NHANES-III), a nationally representative cross-sectional survey performed from 1988 to 1994, were stratified on the basis of fasting status (>= 8 or <8 hours) and followed for a mean of 14.0 (+/- 0.22) years. Propensity score matching was used to assemble fasting and nonfasting cohorts with similar baseline characteristics. The risk of outcomes as a function of LDL-C and fasting status was assessed with the use of receiver operating characteristic curves and bootstrapping methods. The interaction between fasting status and LDL-C was assessed with Cox proportional hazards modeling. Primary outcome was all-cause mortality. Secondary outcome was cardiovascular mortality. One-to-one matching based on propensity score yielded 4299 pairs of fasting and nonfasting individuals. For the primary outcome, fasting LDL-C yielded prognostic value similar to that for nonfasting LDL-C (C statistic=0.59 [95% confidence interval, 0.57-0.61] versus 0.58 [95% confidence interval, 0.56-0.60]; P=0.73), and LDL-C by fasting status interaction term in the Cox proportional hazards model was not significant (P-interaction =0.11). Similar results were seen for the secondary outcome (fasting versus nonfasting C statistic=0.62 [95% confidence interval, 0.60-0.66] versus 0.62 [95% confidence interval, 0.60-0.66]; P=0.96; P-interaction =0.34). Conclusions-Nonfasting LDL-C has prognostic value similar to that of fasting LDL-C. National and international agencies should consider reevaluating the recommendation that patients fast before obtaining a lipid panel.
引用
收藏
页码:546 / +
页数:26
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