Blood cholesterol screening - Influence of fasting state on cholesterol results and management decisions

OBJECTIVE: To compare fasting and nonfasting total and high-density lipoprotein (HDL) cholesterol values in adults and to determine how closely classification into risk groups for coronary heart disease based on nonfasting blood tests compares with classification based on fasting studies. DESIGN: Cross-sectional study. SETTING: A community hospital general internal medicine clinic. PATIENTS: One hundred eighty-one patients at least 20 years of age receiving medical care at a community hospital general internal medicine clinic. INTERVENTIONS: Total and HDL cholesterol levels were measured twice in each patient within 7 days, once while not fasting and once after a minimum 12-hour fast. MEASUREMENTS AND MAIN RESULTS: Fasting and nonfasting total and HDL cholesterol values were compared, patients were classified into desirable, borderline-high, and high cholesterol groups on the basis of fasting and nonfasting blood studies. There were small, statistically significant but clinically insignificant differences in fasting and nonfasting results for total cholesterol. Nonfasting HDL cholesterol levels were similar to fasting HDL levels. The agreement in classification of patients into desirable and high-cholesterol groups between fasting and non-fasting blood testing was 86.7% and 89.5%, respectively. In the borderline-high group, for whom levels of HDL cholesterol are important in determining subsequent management, there was 95% agreement between fasting and nonfasting HDL cholesterol results. Only a small fraction of the patients were classified into lower-risk groups by the nonfasting assessment, creating the potential for less-rigorous monitoring and treatment of their cholesterol status than if fasting results were utilized. These findings were confirmed in this study also for the subgroups of men aged 35 years and older and women aged 45 years and older. CONCLUSIONS: Screening nonfasting adults for total and HDL cholesterol is appropriate for making decisions about primary prevention of coronary heart disease.