{"id":339583,"date":"2017-07-09T02:00:00","date_gmt":"2017-07-09T00:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/lipid-profile-sober-or-not\/"},"modified":"2017-07-09T02:00:00","modified_gmt":"2017-07-09T00:00:00","slug":"lipid-profile-sober-or-not","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/lipid-profile-sober-or-not\/","title":{"rendered":"Lipid profile &#8211; sober or not?"},"content":{"rendered":"<p><strong>Just over a year ago, a consensus statement from two European societies shook up the position of fasting lipid measurement. Concerns about lipid determination in the non-sober state appear largely unfounded.<\/strong><\/p>\n<p> <!--more--> <\/p>\n<p>The consensus statement of two European societies (EAS\/EFLM) [1] has shaken the &#8220;holy grail&#8221; of fasting lipid measurement a good year ago. Rationale: Concerns about lipid determination in the non-fasted state are largely unfounded. According to the authors, data from recent registry and cohort studies demonstrate that prior dietary intake affects the lipid profile only to a small extent and is usually not clinically significant. This was also shown for fasting and non-fasting measurements in the same patients. In addition, non-fasting lipid levels appear to reflect cardiovascular risk equally well or even better: A prospective analysis from the Women&#8217;s Health Study with a median follow-up of over eleven years shows that triglyceride levels two to four hours postprandial have the strongest association with cardiovascular events, whereas with longer food abstinence the association becomes progressively weaker [2].<\/p>\n<p>Both patients and physicians should be pleased with the new recommendations, as they represent a considerable simplification of measurement. &#8220;Particularly for certain groups of people, staying sober can be a burden,&#8221; says Prof. Arnold von Eckardstein, MD, University Hospital Zurich. &#8220;I am thinking here of diabetics, for example.&#8221; Lipid measurement does not necessarily have to be performed in the morning and especially not in a separate, next appointment, which saves time (also for physician decision-making) and improves patient compliance.<\/p>\n<p>Thus, while fasting lipid measurement is no longer indicated for the vast majority of patients <strong>(overview&nbsp;1),<\/strong> it cannot be completely written off. If the paper is followed, the two measurement methods complement each other rather than being mutually exclusive. For example, a fasting withdrawal is certainly justified in the case of:<\/p>\n<ul>\n<li>non-fasting triglyceride levels &gt;5 mmol\/l (440 mg\/dl)<\/li>\n<li>Known hypertriglyceridemia with subsequent referral to a lipid clinic.<\/li>\n<li>Recovery after hypertriglyceridemia-induced pancreatitis.<\/li>\n<li>Planned therapy with drugs that could induce severe hypertriglyceridemia.<\/li>\n<li>other blood tests that must be performed fasting, e.g. determination of fasting blood glucose.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><img fetchpriority=\"high\" decoding=\"async\" class=\" size-full wp-image-8885\" alt=\"\" src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/uebersicht1_hp7_s30.png\" style=\"height:289px; width:400px\" width=\"903\" height=\"653\"><\/p>\n<h2 id=\"limits\">Limits<\/h2>\n<p>The EAS\/EFLM consensus also recommends using the target values of current guidelines rather than traditional laboratory reference values, i.e., for nonfasting profiles, the following limits are judged to be abnormally high:<\/p>\n<ul>\n<li>Triglycerides: \u22652 mmol\/l<\/li>\n<li>Total cholesterol: \u22655&nbsp;mmol\/l<\/li>\n<li>HDL cholesterol: \u22641 mmol\/l<\/li>\n<li>LDL cholesterol: \u22653 mmol\/l<\/li>\n<li>Non-HDL cholesterol: \u22653.9&nbsp;mmol\/l<\/li>\n<\/ul>\n<p>Compared to the fasting value, the cut-off value for triglycerides has been increased by 0.3&nbsp;mmol\/l (based on the mean deviation in studies with non-fasting values).<\/p>\n<p>According to the paper, referral to a specialist is necessary for extreme readings, for example, triglycerides \u226510 mmol\/l, LDL-C \u226513&nbsp;mmol\/l, or Lp(a) \u2265150 mg\/dl.<\/p>\n<p><strong>Overview&nbsp;2<\/strong> summarizes again the most important findings of the consensus.<\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-8886 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/uebersicht2_hp7_s31.png\" style=\"--smush-placeholder-width: 882px; --smush-placeholder-aspect-ratio: 882\/606;height:275px; width:400px\" width=\"882\" height=\"606\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\"><\/p>\n<p>&nbsp;<\/p>\n<h2 id=\"use-of-different-lipid-parameters\">Use of different lipid parameters<\/h2>\n<p>Depending on the purpose (screening, diagnostics, risk monitoring, treatment goals), the different lipid parameters are differently suitable [3].<\/p>\n<p>If one wants to assess the general cardiovascular risk, primarily LDL cholesterol is recommended. Similarly, total cholesterol and HDL cholesterol should be used (&#8220;strongly recommended&#8221;), as well as triglycerides and non-HDL cholesterol (&#8220;recommended&#8221;). The TC\/HDL-C ratio is not recommended. Worth considering is ApoB. An analysis<br \/>\nof lipoprotein(a) may be useful in risk groups.<\/p>\n<p>Total cholesterol is insufficient for diagnosis and stratification. Primary recommended here is also LDL-C, alongside HDL-C, triglycerides and non-HDL-C (&#8220;recommended&#8221;). ApoB and, in risk groups, lipoprotein(a) may also be considered.<\/p>\n<p>Finally, only LDL-C is actually needed for therapy monitoring or for the treatment goals. If this is not available, total cholesterol can also serve as a surrogate lipid parameter. HDL-C or the ratio TC\/HDL-C or ApoB\/ApoA-I are not recommended. Non-HDL-C and ApoB can be considered, in addition triglycerides in case of hypertriglyceridemia (HTG, <strong>Tab.&nbsp;1)<\/strong>.<\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-8887 lazyload\" alt=\"\" data-src=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31.png\" style=\"--smush-placeholder-width: 905px; --smush-placeholder-aspect-ratio: 905\/966;height:427px; width:400px\" width=\"905\" height=\"966\" data-srcset=\"https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31.png 905w, https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31-800x854.png 800w, https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31-120x128.png 120w, https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31-90x96.png 90w, https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31-320x342.png 320w, https:\/\/medizinonline.com\/wp-content\/uploads\/2017\/07\/tab1_hp7_s31-560x598.png 560w\" data-sizes=\"(max-width: 905px) 100vw, 905px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" \/><\/p>\n<p>&nbsp;<\/p>\n<h2 id=\"hypertriglyceridemia\">Hypertriglyceridemia<\/h2>\n<p>&#8220;In hypertriglyceridemia, secondary causes should be considered first&#8221; said Prof. Nicolas Rodondi, MD, Inselspital Bern. &#8220;These include alcohol consumption, diabetes, obesity, and chronic renal failure. Regarding medication, consider estrogens, thiazides, beta blockers, or corticosteroids, for example.&#8221;<\/p>\n<p>Hypertriglyceridemia is responsible for about one-tenth of all cases of acute pancreatitis; alcohol and gallstone disease are far more important precipitating factors, accounting for more than 80%. Etiologic confounding may result from the simultaneous presence of two predisposing factors in the same individual. Specific triglyceride limits do not exist in this context; in general, concentrations of at least 10&nbsp;mmol\/l are associated with increased risk (arbitrary). However, only about one-fifth of individuals with such levels develop pancreatitis. Moreover, it may well occur when values are lower (below 5-10&nbsp;mmol\/l), as a recent study showed [4].<\/p>\n<p>Moreover, one should not forget the cardiovascular risk that hypertriglyceridemia may entail (especially in women) [5]. As mentioned, the non-fasting lipid profile seems to better reflect cardiovascular risk in this regard than the fasting one [2]. The ESC\/EAS guidelines recognize hypertriglyceridemia as a significant independent risk factor (although the association is weaker than for hypercholesterolemia). The risk is particularly associated with moderate hypertriglyceridemia &#8211; even more so than with severe forms with over 10&nbsp;mmol\/l. Unfortunately, the evidence base is insufficient to derive specific triglyceride target values.<\/p>\n<p>With regard to management, non-drug approaches are in the foreground, and these include the classics:<\/p>\n<ul>\n<li>Reduction of alcohol consumption<\/li>\n<li>Dietary recommendations<\/li>\n<li>Daily physical activity<\/li>\n<li>Weight reduction or at least stabilization.<\/li>\n<\/ul>\n<p>At levels below 5.5&nbsp;mmol\/l, the efficacy of drug interventions on cardiovascular events is not clear. At higher levels, the above measures (acutely also low-fat diet with no more than 15% of total calories) and fibrates, if necessary, are used to prevent acute pancreatitis. Familial dyslipidemia should be excluded.<\/p>\n<p><em>Source: SGK\/SGHC Annual Meeting, June 7-9, 2017, Baden.<\/em><\/p>\n<p>\nLiterature:<\/p>\n<ol>\n<li>Nordestgaard BG, et al: Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points &#8211; a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J 2016; 37(25): 1944-1958.<\/li>\n<li>Bansal S, et al: Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007; 298(3): 309-316.<\/li>\n<li>Catapano AL, et al: 2016 ESC\/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37(39): 2999-3058.<\/li>\n<li>Pedersen SB, Langsted A, Nordestgaard BG: Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med 2016; 176(12): 1834-1842.<\/li>\n<li>Nordestgaard BG, et al: Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA 2007; 298(3): 299-308.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><em>HAUSARZT PRAXIS 2017; 12(7): 30-32<\/em><br \/>\n<em>CARDIOVASC 2017; 16(4): 38-40<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Just over a year ago, a consensus statement from two European societies shook up the position of fasting lipid measurement. Concerns about lipid determination in the non-sober state appear largely&hellip;<\/p>\n","protected":false},"author":7,"featured_media":68375,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"SGK\/SGHC Annual Meeting in Baden","footnotes":""},"category":[11359,11513,11297,11460,11548],"tags":[18144,37744,37759,37752,11817],"powerkit_post_featured":[],"class_list":["post-339583","post","type-post","status-publish","format-standard","has-post-thumbnail","category-cardiology","category-congress-reports","category-general-internal-medicine","category-prevention-and-health-care","category-rx-en","tag-cholesterol","tag-lipid-measurement","tag-non-sober","tag-sober","tag-triglycerides","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-20 21:38:15","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"en_US","wpml_translations":{"fr_FR":{"locale":"fr_FR","id":339596,"slug":"profil-lipidique-a-jeun-ou-non","post_title":"Profil lipidique - \u00e0 jeun ou non ?","href":"https:\/\/medizinonline.com\/fr\/profil-lipidique-a-jeun-ou-non\/"},"it_IT":{"locale":"it_IT","id":339609,"slug":"profilo-lipidico-sobrio-o-no","post_title":"Profilo lipidico - sobrio o no?","href":"https:\/\/medizinonline.com\/it\/profilo-lipidico-sobrio-o-no\/"},"pt_PT":{"locale":"pt_PT","id":339619,"slug":"perfil-lipidico-sobrio-ou-nao","post_title":"Perfil lip\u00eddico - s\u00f3brio ou n\u00e3o?","href":"https:\/\/medizinonline.com\/pt-pt\/perfil-lipidico-sobrio-ou-nao\/"},"es_ES":{"locale":"es_ES","id":339626,"slug":"perfil-lipidico-sobrio-o-no","post_title":"Perfil lip\u00eddico - \u00bfsobrio o no?","href":"https:\/\/medizinonline.com\/es\/perfil-lipidico-sobrio-o-no\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/339583","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/comments?post=339583"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/339583\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media\/68375"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media?parent=339583"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/category?post=339583"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/tags?post=339583"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/powerkit_post_featured?post=339583"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}