With the clinical utility of measuring nonfasting triglyceride levels receiving recent attention, the investigators of the Women’s Health Study tested the hypothesis that the measurement of other lipids, including total, LDL, and HDL cholesterol as well as non-HDL cholesterol, apolipoprotein B (apo B), and apo AI, could better discriminate cardiovascular disease (CVD) than the measurement of these CVD risk factors in the fasting state. For that purpose, a total of 26,330 initially healthy women were followed for approximately 11 years. At the time of baseline lipid measurements, 19,983 of them were in the fasting state whereas 6,347 were in the nonfasting state. During the follow-up, 961 women eventually developed CVD (754 fasting and 207 nonfasting). It was reported that with the exception of triglyceride levels that were higher in women in the nonfasting state, the concentration of lipids and apolipoproteins varied minimally during the postprandial state (<5%). The associations for CVD were stronger for total and LDL cholesterol, apo B, non-HDL cholesterol, and the apo B/apo AI ratio in the fasting vs. nonfasting state. However, investigators found no differences between the fasting and nonfasting measurements of HDL cholesterol, the total cholesterol/HDL cholesterol ratio, and apo AI. As previously proposed, nonfasting levels of triglycerides are of greater predictive value than fasting levels. Based on these results, the authors suggested that guidelines for lipid screening may need to consider these differences.
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