TY - JOUR
T1 - Fasting versus nonfasting and low- density lipoprotein cholesterol accuracy
AU - Sathiyakumar, Vasanth
AU - Park, Jihwan
AU - Golozar, Asieh
AU - Lazo, Mariana
AU - Quispe, Renato
AU - Guallar, Eliseo
AU - Blumenthal, Roger S.
AU - Jones, Steven R.
AU - Martin, Seth S.
N1 - Funding Information:
The VLDL study is supported by a charitable gift from the David and June Trone Family Foundation. Dr Martin has research support from the PJ Schafer Cardiovascular Research Fund, American Heart Association, Aetna Foundation, CASCADE FH, Google, and Apple.
Publisher Copyright:
© 2017 American Heart Association, Inc.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/1
Y1 - 2018/1
N2 - BACKGROUND: Recent recommendations favoring nonfasting lipid assessment may affect low-density lipoprotein cholesterol (LDL-C) estimation. The novel method of LDL-C estimation (LDL-C N ) uses a flexible approach to derive patientspecific ratios of triglycerides to very low-density lipoprotein cholesterol. This adaptability may confer an accuracy advantage in nonfasting patients over the fixed approach of the classic Friedewald method (LDL-C F ). METHODS: We used a US cross-sectional sample of 1 545 634 patients (959 153 fasting ≥10-12 hours; 586 481 nonfasting) from the second harvest of the Very Large Database of Lipids study to assess for the first time the impact of fasting status on novel LDL-C accuracy. Rapid ultracentrifugation was used to directly measure LDL-C content (LDL-C D ). Accuracy was defined as the percentage of LDLC D falling within an estimated LDL-C (LDL-C N or LDL-C F ) category by clinical cut points. For low estimated LDL-C (<70 mg/dL), we evaluated accuracy by triglyceride levels. The magnitude of absolute and percent differences between LDL-CD and estimated LDL-C (LDL-C N or LDL-C F ) was stratified by LDL-C and triglyceride categories. RESULTS: In both fasting and nonfasting samples, accuracy was higher with the novel method across all clinical LDL-C categories (range, 87%-94%) compared with the Friedewald estimation (range, 71%-93%; P≤0.001). With LDL-C <70 mg/dL, nonfasting LDL-C N accuracy (92%) was superior to LDL-C F accuracy (71%; P<0.001). In this LDL-C range, 19% of fasting and 30% of nonfasting patients had differences ≥10 mg/dL between LDL-CF and LDL-C D , whereas only 2% and 3% of patients, respectively, had similar differences with novel estimation. Accuracy of LDL-C <70 mg/dL further decreased as triglycerides increased, particularly for Friedewald estimation (range, 37%-96%) versus the novel method (range, 82%-94%). With triglycerides of 200 to 399 mg/dL in nonfasting patients, LDLC N <70 mg/dL accuracy (82%) was superior to LDL-C F (37%; P<0.001). In this triglyceride range, 73% of fasting and 81% of nonfasting patients had ≥10 mg/dL differences between LDL-C F and LDL-C D compared with 25% and 20% of patients, respectively, with LDL-C N . CONCLUSIONS: Novel adaptable LDL-C estimation performs better in nonfasting samples than the fixed Friedewald estimation, with a particular accuracy advantage in settings of low LDL-C and high triglycerides. In addition to stimulating further study, these results may have immediate relevance for guideline committees, laboratory leadership, clinicians, and patients.
AB - BACKGROUND: Recent recommendations favoring nonfasting lipid assessment may affect low-density lipoprotein cholesterol (LDL-C) estimation. The novel method of LDL-C estimation (LDL-C N ) uses a flexible approach to derive patientspecific ratios of triglycerides to very low-density lipoprotein cholesterol. This adaptability may confer an accuracy advantage in nonfasting patients over the fixed approach of the classic Friedewald method (LDL-C F ). METHODS: We used a US cross-sectional sample of 1 545 634 patients (959 153 fasting ≥10-12 hours; 586 481 nonfasting) from the second harvest of the Very Large Database of Lipids study to assess for the first time the impact of fasting status on novel LDL-C accuracy. Rapid ultracentrifugation was used to directly measure LDL-C content (LDL-C D ). Accuracy was defined as the percentage of LDLC D falling within an estimated LDL-C (LDL-C N or LDL-C F ) category by clinical cut points. For low estimated LDL-C (<70 mg/dL), we evaluated accuracy by triglyceride levels. The magnitude of absolute and percent differences between LDL-CD and estimated LDL-C (LDL-C N or LDL-C F ) was stratified by LDL-C and triglyceride categories. RESULTS: In both fasting and nonfasting samples, accuracy was higher with the novel method across all clinical LDL-C categories (range, 87%-94%) compared with the Friedewald estimation (range, 71%-93%; P≤0.001). With LDL-C <70 mg/dL, nonfasting LDL-C N accuracy (92%) was superior to LDL-C F accuracy (71%; P<0.001). In this LDL-C range, 19% of fasting and 30% of nonfasting patients had differences ≥10 mg/dL between LDL-CF and LDL-C D , whereas only 2% and 3% of patients, respectively, had similar differences with novel estimation. Accuracy of LDL-C <70 mg/dL further decreased as triglycerides increased, particularly for Friedewald estimation (range, 37%-96%) versus the novel method (range, 82%-94%). With triglycerides of 200 to 399 mg/dL in nonfasting patients, LDLC N <70 mg/dL accuracy (82%) was superior to LDL-C F (37%; P<0.001). In this triglyceride range, 73% of fasting and 81% of nonfasting patients had ≥10 mg/dL differences between LDL-C F and LDL-C D compared with 25% and 20% of patients, respectively, with LDL-C N . CONCLUSIONS: Novel adaptable LDL-C estimation performs better in nonfasting samples than the fixed Friedewald estimation, with a particular accuracy advantage in settings of low LDL-C and high triglycerides. In addition to stimulating further study, these results may have immediate relevance for guideline committees, laboratory leadership, clinicians, and patients.
KW - Cholesterol
KW - Data accuracy
KW - Fasting
KW - LDL
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U2 - 10.1161/CIRCULATIONAHA.117.030677
DO - 10.1161/CIRCULATIONAHA.117.030677
M3 - Article
C2 - 29038168
AN - SCOPUS:85046573893
VL - 137
SP - 10
EP - 19
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 1
ER -