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Do You Need to Fast Before a Cholesterol Test?

By Michael O'Riordan
Medscape Medical News

July 17, 2014 -- Do you really need to check your cholesterol levels on an empty stomach? New research suggests checking your cholesterol even if you’ve eaten gives you similar information. 

Using data from the National Health and Nutrition Survey III (NHANES III), Bethany Doran, MD, of the NYU School of Medicine, and her colleagues found that higher LDL levels (the bad cholesterol) were linked to a higher risk of death. And it didn’t matter if the test was taken after fasting overnight or after eating.  

"Based on the clinical guidelines, we've been advising patients to fast before a lipid panel," senior investigator Sripal Bangalore, MD, of the NYU School of Medicine, told heartwire. "But we might see the patient today, tell the patient to fast and come back another day for the test, and then I have to wait for the results. It's a lot of inconvenience, for the patient and also for us. We're able to start therapy only when we know their results. And we lose patients who simply drop out because they don't have the time to come back again."

For the study, published in the journal Circulation, researchers looked at 8,598 people who measured their cholesterol levels in the NHANES III study and were followed for about 14 years.

Increasing LDL levels were linked to an increasing risk of death for any reason in those who were fasting or not before their cholesterol test. This same group also had a greater risk of death from heart and blood vessel disease.

"All the guidelines' recommendations are based more on expert opinion rather than evidence," Bangalore says. "But we're really looking at the patient when he or she is on their best behavior. We tell them, 'Don't eat your French fries for 8 hours, and then we'll take your lipid panel.' But that's not what the body is exposed to the majority of the time. What the body is exposed to the majority of the day is the non-fasting state, so this actually makes more sense. I always say fasting is a bit like cramming for an exam. You're staying up late the night before, trying to cram and pass the test that way."

By not insisting you have to be fasting for the cholesterol test, the study suggests you’ll still get the health information you need, and it will make it easier for you to get the test done.

Bangalore is on the advisory board for Pfizer. Disclosures for the coauthors are listed in the paper.

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Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

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Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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