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Wednesday, April 23, 2014

Random testing vs. fasting for cholesterol tests

I got a call this afternoon. It was the nurse at my family doctor's office. She told me my doctor wanted me to have some blood work done and soon. No need to fast, I was told, just get to the lab for some cholesterol tests and others. I went immediately.

In the past, I've puzzled over the fasting instructions that have always been part of having these tests. Would there be any to be gained in having test numbers reflective of cholesterol levels occurring after a meal rather than after 8 to 12 hours of fasting? Once I mistakenly had a little coffee before going to the lab. The lab staff insisted I put the test off for a day. Just how damaging can a few sips of coffee be to one's numbers, I wondered.

Today at the lab, I asked a technician about the change from fasting to random testing. She told me she could see advantages and disadvantages in both. She thought it best not to adhere to either approach in all situations. She herself has cholesterol problems she confessed. In her case, it was genetically caused. For her, she knew it was best to have both fasting and random testing done.

I googled the question and learned:

If nonfasting lipid profiles for cardiovascular risk prediction were used, it would simplify clinical care for patients worldwide. Because only minimal, and clinically unimportant, changes in levels of lipids, lipoproteins, and apolipoproteins have been noted in response to normal food intake in the general population and because nonfasting levels predict cardiovascular events, fasting may not be necessary before determining lipid profiles for predicting cardiovascular risk.

For more on this, read: Fasting and Nonfasting Lipid Levels in the American Heart Association publication Circulation.

Personally, I feel more comfortable having my cardiovascular risks calculated from random tests. First, I am not part of the general populace. I have known cardiovascular problems. The average person doesn't have an ICD hidden in their chest and hardwired to their heart. The average person doesn't have a history of relatively frequent TIAs. The average person doesn't have plaque building up in the carotid artery. How the average person's lipid profile changes, or doesn't, after a meal may not be relevant in my case. I'll leave that to my doctors.

My lipid profile, created from years of blood work done in the morning after a night of fasting, has developed some solid numbers. It will be interesting to see what profile modifications will ensue now that my tests are being based on blood work taken randomly.

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