Fri, Oct-07-16, 07:23
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Forum Founder
Posts: 37,234
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Plan: LC, GF
Stats: 241/188/140
BF:
Progress: 52%
Location: Eastern ON, Canada
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Quote:
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Originally Posted by JEY100
Fasting for only 8 hours is an "unnecessary burden"?  After following Dr Fung a while, this comment is pretty funny. Note industry conflicts, one author would not want to miss a potential statin user [” Bangalore said abandoning the fasting requirement could speed up the process of identifying and treating patients who need to be on statin therapy.”] and the other would not want a patient to skip a return visit to the Quest lab for a blood draw. 
In the US a regular annual exam, the cholesterol draw is often one test along with others including a fasting blood glucose, which must be done fasted. So I'll just have to drag my famished body to the lab anyway 
But serious question, if Canada Health decided fasting makes no difference, then why add this line to her test results: "LDL-C calculation is decreased if fasting < or = 10 hours. Consider the Non HDL-C value as an alternate lipid target if monitoring treatment in intermediate or high risk patients."
Does this mean her doctor should decrease the 5.10 mmlo LDL result or is it already somehow lower than it should be had she fasted longer, And by how much? The LDL is only a few points away from what is now considered a good level in the US, so this is a minor point ignored before, but interesting in light of the study Doreen posted. |
Janet, I had the same questions and misgivings when I had my bloodwork done last winter. As it was explained to me, non-fasting is the norm now for routine or screening lipid panel. If the patient has a history of abnormal results, or if the non-fasting test comes back out of whack, then the dr. may order a follow-up fasting panel.
I also noticed I had no fasting glucose ordered, just HbA1c. I'm assuming this too is the new norm for routine screening as long as the patient's history is normal. Guess I should be happy I'm considered "normal" 
The "LDL-C calculation is decreased if fasting < or = 10 hours .. etc" blurb that's printed with jude's results is exactly the same on mine. I suspect it's cookie-cutter info that's provided with everyone's results, and is not an indicator of anything untoward.
Here are the official guidelines for medical labs in Ontario, current as of November 2013 .. http://oaml.com/wp-content/uploads/...ngFinal2013.pdf. (Note that each province/territory in Canada has its own guidelines which may vary from these ... I'm posting Ontario-specific info for jude's benefit ).
Quote:
3. Option to Use Non-Fasting Samples for the Measurement of Lipid Levels
Traditionally, fasting samples have been used for the assessment of dyslipidemia. However, the CCS’s 2012 Dyslipidemia Guidelines introduced the use of non-fasting specimens for lipid assessment with the introduction of non-HDL-C and apo-B as alternate lipid assessment targets. Neither non-HDL-C nor apo-B are affected by the patient’s fasting status.
In addition, Sidhu and Naugler’s 2012 community-based population study, published in 2012 in the Archives of Internal Medicine, with lipid data from 209,180 patients, also suggests fasting for routine lipid levels is largely unnecessary, as non-fasting lipid profiles change minimally in response to food intake. This study illustrated that the change in measured TC, or HDL-C for fasting compared to non-fasting specimens was less than 2%. Average differences between fasting and non-fasting measurements were less than 10% for LDL-C and less than 20% for TG.
Clinically, fasting carries some risks for patients as noted on the previous page. Therefore, alternative effective markers which do not require fasting have been sought and found. These include non-HDL-C and apo-B. Both may be determined on non-fasting specimens and both are equally effective, if not superior, for determining whether therapeutic targets have been met.
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