Nonfasting Triglyceride Levels Predict Cardiovascular Risk

Laurie Barclay, MD

May 23, 2003

May 23, 2003 -- Nonfasting triglyceride (TG) levels are easier to obtain than fasting TG levels and may offer significant prognostic value, according to the results of the Multiple Risk Factor Intervention Trial (MRFIT) published in the May 12 issue of the Archives of Internal Medicine.

"It remains unclear whether hypertriglyceridemia is an independent risk factor for coronary heart disease (CHD), and whether fasting and nonfasting [TG] levels are equally predictive," write Lynn E. Eberly, PhD, and colleagues from the MRFIT Research Group. "This work is, to our knowledge, the first direct comparison -- from the same study cohort -- of the prognostic importance of fasting and nonfasting TG levels for fatal and nonfatal CHD."

Of 12,866 men enrolled from 1973 to 1975 into MRFIT who had fasting and nonfasting TG levels measured at baseline, 2,809 were followed up for CHD incidence and death.

Average TG levels were 187 mg/dL (2.11 mmol/L) fasting and 284 mg/dL (3.21 mmol/L) nonfasting. Prevalence of hypertriglyceridemia, defined as at least 200 mg/dL (2.26 mmol/L), was 31% for fasting and 61% for nonfasting. Over an eight-year period, there were 175 nonfatal or fatal CHD events, and there were 328 CHD deaths during 25 years.

Compared with TG levels less than 200 mg/dL, hypertriglyceridemia was associated with increased risk of of CHD mortality (adjusted hazard ratio [HR], 1.24; P = .09 for fasting; HR, 1.26; P = .07 for nonfasting). Fasting and nonfasting TG levels were similarly predictive of nonfatal or fatal CHD (HR, 1.64; P = .004 for fasting; HR, 1.46; P = .03 for nonfasting).

The authors suggest that these associations for fasting TG levels could be underestimated by 56% because of regression dilution bias; this is especially the case for nonfasting TG levels. Study limitations also include failure to determine time since the last meal for the nonfasting TG measurement.

"Greater ease of obtaining nonfasting than fasting measurements, greater prevalence of hypertriglyceridemia with nonfasting than fasting values, and similarly increased risk with each indicate that nonfasting TG levels may be more useful than fasting ones for risk stratification," the authors write. "Although multiple measurements may be required for accurate classification, nonfasting readings may provide information about risk that is not apparent from fasting readings alone."

The authors list no pertinent financial disclosures.

Arch Intern Med. 2003;163:1077-1083

Reviewed by Gary D. Vogin, MD

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