Naugler Christopher, Sidhu Davinder
Family physician, a general pathologist, and Division Head of General Pathology at the University of Calgary in Alberta.
Lawyer and senior resident in the General Pathology residency training program at the University of Calgary.
Can Fam Physician. 2014 Oct;60(10):895-7, e471-4.
To provide an update on the clinical usefulness of nonfasting versus fasting lipid testing to improve patient compliance, patient safety, and clinical assessment in cholesterol testing.
Recommendations are identified as supported by good, fair, and poor (conflicting or insufficient) evidence, according to the classifications adopted by the Canadian Task Force on Preventive Health Care.
Screening for dyslipidemia as a risk factor for coronary artery disease and management of lipid-lowering medications are key parts of primary care. Recent evidence has questioned the fasting requirement for lipid testing. In population-based studies, total cholesterol, high-density lipoprotein cholesterol, and non-low-density lipoprotein cholesterol all varied by an average of 2% with fasting status. For routine screening, nonfasting cholesterol measurement is now a reasonable alternative to a fasting cholesterol measurement. For patients with diabetes, the fasting requirement might be an important safety issue because of problems with hypoglycemia. For the monitoring of triglyceride and low-density lipoprotein cholesterol levels in patients taking lipid-lowering medications, fasting becomes more important.
Fasting for routine lipid level determinations is largely unnecessary and unlikely to affect patient clinical risk stratification, while nonfasting measurement might improve patient compliance and safety.
提供关于非空腹与空腹血脂检测临床实用性的最新信息，以改善患者在胆固醇检测中的依从性、安全性及临床评估。
根据加拿大预防保健工作组采用的分类，建议被确定为有充分、中等和较差（相互矛盾或不充分）证据支持。
将血脂异常作为冠状动脉疾病的危险因素进行筛查以及降脂药物的管理是初级保健的关键部分。近期证据对血脂检测的空腹要求提出了质疑。在基于人群的研究中，总胆固醇、高密度脂蛋白胆固醇和非低密度脂蛋白胆固醇随空腹状态的平均变化均为2%。对于常规筛查，非空腹胆固醇测量现在是空腹胆固醇测量的合理替代方法。对于糖尿病患者，由于低血糖问题，空腹要求可能是一个重要的安全问题。对于服用降脂药物患者的甘油三酯和低密度脂蛋白胆固醇水平监测，空腹则更为重要。
常规血脂水平测定时基本无需空腹，且不太可能影响患者的临床风险分层，而非空腹测量可能会提高患者的依从性和安全性。
