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Dr K K Aggarwal

Cholesterol tips released

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Blood lipid levels may exhibit mild seasonal variation with a drop in the summer and total cholesterol level peaking in the winter. The variation can be up to 5 mg/dL, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President Elect IMA.

Serum total and HDL-cholesterol can be measured in fasting or non-fasting individuals. There are only small clinically insignificant differences in these values when measured in the fasting or non-fasting state.

The total cholesterol can vary by 4 to 11 percent within an individual due to multiple factors including stress, minor illness and posture. Values may also vary between different laboratories, with data suggesting that a single measurement of serum cholesterol can vary as much as 14 percent. Therefore in an individual with “true” serum cholesterol concentration of 200 mg/dL the range of expected values is 172 to 228 mg/dL.

More than one measurement of total cholesterol should therefore be obtained when treatment considerations demand a precise determination. Measurement of serum HDL-C and triglycerides may demonstrate even greater variability.

A standard serum lipid profile consists of total cholesterol, triglycerides, and HDL-cholesterol. Lipid profile should be performed after 12 to 14 hours of fasting to minimize the influence of postprandial hyperlipidemia. One can use either plasma or serum specimen. The serum cholesterol is approximately 3 percent lower than the plasma value.

Fasting Before A Lipid Profile Test May Not Be Necessary

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It may not be necessary to fast overnight before a routine cholesterol profile quoting a large community-based population study suggested done by Christopher Naugler, MSc, MD, of the University of Calgary in Alberta and published in the Nov. 12 issue of the journal Archives of Internal Medicine.

In the study, the mean cholesterol subclass levels varied by less than 2% for total cholesterol and good HDL cholesterol, by less than 10% for calculated bad LDL cholesterol and by less than 20% for triglycerides.

Fasting is often inconvenient for patients and discourages compliance with routine screening programs.

On the other hand, eating before a cholesterol test can highlight insulin resistance, which is associated with worse post meal lipid clearance. High triglyceride levels after eating are predictors of insulin resistance. Total and good HDL cholesterol values do not change with food.

Current guidelines suggest that blood samples for lipid profiles should be obtained after a 9- to 12-hour fast. This requirement is not always practical for patients, who rarely present in a fasting state.