Introduction

2. Introduction • Diabetics have higher risk of atherosclerotic cardiovascular disease than nondiabetics • Lipid derangements in diabetics • High plasma triglycerides • Low HDL cholesterol • (High LDL cholesterol)

3. Introduction • Fasting or nonfasting lipid measurementsA controversial subject • In the general population • Concentrations of lipids, lipoproteins and apolipoproteins • only differ minimally in fasting and nonfasting samples • For diabeticsPresently unknown • The objective of this study

4. Questions • What are the main mechanisms for developing atherosclerotic cardiovascular disease? • Why do diabetics have a particularly high risk of developing atherosclerotic cardiovascular disease?

5. Materials and methods • Copenhagen General Population Study • Participants randomly selected from the general population of Copenhagen, Denmark • Total participants between 2003 and 2009 • N= 58434 • With diabetes (self-reported, taking insulin or other antidiabetic medication, random plasma glucose >11 mmol/L) • N= 2270 Denmark

6. Materials and methods • Analyses • Fresh blood samples collected at Copenhagen University Hospital • Standard hospital assays (Konelab) used to measure glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B and albumin • Non-HDL cholesterol = total cholesterol – HDL cholesterol • If triglycerides <4 mmol/L, LDL cholesterol was calculated by the Friedewald equation

7. Materials and methods • Statistical analyses • All analyses performed using Stata 10. • Student t-tests were used to identify differences in lipids, lipoproteins, apolipoproteins and albumin as a function of time since the last meal. • All t-tests were corrected for multiple comparison with the Bonferroni method.

8. Questions • What are the criteria for a fasting blood sample? Are you allowed to drink anything before the sample is taken?

9. Results

10. Results

11. Results

12. Questions • What would be the advantages of measuring lipid profiles in the nonfasting state? • How could this be implemented?

13. Discussion Conclusions • Mean plasma triglycerides only increased a maximum of 0.2 mmol/L after normal food intake in both diabetic and nondiabetic individuals • Reduction in LDL cholesterol observed after normal food intake in both diabetic and nondiabetic individuals most likely caused by hemodilution due to fluid intake • Apolipoprotein B concentrations did not change after normal food intake • Non-HDL cholesterol was found to be quite stable

14. Discussion • Still controversial whether lipid profiles should be measured fasting or nonfasting; present data suggest that nonfasting samples can be used in diabetics and nondiabetics alike • Nonfasting blood sampling would simplify the process for both patients and general practitioners/hospitals • In Denmark: nonfasting lipid measurements as a standard is recommended by the Danish Society for Clinical Biochemistry • - and by 2010 implemented in most of the country • In Denmark: if nonfasting triglycerides are >4 mmol/L, the clinician can choose to measure triglycerides fasting. • However, most do not use this option.

15. Discussion • Editorial by Gerald F Watts and Jeffrey S Cohn: • Distinctions between screening, assessment, and treatment • For initial screening for dyslipidemia, nonfasting blood samples are sufficient • Recommend a fasting sample as the benchmark for risk assessment, diagnosis, and therapy of lipid disorders • - with consideration given to nonfasting samples in specific clinical circumstances like stable drug therapy