From the Guidelines
Fasting is not required for a Lipoprotein(a) [Lp(a)] test, as Lp(a) levels remain relatively stable regardless of recent food intake. This is because Lp(a) is a genetically determined lipoprotein particle that doesn't fluctuate significantly with meals, as its concentration is primarily determined by genetics rather than dietary factors 1.
Key Points to Consider
- Lp(a) levels are stable and not affected by food intake, making fasting unnecessary for this specific test.
- The European Heart Journal study from 2020 recommends lipid assessment, including Lp(a) screening, without specifying the need for fasting 1.
- Other studies, such as those from the Annals of Internal Medicine, support the idea that non-fasting lipid profiles provide acceptably accurate measures for risk calculation, although they primarily focus on total cholesterol, HDL-C, and LDL-C levels rather than Lp(a) specifically 1.
Clinical Implications
- Patients can have their blood drawn for an Lp(a) test at any time of day, even after eating, making this test more convenient than other lipid measurements.
- However, it's essential to follow the healthcare provider's specific instructions, as they may sometimes request fasting for convenience if multiple lipid tests are done simultaneously.
From the Research
Lipoprotein(a) Test Requirements
- The Lipoprotein(a) test does not require fasting, as levels of Lipoprotein(a) do not change significantly in response to normal food intake 2.
- Studies have shown that median fasting levels of Lipoprotein(a) are similar to levels at 3-4 hours since the last meal, with no significant difference between the two 2.
- However, Lipoprotein(a) levels may be minimally increased at higher levels of C-reactive protein (CRP), indicating inflammation 2.
Clinical Significance of Lipoprotein(a) Levels
- Elevated levels of Lipoprotein(a) are associated with an increased risk of cardiovascular events, including ischemic heart disease and myocardial infarction 2, 3.
- The ability of Lipoprotein(a) to predict cardiovascular risk is not affected by normal food intake or inflammation 2.
- Certain therapies, such as PCSK9 inhibitors, can significantly reduce Lipoprotein(a) levels and may provide clinical benefit in reducing cardiovascular risk 4, 3, 5.