Agreement between fasting and postprandial LDL cholesterol measured with 3 methods in patients with type 2 diabetes mellitus.
BACKGROUND
LDL cholesterol (LDL-C) is a modifiable cardiovascular disease risk factor. We used 3 LDL-C methods to study the agreement between fasting and postprandial LDL-C in type 2 diabetes (T2DM) patients.


METHODS
We served 74 T2DM patients a standardized meal and sampled blood at fasting and 1.5, 3.0, 4.5, and 6.0 h postprandially. We measured LDL-C by use of modified β quantification (MBQ), the Friedewald equation (FE), and a direct homogeneous assay (DA). We evaluated agreement using 95% limits of agreement (LOA) within ±0.20 mmol/L (±7.7 mg/dL).


RESULTS
LDL-C concentrations at all postprandial times disagreed with those at fasting for all methods. In 66 patients who had complete measurements with all LDL-C methods, maximum mean differences (95% LOA) in postprandial vs fasting LDL-C were -0.16 mmol/L (-0.51; 0.19) [-6.2 mg/dL (-19.7; 7.3)] with MBQ at 3 h; -0.36 mmol/L (-0.89; 0.17) [-13.9 mg/dL (-34; 6.6)] with FE at 4.5 h; and -0.24 mmol/L (-0.62; 0.05) [-9.3 mg/dL (-24; 1.9)] with DA at 6.0 h. In postprandial samples, FE misclassified 38% of patients (two-thirds of statin users) into lower Adult Treatment Panel III (ATP III) risk categories. Greater disagreement between fasting and postprandial LDL-C was observed in individuals with postprandial triglyceride concentrations >2.08 mmol/L (>184 mg/dL) and in women (interactions: P ≤ 0.038).


CONCLUSIONS
Differences up to 0.89 mmol/L (34 mg/dL) between fasting and postprandial LDL-C concentrations, with postprandial LDL-C concentrations usually being lower, were found in T2DM by 3 different LDL-C methods. Such differences are potentially relevant clinically and suggest that, irrespective of measurement method, postprandial LDL-C concentrations should not be used to assess cardiovascular disease risk.
Steno Diabetes Center, Gentofte, Denmark. sqrl@steno.dk
Søren S
SS
Lund
Martin
M
Petersen
Merete
M
Frandsen
Ulla M
UM
Smidt
Hans-Henrik
HH
Parving
Allan A
AA
Vaag
Tonny
T
Jensen
D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005215:Fasting; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides