Background: Lipid profiles differ naturally between individuals and
between populations. So far, the data relating to non-fasting lipid profiles has
been derived predominantly from studies on Western population. The
characteristics and clinical significance of non-fasting lipids in Chinese
patients with coronary heart disease (CHD) in response to traditional Chinese
diets remain poorly understood. Methods: A total of 1022 Chinese CHD
patients with coronary artery luminal stenosis 40% as diagnosed by coronary
artery angiography were enrolled in the study. All patients received standard
treatment for CHD, including statins. They were divided into an intermediate
stenosis group (luminal stenosis 40–70%, n = 486) or a severe stenosis group
(luminal stenosis 70%, n = 536). Their blood lipid profiles were measured in
the fasting state, and 4 hours after normal breakfast. All participants were
followed up for five years. Major adverse cardiovascular events (MACE) including
all-cause death, cardiac death, myocardial infarction, unscheduled coronary
revascularization and stroke were recorded. Results: After normal
breakfast intake, patients with intermediate or severe stenosis showed an
apparent increase in the levels of triglyceride (TG), remnant cholesterol (RC)
and Apo (apolipoprotein) A1 compared to the fasting state, but a significant reduction in the
levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C),
non-high-density lipoprotein cholesterol (non-HDL-C), Apo B and Apo E. In
addition to the traditional risk factors (older age, male, diabetes and smoking)
and coronary artery stenosis, the fasting levels of LDL-C and Apo B, as well as
non-fasting levels of HDL-C and Apo A1, were identified as independent predictors
of 5-year MACE occurrence by multivariate Cox proportional hazards analysis.
Patients in the 1st tertile of the non-fasting HDL-C group (0.86 mmol/L)
showed a significantly higher risk of MACE than 3rd tertile (1.07 mmol/L) (1st
tertile: 2.786, 95% CI (confidence intervals) [1.808, 4.293], p 0.001).
Conclusions: This prospective observational study found that lipid
profiles in either the fasting or non-fasting states were associated with the
long-term risk of MACE in Chinese CHD patients. In addition to the fasting LDL-C
level, a low non-fasting HDL-C level may also be an independent risk factors for
cardiovascular events. Measurement of lipid profiles during the non-fasting state
may be feasible for the management of CHD patients in routine clinical practice
in China.