Jørgensen 2013: Nonfasting Triglycerides and Cardiovascular Risk

Background

Dr. A.B. Jørgensen and colleagues from Copenhagen published this study from the Copenhagen City Heart Study in JAMA (PMID: 23248205), demonstrating that nonfasting triglycerides predict cardiovascular events.

Study Design

Design: Prospective cohort study Population: 7,581 women and 6,391 men from general Copenhagen population Follow-up: Up to 31 years Exposure: Nonfasting triglycerides (2-4 hours after last meal) Outcomes: Myocardial infarction, ischemic heart disease, death

Key Findings

Hazard ratios for highest vs. lowest triglyceride quintile:

Outcome	Women HR (95% CI)	Men HR (95% CI)
MI	5.0 (2.5-9.8)	2.3 (1.5-3.7)
IHD	4.5 (2.7-7.5)	2.3 (1.6-3.3)
Total mortality	2.2 (1.7-2.9)	1.5 (1.2-1.8)

Key insight: Risk was continuous across the triglyceride range—no safe threshold.

Nonfasting vs. fasting: Nonfasting triglycerides were equally or more predictive than fasting values.

Mechanistic Insights

Nonfasting triglycerides reflect:

1. •Postprandial lipemia (chylomicron remnants)
2. •Remnant cholesterol content
3. •Clearance capacity (related to insulin sensitivity)

The fed state may better reveal metabolic dysfunction than the artificial fasting state.

Clinical Implications

This study supported the shift away from mandatory fasting for lipid testing. Nonfasting triglycerides are clinically meaningful and may be more practical for routine screening.

Metabolic Health Perspective

Elevated postprandial triglycerides mark carbohydrate intolerance and insulin resistance. Dietary carbohydrate restriction effectively lowers both fasting and nonfasting triglycerides.