ABC | Volume 111, Nº5, November 2018

Viewpoint Cordova & Galgowski Flexibilization of fasting: science or convenience Arq Bras Cardiol. 2018; 111(5):747-749 1. Sociedade Brasileira de Patologia Clínica –Medicina Laboratorial. SBPC-ML Necessidade de jejum para coleta de sangue para a realização de exams laboratoriais. [Citado em 2016 dez 10. Disponível em: http://www.sbpc . org.br/upload/conteudo/consenso_jejum_dez2016_final.pdf 2. Martin SS, BlahaMJ, ElshazlyMB, Toth PP, Kwiterovich PO, Blumenthal RS, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA. 2013;310(19):2061-8. 3. Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, et al; European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) joint consensus initiative. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points-a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J. 2016;37(25):1944-58. 4. Boekholdt SM, Arsenault BJ, Mora S, Pedersen TR, LaRosa JC, Nestel PJ, et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins. JAMA. 2012;307(12):1302-9. Erratum in: JAMA. 2012;307(18):1915. 5. Mora S, Rifai N, Buring JE, Ridker PM. Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events. Circulation. 2008;118(10):993-1001. 6. Mora S, Rifai N, Buring JE, Ridker PM. Comparison of LDL cholesterol concentrationsbyFriedewaldcalculationanddirectmeasurement inrelation to cardiovascular events in 27,331women. ClinChem. 2009;55(5):888-94. 7. Catapano AL, Reiner Z, De Backer G, Graham I, Taskinen MR, Wiklund O, et al; European Society of Cardiology (ESC); European Atherosclerosis Society (EAS). ESC/EAS Guidelines for the management of dyslipidaemias The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011;217(1):3-46. 8. Guidi GC, Simundic AM, Salvagno GL, Aquino JL, Lima-Oliveira G. To avoid fasting time, more risk than benefits. Clin Chem Lab Med. 2015;53(10):e261-4. 9. Young DS, Bermes EW Jr. Preanalytical variables and biological variation. In: BurtisCA,AshwoodER,BrunsDE.(editors).Tietztextbookofclinicalchemistry andmolecular diagnostics. 4 th ed. St Louis: Elsevier; 2006. p. 449-84. 10. Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M. Standardization of collection requirements for fasting samples: for the Working Group on Preanalytical Phase (WG-PA) of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Clin Chim Acta. 2014 May 15;432:33-7. 11. RasouliM,MokhtariH.CalculationofLDL-cholesterolvsdirecthomogenous assay. J Clin Lab Anal. 2017;31(3):e22057. 12. de Cordova CM, de Cordova MM. A new accurate, simple formula for LDL cholesterol estimation based on directly measured blood lipids from a large cohort. Ann Clin Biochem. 2013;50(Pt 1):13-9. 13. Sathyapalan T, Atkin SL, Kilpatrick ES. LDL cholesterol variability in patients with Type 2 diabetes taking atorvastatin and simvastatin: a comparison of two formulae for LDL-C estimation. Ann Clin Biochem. 2015;52(Pt 1):180-2. References And fifth, finally, the suggested Martin’s formula still uses TG in its calculations, a parameter that has been demonstrated by many authors not to be correlated with LDL-c or TC. Martin et al. 2 have made a huge mathematical effort to achieve a satisfactory result to include TG in the calculation. And most importantly, this equation has to be validated or at least evaluated, in other populations before being universally recommended. For instance, the proposed Martin’s formula, as well as ours, was evaluated in comparison to newly proposed formulas for LDL-c estimation in Iran, and the former was demonstrated to not add value to the estimations in a small cohort. 11 Anyway, LDL-c remains a frequent parameter requested at clinical laboratories in medical routine, and will likely continue to be so, hence precise methods for its estimation are needed when its direct measurement is not available. A simple and accurate equation developed and evaluated in the Brazilian population has already been developed. 12 It should be noted that this equation performs equally well, for instance, in populations fromGermany and United Kingdom, 13 but not as well in others, such as in South Africa, 14 Spain, 15 and Thailand. 16 It seems that the debate on which method to use for LDL-c determination, in each particular population of the globe, is more open than defined. 17 Sadly, history is full of examples demonstrating that when corporate interests meet with poor science, the only losers are science itself, and patient care. It is apparent and worthy of concern that the Brazilian 'consensus' has recommended the use of an equation for LDL-c estimation that was not validated in the local population and was moved by reasons that are driven more by convenience than by rigorous and unbiased science. Author contributions Conception and design of the research: Cordova CMM; Acquisition of data, Analysis and interpretation of the data and Critical revision of the manuscript for intellectual content: Cordova CMM, Galgowski C; Writing of the manuscript: Galgowski C. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. 748