Fasting Is Not Routinely Required for Determination of a Lipid Profile: Clinical and Laboratory Implications Including Flagging at Desirable Concentration Cutpoints—A Joint Consensus Statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine

Abstract

AIMS:To critically evaluate the clinical implications of the use of non-fasting rather than fasting lipid profiles and to provide guidance for the laboratory reporting of abnormal non-fasting or fasting lipid profiles. METHODS AND RESULTS:Extensive observational data, in which random non-fasting lipid profiles have been compared with those determined under fasting conditions, indicate that the maximal mean changes at 1-6 h after habitual meals are not clinically significant [ϩ0.3 mmol/L (26 mg/dL) for triglycerides; Ϫ0.2 mmol/L (8 mg/dL) for total cholesterol; Ϫ0.2 mmol/L (8 mg/dL) for LDL cholesterol; ϩ0.2 mmol/L (8 mg/dL) for calculated remnant cholesterol; Ϫ0.2 mmol/L (8 mg/dL) for calculated non-HDL cholesterol]; concentrations of HDL cholesterol, apolipoprotein A1, apolipoprotein B, and lipoprotein(a) are not affected by fasting/non-fasting status. In addition, non-fasting and fasting concentrations vary similarly over time and are comparable in the prediction of cardiovascular disease. To improve patient compliance with lipid testing, we therefore recommend the routine use of non-fasting lipid profiles, whereas fasting sampling may be considered when non-fasting triglycerides are Ͼ5 mmol/L (440 mg/dL). For non-fasting samples, laboratory reports should flag abnormal concentrations as triglycerides Ն2 mmol/L (175 mg/dL), total cholesterol Ն5 mmol/L (190 mg/dL), LDL cholesterol Ն3 mmol/L (115 mg/dL), calculated remnant cholesterol Ն0.9 mmol/L (35 mg/dL), calculated non-HDL cholesterol Ն3.9 mmol/L (150 mg/dL), HDL cholesterol Յ1 mmol/L (40 mg/dL), apolipoprotein A1 Յ1.25 g/L (125 mg/dL), apolipoprotein B Ն1.0 g/L (100 mg/dL), and lipoprotein(a) Ն50 mg/dL (80th percentile); for fasting samples, abnormal concentrations correspond to triglycerides Ն1.7 mmol/L (150 mg/dL). Life-threatening concentrations require separate referral for the risk of pancreatitis when triglycerides are Ͼ10 mmol/L (880 mg/dL), for homozygous familial hypercholesterolemia when LDL cholesterol is Ͼ13 mmol/L (500 mg/dL), for heterozygous familial hypercholesterol-

Lifestyle and Dietary Determinants of Serum Apolipoprotein A1 and Apolipoprotein B Concentrations: Cross-Sectional Analyses within a Swedish Cohort of 24,984 Individuals

“…Lipid and lipoprotein concentrations are traditionally measured in fasting blood samples; however, triglyceride concentrations seem to be a better predictor of risk when measured in non-fasting blood samples [38,39,40]. Fasting and non-fasting lipid, lipoprotein and Apo levels seem to be valuable for risk prediction [41,42]. Compared to measuring HDL-C and LDL-C, Apo assays are expensive and not widely available in the clinic.…”

Is it time to break the fast?—a paradigm shift in clinical lipidology

“…Therefore, falsely lower nonfasting LDL-C levels could potentially result in insufficient lipid lowering treatment. This problem is addressed in the consensus statement by Nordestgaard et al and judged as probably non-significant in clinical practice (6). We have previously recommended calculating LDL-C in the fasting state to determine lipid lowering intensity in order to prevent undertreatment (7).…”

“…Prospective studies and meta-analyses have consistently demonstrated that non-HDL-C and apo B are least as good as or superior to LDL-C in the prediction of CVD during lipid-lowering therapy (7). Another advantage of non-HDL-C and apo B over LDL-C is the fact that apo B measurements are not influenced by the prandial state and non-HDL-C only slightly (6).…”

“…Despite this overwhelming quantity of data, some laboratories for clinical chemistry still send people away when asked to measure plasma lipids if the subjects are not fasting. The European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine have released a joint consensus statement proposing to use non-fasting lipid samples to determine lipid profiles (6). This report will lead to a paradigm shift in clinical lipidology and it will simplify cardiovascular risk assessment in clinical practice.…”

Determination of Fasting and Non-Fasting Cholesterol Levels of Low- and High-Density Lipoproteins with Homogenous Assays: A Promising Reliable Way to Assessment of Dyslipidemia

“…In 2016, the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine presented a similar recommendation with regard to the clinical significance of non-fasting lipid profile 20, 21) . They recommended that laboratory reports should flag abnormal values of serum lipids for non-fasting samples ( Table 1 ).…”