Fasting no Longer Necessary Before Lipid Profile

A team of international experts recommends that most people do not need to fast before having their cholesterol and triglyceride levels tested.

The joint consensus statement, issued by the European Atherosclerosis Society (EAS; Göteborg, Sweden) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM; Milano, Italy), is based on research from Denmark, Canada, and the United States that combined included over 300,000 people, and which found that cholesterol and triglyceride levels are similar whether a person fasts or not.

According to extensive observational data, the experts concluded that the maximal mean changes one to six hours after habitual meals are not clinically significant for triglycerides, total cholesterol, LDL cholesterol, calculated remnant cholesterol, calculated non-HDL cholesterol, concentrations of HDL cholesterol, apolipoprotein A1, apolipoprotein B, and lipoprotein. In addition, they found that 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, they therefore recommend the routine use of non-fasting lipid profiles, while fasting sampling may be considered when non-fasting triglycerides are higher than 440 mg/dL. For non-fasting samples, laboratory reports should flag abnormal concentrations as triglycerides over 175 mg/dL, total cholesterol over 190 mg/dL, LDL cholesterol over 115 mg/dL, calculated remnant cholesterol over 35 mg/dL, calculated non-HDL cholesterol over 150 mg/dL, HDL cholesterol under 40 mg/dL, apolipoprotein A1 under 125 mg/dL, apolipoprotein B over100 mg/dL, and lipoprotein(a) over 50 mg/dL. The consensus statement was published on April 24, 2106, in European Heart Journal.

“This will improve patients compliance to preventive treatment aimed at reducing number of heart attacks and strokes, the main killers in the world,” says lead author Professor Børge Nordestgaard, MD, of the department of clinical medicine at the University of Copenhagen (KU, Denmark). “We hope that non-fasting cholesterol testing will make more patients together with their doctors implement lifestyle changes, and if necessary statin treatment, to reduce the global burden of cardiovascular disease and premature death.”

In Denmark, the use of random, non-fasting cholesterol testing at any time of the day irrespective of food intake has been used successfully since 2009. Apart from Denmark, all the other countries reviewed require that patients fast for at least eight hours before having a lipid profile to check cholesterol and triglyceride levels.

Related Links:
European Atherosclerosis Society
European Federation of Clinical Chemistry and Laboratory Medicine
University of Copenhagen