Fasting Before Lipid Tests May Be Unnecessary

The European Atherosclerosis Society (EAS) and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) have released a joint consensus statement that is the first international recommendation suggesting that fasting before cholesterol and triglyceride testing is unnecessary.

This recommendation is “based on evidence from large-scale population studies and registries and on consensus of expert opinions,” and is designed to help improve patient adherence with lipid testing.
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“Fasting can be a barrier to population screening, is unpopular with children, is often unsuitable for patients with diabetes, and counters the use of point-of-care testing, and fasting requirements can add to the overall costs of lipid testing,” the expert groups wrote.

For fasting test results, the recommendations suggest that laboratory reports should flag abnormal concentrations of triglycerides at ≥1.7 mmol/L (150 mg/dL). For nonfasting test results, they suggest flagging the following:

  • Triglycerides at ≥2 mmol/L (175 mg/dL)
  • Total cholesterol at ≥5 mmol/L (190 mg/dL)
  • LDL cholesterol at ≥3 mmol/L (115 mg/dL)
  • Calculated remnant cholesterol at ≥0.9 mmol/L (35 mg/dL)
  • Calculated non-HDL cholesterol at ≥3.9 mmol/L (150 mg/dL)
  • HDL cholesterol at ≤1 mmol/L (40 mg/dL)
  • Apolipoprotein A1 at ≤1.25 g/L (125 mg/dL)
  • Apolipoprotein B at ≥1.0 g/L (100 mg/dL)
  • Lipoprotein(a) at ≥50 mg/dL (80th percentile)

“To improve patient compliance with lipid testing, we therefore recommend the routine use of non-fasting lipid profiles, while fasting sampling may be considered when non-fasting triglycerides >5 mmol/L (440 mg/dL),” they concluded.

—Amanda Balbi

Reference:

Nordestgaard BG, Langsted A, Mora S, et al. 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 [published online April 26, 2016]. Eur Heart J. DOI: http://dx.doi.org/10.1093/eurheartj/ehw152.