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.
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.



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 [+0.3 mmol/L (26 mg/dL) for triglycerides; -0.2 mmol/L (8 mg/dL) for total cholesterol; -0.2 mmol/L (8 mg/dL) for LDL cholesterol; +0.2 mmol/L (8 mg/dL) for calculated remnant cholesterol; -0.2 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, while fasting sampling may be considered when non-fasting triglycerides >5 mmol/L (440 mg/dL). For non-fasting samples, laboratory reports should flag abnormal concentrations as triglycerides ≥2 mmol/L (175 mg/dL), total cholesterol ≥5 mmol/L (190 mg/dL), LDL cholesterol ≥3 mmol/L (115 mg/dL), calculated remnant cholesterol ≥0.9 mmol/L (35 mg/dL), calculated non-HDL cholesterol ≥3.9 mmol/L (150 mg/dL), HDL cholesterol ≤1 mmol/L (40 mg/dL), apolipoprotein A1 ≤1.25 g/L (125 mg/dL), apolipoprotein B ≥1.0 g/L (100 mg/dL), and lipoprotein(a) ≥50 mg/dL (80th percentile); for fasting samples, abnormal concentrations correspond to triglycerides ≥1.7 mmol/L (150 mg/dL). Life-threatening concentrations require separate referral when triglycerides >10 mmol/L (880 mg/dL) for the risk of pancreatitis, LDL cholesterol >13 mmol/L (500 mg/dL) for homozygous familial hypercholesterolaemia, LDL cholesterol >5 mmol/L (190 mg/dL) for heterozygous familial hypercholesterolaemia, and lipoprotein(a) >150 mg/dL (99th percentile) for very high cardiovascular risk.



We recommend that non-fasting blood samples be routinely used for the assessment of plasma lipid profiles. Laboratory reports should flag abnormal values on the basis of desirable concentration cut-points. Non-fasting and fasting measurements should be complementary but not mutually exclusive.
Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2730 Herlev, Denmark boerge.nordestgaard@regionh.dk.
Børge G
BG
Nordestgaard
Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2730 Herlev, Denmark.
Anne
A
Langsted
Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Samia
S
Mora
Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
Genovefa
G
Kolovou
Institute for Laboratory Medicine, Blutdepot und Krankenhaushygiene, Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany.
Hannsjörg
H
Baum
Pitié-Salpetriere University Hospital, Paris, France.
Eric
E
Bruckert
University of Western Australia, Perth, Australia.
Gerald F
GF
Watts
Department of Laboratory Medicine, Collegium Medicum, NC University, Bydgoszcz, Poland.
Grazyna
G
Sypniewska
Sahlgrenska University Hospital, Gothenburg, Sweden.
Olov
O
Wiklund
Sahlgrenska University Hospital, Gothenburg, Sweden.
Jan
J
Borén
INSERM U939, Pitié-Salpetriere University Hospital, Paris, France.
M John
MJ
Chapman
Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Christa
C
Cobbaert
Hopital de Jolimont, Haine-Saint-Paul, Belgium.
Olivier S
OS
Descamps
Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.
Arnold
A
von Eckardstein
Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, DK-2730 Herlev, Denmark.
Pia R
PR
Kamstrup
Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland.
Kari
K
Pulkki
Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
Florian
F
Kronenberg
Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Alan T
AT
Remaley
Childrens Hospital, Laboratory Medicine, Harvard University, Boston, MA, USA.
Nader
N
Rifai
Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona, Spain Ciber Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.
Emilio
E
Ros
Department of Laboratory Medicine, AZ St-Jan, Brugge, Belgium University of Ghent, Ghent, Belgium.
Michel
M
Langlois
D050197:Atherosclerosis; D002318:Cardiovascular Diseases; D002624:Chemistry, Clinical; D002784:Cholesterol; D032921:Consensus; D005215:Fasting; D006801:Humans; D050356:Lipid Metabolism; D008055:Lipids; D012307:Risk Factors; D014280:Triglycerides
D008055:Lipids; D014280:Triglycerides; D002784:Cholesterol
Cardiovascular disease; Lipids; Lipoproteins; Normal values; Reference values; Stroke