title: 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: OBJECTIVE
  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.
  
  
  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 [+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, whereas fasting sampling may be considered when non-fasting triglycerides are >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 for the risk of pancreatitis when triglycerides are >10 mmol/L (880 mg/dL), for homozygous familial hypercholesterolemia when LDL cholesterol is >13 mmol/L (500 mg/dL), for heterozygous familial hypercholesterolemia when LDL cholesterol is >5 mmol/L (190 mg/dL), and for very high cardiovascular risk when lipoprotein(a) >150 mg/dL (99th percentile).
  
  
  CONCLUSIONS
  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 cutpoints. Non-fasting and fasting measurements should be complementary but not mutually exclusive.
authors.affiliation: Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Herlev, Denmark; boerge.nordestgaard@regionh.dk.
authors.forename: Børge G
authors.initials: BG
authors.lastname: Nordestgaard
authors.affiliation: Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Herlev, Denmark;
authors.forename: Anne
authors.initials: A
authors.lastname: Langsted
authors.affiliation: Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;
authors.forename: Samia
authors.initials: S
authors.lastname: Mora
authors.affiliation: Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece;
authors.forename: Genovefa
authors.initials: G
authors.lastname: Kolovou
authors.affiliation: Institute for Laboratory Medicine, Blutdepot und Krankenhaushygiene, Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany;
authors.forename: Hannsjörg
authors.initials: H
authors.lastname: Baum
authors.affiliation: Pitié-Salpetriere University Hospital, Paris, France;
authors.forename: Eric
authors.initials: E
authors.lastname: Bruckert
authors.affiliation: University of Western Australia, Perth, Australia;
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Watts
authors.affiliation: Department of Laboratory Medicine, Collegium Medicum, NC University, Bydgoszcz, Poland;
authors.forename: Grazyna
authors.initials: G
authors.lastname: Sypniewska
authors.affiliation: Sahlgrenska University Hospital, Gothenburg, Sweden;
authors.forename: Olov
authors.initials: O
authors.lastname: Wiklund
authors.affiliation: Sahlgrenska University Hospital, Gothenburg, Sweden;
authors.forename: Jan
authors.initials: J
authors.lastname: Borén
authors.affiliation: INSERM U939, Pitié-Salpetriere University Hospital, Paris, France;
authors.forename: M John
authors.initials: MJ
authors.lastname: Chapman
authors.affiliation: Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands;
authors.forename: Christa
authors.initials: C
authors.lastname: Cobbaert
authors.affiliation: Hopital de Jolimont, Haine-Saint-Paul, Belgium;
authors.forename: Olivier S
authors.initials: OS
authors.lastname: Descamps
authors.affiliation: Institute for Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland;
authors.forename: Arnold
authors.initials: A
authors.lastname: von Eckardstein
authors.affiliation: Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Herlev, Denmark;
authors.forename: Pia R
authors.initials: PR
authors.lastname: Kamstrup
authors.affiliation: Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland;
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.affiliation: Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria;
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
authors.affiliation: Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD;
authors.forename: Alan T
authors.initials: AT
authors.lastname: Remaley
authors.affiliation: Children's Hospital, Laboratory Medicine, Harvard University, Boston, MA;
authors.forename: Nader
authors.initials: N
authors.lastname: Rifai
authors.affiliation: 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;
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.affiliation: Department of Laboratory Medicine, AZ St-Jan, Brugge, Belgium; and University of Ghent, Ghent, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Langlois
mesh_terms: D050197:Atherosclerosis / Q000097:blood*; D002624:Chemistry, Clinical / Q000592:standards*; D019411:Clinical Laboratory Techniques / Q000592:standards*; D032921:Consensus; D005060:Europe; D005215:Fasting / Q000097:blood*; D006801:Humans; D008055:Lipids / Q000097:blood*; D012955:Societies, Medical
chemical_list: D008055:Lipids