Non-fasting lipid profiles: implications for lipoprotein testing and reporting

Fasting blood samples have been the standard for measurement of triglycerides and cholesterol, despite the fact that we spend the vast majority of our time in non-fasting conditions. However, when recent studies suggest that postprandial effects do not substantially alter lipid concentrations and do not weaken, and even may strengthen, their association with cardiovascular risk, then a non-fasting blood draw has many practical advantages. Non-fasting cholesterol measurements include the ‘remnant cholesterol’ fraction, a strong risk factor for developing atherosclerosis independent of LDL cholesterol. Remnant cholesterol reflects the cholesterol in chylomicron- and VLDL-remnant particles and it is included in the ‘non-HDL cholesterol’ calculation.
Until recently, most guidelines focused on targeting primarily LDL cholesterol for the prevention of cardiovascular disease, but they now recognize that non-HDL cholesterol (or apolipoprotein B, the molecule carried by all non-HDL particles) is a more accurate and comprehensive predictor of atherogenic lipoprotein-related risk.
In 2016, the European Atherosclerosis Society (EAS) and EFLM Joint Consensus Panel recommended using non-fasting lipid testing for routine clinical practice and provided specific cutpoints for desirable fasting and non-fasting lipid concentrations to be reported by the laboratories uniformly.

Teacher: Daniel Rajdl