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Klinisk Biokemi i Norden · 2 2017
Nonfasting lipid profile as the standard:
a joint consensus statement from the EAS and EFLM
Running title: Clinical implications of nonfasting lipid profiles
Børge G. Nordestgaard1 and Anne Langsted1 on behalf of the European Atherosclerosis Society
(EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)
joint consensus initiative.
1
Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.
This article is a shortened version of a joint consensus
paper published in both Clinical Chemistry
1
and in
European Heart Journal
2
in 2016:
Nordestgaard BG, Langsted A, Mora S, Kolovou G,
Baum H, Bruckert E, et. al., for the European Atheros-
clerosis Society (EAS) and the European Federation of
Clinical Chemistry and Laboratory Medicine (EFLM)
joint consensus initiative. Fasting is not routinely requi-
red for determination of a lipid profile: Clinical and
laboratory implications including flagging at desirable
concentration cut-points. A joint consensus statement
from the EAS and EFLM. Clin Chem 2016; 62: 930-946
& Eur Heart J 2016; 37:1944-58.
Abstract
The aim was to critically evaluate the clinical impli-
cations of the use of nonfasting rather than fasting
lipid profiles, and to provide guidance for laboratory
reporting of abnormal nonfasting or fasting lipid pro-
files. Extensive observational data, in which random
nonfasting lipid profiles have been compared with
those determined under fasting conditions, indi-
cates that the maximal mean changes at 1-6 hours
after habitual meals are not clinically significant
(+0.3mmol/L(26mg/dL) for triglycerides; -0.2mmol/
L(8mg/dL) for total cholesterol; -0.2mmol/L(8mg/
dL) for LDL cholesterol; +0.2mmol/L(8mg/dL) for
calculated remnant cholesterol; -0.2mmol/L(8mg/dL)
for calculated nonHDL cholesterol); concentrations
of HDL cholesterol, apolipoproteinA1, apolipopro-
teinB, and lipoprotein(a) are not affected by fasting/
nonfasting status. In addition, nonfasting and fasting
concentrations vary similarly over time. To improve
patient compliance with lipid testing, we therefore
recommend routine use of nonfasting lipid profi-
les, while fasting sampling may be considered when
nonfasting triglycerides >5mmol/L(440mg/dL). For
nonfasting samples, laboratory reports should flag
abnormal concentrations as triglycerides ≥2mmol/
L(175mg/dL), total cholesterol ≥5mmol/L(190mg/dL),
LDL cholesterol ≥3mmol/L(115mg/dL), calculated
remnant cholesterol ≥0.9mmol/L(35mg/dL), calculated
nonHDL cholesterol ≥3.9mmol/L(150mg/dL), HDL
cholesterol ≤1mmol/L(40mg/dL), apolipoproteinA1
≤1.25g/L(125mg/dL), apolipoproteinB ≥1.0g/L(100mg/
dL), and lipoprotein(a) ≥50mg/dL(80
th
percentile); for
fasting samples, abnormal concentrations correspond
to triglycerides ≥1.7mmol/L(150mg/dL). In conclusion,
we recommend that nonfasting blood samples be
routinely used for assessment of plasma lipid profiles.
Laboratory reports should flag abnormal values based
on desirable concentration cut-points.
Introduction
Most individuals consume several meals during the
day and some consume snacks between meals; the
postprandial state therefore predominates over a 24
hr period. Nonetheless, in clinical practice the lipid
