Klinisk Biokemi i Norden · 2 2017
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cholesterol, -0.2mmol/L(8mg/dL) for LDL choleste-
rol, +0.2mmol/L (8mg/dL) for calculated remnant
cholesterol, and -0.2mmol/L(8mg/dL) for calculated
nonHDL cholesterol, while concentrations for HDL
cholesterol, apolipoproteinA1, apolipoprotein B, and
lipoprotein(a) remained unchanged (Figure 3). Natu-
rally, the corresponding changes in concentrations in
individual patients will differ from the mean changes
seen in Figure 3, exactly as concentrations will differ
from one fasting measurement to another in the same
individual.
Recommendations on the use of nonfasting lipid
profiles
To improve patient compliance with lipid testing, we
therefore recommend that nonfasting lipid profiles be
used in the majority of patients (Table 2), while with
nonfasting plasma triglyceride >5mmol/L(440mg/dL),
fasting sampling may be considered. However, as lipid
profile measurements often are taken repeatedly in the
same patient, a single, spurious, nonfasting very high
triglyceride concentration due to a very high fat intake
preceding blood sampling will be followed by other
measurements with lower concentrations.
Fasting can be a barrier to population screening, is
unpopular with children, often unsuitable for patients
with diabetes, counters the use of point-of-care tes-
ting and fasting requirements can add to the overall
costs of lipid testing. Nonfasting tests are also used to
assess other metabolic disorders, such as hemoglobin
A1c in diabetes. The collective sources of evidence
reviewed above have therefore led to the notion that
fasting samples are not essential for evaluation of car-
diovascular risk.
Novel findings from experience in Denmark
In 2009 the Danish Society for Clinical Biochemistry
recommended that all laboratories in Denmark use
random nonfasting lipid profile measurements rather
than fasting profiles
10,11
. It was believed that a single
spurious, nonfasting very high triglyceride concen-
tration due to high fat intake preceding blood samp-
ling would be followed by other measurements with
lower concentrations. However, it was also recom-
mended that laboratories should offer the option of
re-measurement of triglyceride concentrations in the
fasting state, if nonfasting triglyceride values were at
>4 mmol/L(>350mg/dL).
This change in blood sampling was easy to imple-
ment in Denmark: after adoption of the nonfasting
strategy by major university hospitals in Copenhagen
and subsequent corresponding reports in written and
electronic media nationwide, patients and clinicians
in the entire country pushed for similar changes at
their local clinical biochemical laboratory. Only a few
laboratories refused initially to follow this new prac-
tice, but by 2015 practically all laboratories in Denmark
use nonfasting lipid profiles.
To illustrate the consequences of implementing this
new blood sampling policy and for the purpose of the
present joint consensus statement, we retrieved results
for all triglyceride measurements at Herlev Hospital,
Copenhagen University Hospital in the period April
2011 through April 2015: of approximately 60.000
triglyceride measurements, only 10% were measured
in the fasting state. Further, among the 5538 patients
with both a nonfasting and a fasting triglyceride mea-
surement, concentrations were very similar fasting and
nonfasting measures overall as well as when stratified
by triglyceride concentrations and the presence or
absence of diabetes (Figure 4, top). In groups stratified
for triglyceride concentrations, the interquartile ranges
Foto: Henrik Alfthan.
