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#121 Can I get my cholesterol checked fast (without fasting)?

Can non-fasting lipid levels be used to predict future cardiovascular disease (CVD) risk?

Minimal differences exist between fasting and non-fasting HDL, LDL, and total cholesterol (TC). Also, non-fasting HDL and non-HDL levels correlate with future CVD events. Therefore, fasting for lipid testing is not required.  

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Surrogate Outcomes: Lipid results: 
  • Cross sectional study of >200,000 Canadians (mean age 52.8 years, 53.1% female) examined fasting intervals (1-16 hours) on lipids.1 Fasting changed lipid levels by: 
    • <2% for TC and high density lipoprotein (HDL). 
    • ~10% for low density lipoprotein (LDL).  
    • ~20% for triglycerides. 
  • Cross sectional study of 33,391 Danish patients (mean age 60, 53% women) found maximal changes between lipid levels collected 0 to >8 hours post-fasting were:2  
    • -0.2mmol/L for LDL and TC. 
    • -0.1mmol/L for HDL. 
    • +0.3mmol/L for triglycerides. 
  • Smaller studies where fasting and non-fasting lipids were done on the same patients found similar results: 
    • Small changes in TC, HDL,3,4 and LDL.4-7 
    • Larger changes in triglycerides4 especially after a high fat meal.5-7   
  • Theses small changes are unlikely to significantly effect cardiovascular risk prediction and are less than the within person variation of repeat lipids.8  
Clinical Outcomes: Cardiovascular events:  
  • A large compilation of prospective cohort studies examined 302,430 individual patient records, (mean age 59 years, 43% women) with 2.8 million person-years of follow-up demonstrated:9 
    • Non-fasting and fasting HDL and non-HDL cholesterol similarly predicted CVD risk. 
    • After adjusting for HDL and non-HDLtriglycerides did not predict CVD risk.   
  • Restricting patients to fasting before laboratory testing may contribute to: 
    • Testing non-adherence. 
    • Fluctuations in laboratory demand and wait times. 
    • Hypoglycemia in diabetic patients.10  
  • Guidelines differ regarding lipid testing: some recommend11 or prefer12 fasting, while others do not require fasting.13  

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  • Adrienne J Lindblad BSP ACPR PharmD
  • Michael R Kolber BSc MD CCFP MSc

1. Sidhu D, Naugler C. Arch Intern Med. 2012; 172:1707-1710.

2. Langsted A, Freiberg JJ, Nordestgaard BG. Circulation. 2008; 118: 2047-56.

3. Craig SR, Amin RV, Russell DW, et al. J Gen Intern Med. 2000; 15:395-9.

4. Wilder LB, Bachorik PS, Finney CA, et al. Am J Med. 1995; 99:374-7.

5. Schaefer EJ, Audelin MC, McNamara JR, et al. Am J Cardiol. 2001; 88:1129-33.

6. Lund SS, Petersen M, Frandsen M, et al. Clin Chem. 2011; 57:298-308.

7. Cohn JS, McNamara JR, Schaefer EJ. Clin Chem. 1988; 34:2456-9.

8. Glasziou PP, Irwig L, Heritier S, et al. Ann Intern Med. 2008; 148:656-61.

9. The Emerging Risk Factors Collaboration. JAMA. 2009; 302:1993-2000.

10. Aldasouqi S, Sheikh A, Klosterman A, et al. Diabetes Care 2011; 34:e52.

11. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2011; 32:1769-1818.

12. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Circulation. 2014; 129(25 suppl 2):S1-S45.

13. National Institute for Health and Care Excellence. Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. July 2014. Available at Accessed May 25, 2014.

Authors do not have any conflicts of interest to declare.