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Evidence to Practice
July 2016

Nonfasting for Routine Lipid Testing: From Evidence to Action

Author Affiliations
  • 1Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2016;176(7):1005-1006. doi:10.1001/jamainternmed.2016.1979

Relevant English-language peer-reviewed studies were identified through a literature search of MEDLINE and specific health economic journals through 2016. Bibliographies from these references as well as meta-analyses and applicable guideline statements were also reviewed.

Lipid testing plays a major role in cardiovascular risk stratification and the assessment of responses to clinical interventions. Historically, it has been recommended that blood samples for lipid testing should be obtained after an 8- to 12-hour fast. Despite that we spend the vast majority of our time in nonfasting conditions, fasting samples have been the standard for measurement of triglycerides and cholesterol because measuring lipids in the fasting state is believed to reduce variability and allow for a more accurate derivation of the commonly used Friedewald-calculated low-density lipoprotein (LDL) cholesterol. However, if postprandial effects do not substantially alter lipid levels or their association with cardiovascular risk, then a nonfasting blood draw has many practical advantages.1 Indeed, recent studies suggest that postprandial effects do not weaken, and even may strengthen, the risk associations of lipids with cardiovascular disease (CVD).

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    1 Comment for this article
    NonFasting Lipid Profile Not As Good As It Sounds And Leading to Increased Cost
    Steve Furr, M.D. | Jackson Medical Clinic
    I have found the practicality of this of using NONfasting lipids NOT useful and very often leading to repeat testing which increase costs. I've had to redo multiple lipid profiles on patients due to elevated triglycerides some of which were so elevated the LDL cannot be evaluated. I have had numerous patients burned by having non fasting lipids done on their health screenings and because of those numbers were forced to go to go through a process with their healthcare insurer because of the abnormalities. When their lipid profiles were repeated fasting their numbers were acceptable.
    CONFLICT OF INTEREST: None Reported
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