CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia.
Fasting or nonfasting lipid measurements
The joint American College of Cardiology and American Heart Association “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults” replaces low-density lipoprotein cholesterol treatment thresholds with a more global measurement of risk. In the laboratory, it is customary to perform fasting lipid measurements to help assess risk in these patients. With this more personalized approach to treatment recommendations for atherosclerotic cardiovascular disease (ASCVD), the authors re-examined the need for fasting lipid and lipoprotein measurements in various clinical scenarios to help clarify when fasting lipids are required and when nonfasting levels may be adequate. They initially reviewed the case of a man who was concerned about the inconvenience of prolonged fasting for a late afternoon office visit. A nurse asked the clinician if it is necessary for the patient to fast. Instead of focusing on the one best answer, the authors recommend that clinicians carefully consider six clinical scenarios before responding: (1) estimating initial risk for ASCVD in the typical primary prevention patient (nonfasting acceptable); (2) screening for familial hypercholesterolemia in a patient with a strong family history of premature ASCVD or other genetic dyslipidemia (fasting required); (3) attempting to clarify a diagnosis of metabolic syndrome (nonfasting acceptable); (4) assessing residual risk in a treated patient (fasting preferred); (5) diagnosing and treating patients with suspected hypertriglyceridemia pancreatitis (fasting preferred); and (6) diagnosing hypertriglyceridemia (fasting preferred). The authors concluded that there are a number of clinical scenarios where it would be appropriate to obtain nonfasting lipid levels. For example, a fasting or nonfasting total cholesterol and high-density lipoprotein cholesterol level will provide information to assess the initial risk of ASCVD in an untreated patient. However, there are certain situations, such as when the patient has a family history of premature ASCVD or features suggestive of familial hyperlipidemia, in which screening and follow-up should involve fasting lipid panels.
Driver SL, Martin SS, Gluckman TJ, et al. Fasting or nonfasting lipid measurements. J Am Coll Cardiol. 2016;67:1227–1234.
Correspondence: Dr. Steven Driver at steven.driver@northwestern.edu