Re-assessing the role of non-fasting lipids; a change in perspective

Lipid testing plays a major role in cardiovascular risk stratification and management in clinical practice. Despite the fact that we spend the vast majority of our time in a non-fasting state, fasting samples have long been the standard for measurement of triglycerides and cholesterol, as fasting is believed to reduce variability and allow for a more accurate derivation of the commonly used Friedewald-calculated low-density lipoprotein (LDL) cholesterol. Another reason for preferring fasting lipid profiles has been the concern for an increase in triglyceride concentration seen after consuming a fatty meal (i.e., a fat tolerance test). However, the increase in plasma triglycerides observed after habitual food intake is much less than that observed during a fat tolerance test, making this concern less of a concern. In addition, recent studies suggest that postprandial effects do not weaken, and may even strengthen, the risk associations of lipids with cardiovascular disease (CVD). If postprandial effects do not substantially alter lipid levels or their association with cardiovascular risk, then a non-fasting blood draw has many practical and possibly economic advantages (1).