A headline in a recent issue of the New York Times suggested that “fasting before a lipid panel may offer no clinical value.” Indeed, non-HDL-cholesterol (now regarded as a better indicator of cardiovascular risk by the International Atherosclerosis Society and many other lipid experts) does NOT require fasting. Fasting does not affect either the total cholesterol or the high-density lipoprotein cholesterol (HDL-C) numbers from which non-HDL-C is calculated. (Non-HDL-C = Total C minus HDL-C). Triglyceride levels, however, should be done on a fasting specimen and hence the 2013 ACC/AHA Cholesterol Guideline states that a “fasting lipid profile is preferred” and “If non-fasting triglycerides are >500 mg/dL, a fasting lipid profile is required.” For simplicity in screening though, the National Heart, Lung, and Blood Institute 2011 Pediatric Cardiovascular Risk Reduction Guidelines recommended non-HDL-C as a screening tool in children and adolescents once between 9-11 and 17-21 years of age. Then if non-HDL-C levels are above recommended levels, these guidelines recommend that follow-up include a fasting lipid profile.
Reference: 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: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2013, published on line Nov. 12, 2013.