A simplified procedure for patients’ benefit
Fasting is a problem for many patients, and the latest research shows that cholesterol and triglyceride levels are similar whether you fast or not. Therefore, it is now advised that patients no longer need to fast. “This will improve patients compliance to preventive treatment aimed at reducing number of heart attacks and strokes, the main killers in the world,” says Clinical Professor Børge Nordestgaard, Department of Clinical Medicine, Herlev Hospital, University of Copenhagen.
In Denmark, the use of random, non-fasting cholesterol testing at any time of the day irrespective of food intake has been used successfully since 2009. Patients, doctors and laboratories have all benefitted from this simplified procedure. For people at work, children, patients with diabetes and the elderly it is particularly beneficial not to have to fast before blood sampling for cholesterol and triglyceride testing.
This is the first international recommendation that fasting is no longer necessary before cholesterol and triglyceride testing. For cholesterol testing after a fast, patients are often inconvenienced by having to return on a separate visit and may default on essential testing. Also, because of fasting cholesterol testing doctors are burdened by having to review cholesterol findings at a later date, additional phone calls, e-mails, or even follow-up clinic visits, placing extra workloads on busy clinical staff. These problems disappear by using non-fasting cholesterol and triglyceride testing.
"The requirement of cholesterol testing after a fast often causes inconvenience to patients, who usually have to return on a separate visit if they are not in fast conditions prior to analysis. This makes the patient default on essential testing. At the blood collection centers in large hospitals, where citations begin at 7 am and end at 2 pm, if fast is not required will be a great relief for patients and will avail space and resources in the afternoon, when now rarely blood extractions are made", explains Dr. Emili Ros. "It is important to take into account that the lack of fasting does not affect the other usual variables in the analysis, such as blood count, liver or kidney functions, etc. It does affect the blood glucose levels, but now the control of diabetes is made with glycated hemoglobin, that it is not modified by the absence of fasting. In short, the testing of cholesterol and triglycerides without fasting solves many problems," he concludes.
The experts participating in these recommendations explain that the fact that more patients will have their cholesterol and triglycerides measured will facilitate advice from their doctors on how best to prevent heart attacks and strokes in the future. Non-fasting cholesterol testing will hopefully make more patients, together with their doctors, implement lifestyle changes and if necessary statin treatment to reduce the global burden of cardiovascular disease and premature death.
Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine (CC)
Børge G. Nordestgaard, Anne Langsted, Samia Mora, Genovefa Kolovou, Hannsjörg Baum, Eric Bruckert, Gerald F. Watts, Grazyna Sypniewska, Olov Wiklund, Jan Borén, M. John Chapman, Christa Cobbaert, Olivier S. Descamps, Arnold von Eckardstein, Pia R. Kamstrup, Kari Pulkki, Florian Kronenberg, Alan T. Remaley, Nader Rifai, Emilio Ros, Michel Langlois on behalf of for the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) joint consensus initiative
DOI: http://dx.doi.org/10.1093/eurheartj/ehw152 ehw152 First published online: 26 April 2016