Frontiers in lipid research: mechanisms, diet, and novel lipids

Abstract

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] The measurement of lipid profiles is crucial in primary and secondary prevention, and is recommended by the most recent European Society of Cardiology (ESC) Prevention Guidelines.1 There is, however, uncertainty on how to do this properly. The European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine clarify this issue in their joint consensus statement ‘ Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points .’ The authors critically evaluate the clinical implications of the use of non-fasting rather than fasting lipid profiles, and provide guidance for laboratory reporting of abnormal non-fasting or fasting lipid profiles.2 Extensive observational data, in which random non-fasting lipid profiles were compared with those determined under fasting conditions, indicate that the maximal mean changes at 1–6 h after habitual meals are not clinically significant and averaged 0.3 mmol/L or 26 mg/dL for triglycerides, 0.2 mmol/L or 8 mg/dL for total cholesterol, 0.2 mmol/L or 8 mg/dL for LDL-cholesterol, 0.2 mmol/L or 8 mg/dL for calculated remnant cholesterol, and 0.2 mmol/L or 8 mg/dL for calculated non-HDL cholesterol. Concentrations of HDL-cholesterol, apolipoprotein A1, apolipoprotein B, and lipoprotein(a) were not affected by fasting or non-fasting status, respectively. In addition, non-fasting and fasting concentrations vary similarly over time and are comparable in their ability to predict cardiovascular disease. To improve patient compliance with lipid testing, the authors therefore recommend routine use of non-fasting lipid profiles, while fasting sampling may be considered when non-fasting triglycerides are higher than 5 mmol/L or 440 mg/dL. For non-fasting samples, laboratory reports should flag abnormal concentrations of triglycerides ≥2 mmol/L or 175 mg/dL, total cholesterol ≥5 mmol/L or 195 mg/dL, LDL-cholesterol ≥3 mmol/L or … [1]: /embed/inline-graphic-1.gif