European study says fasting unnecessary for cholesterol tests

Obtaining a lipid profile with or without a patient fasting beforehand doesn’t significantly affect the results, according to a new study published in the European Heart Journal.

The study, headed by Borge Nordestgaard, MD, DMSc, of the University of Copenhagen, gathered data from several other studies to examine the results of both fasting and non-fasting lipid profiles.

“Among all studies comparing non-fasting with fasting lipid profiles, minor increases in plasma triglycerides and minor decreases in total and LDL cholesterol concentrations were observed, with no change in HDL cholesterol concentrations. These minor and transient changes in lipid concentrations appear to be clinically insignificant,” Nordestgarrd and his coauthors wrote.

Based off this new study, the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine released a joint statement recommending non-fasting profiles over requiring fasting, following the lead of Nordestgaard’s home country of Denmark, which began using non-fasting tests in 2009.

Researchers argued more patients are more likely to have their cholesterol checked if they’re not asked to fast for 8 to 12 hours.

“Patients are often inconvenienced by having to return on a separate visit for a fasting lipid profile and may default on essential testing,” Nordestgaard and his coauthors wrote. “Also, laboratories are burdened by a large volume of patients attending for tests in the morning. Finally, clinicians are burdened by having to review and make decisions on the findings in the lipid profile at a later date. This situation may also require an additional phone call, email, or even a follow-up clinic visit, placing extra workloads on busy clinical staff.”

The study does recommend the traditional fasting rules apply in certain situations, such as when a patient’s triglycerides in a non-fasting test are above 5 mmol/L (440mg/DL), a patient is recovering from pancreatitis or beginning medications that may cause hypertriglyceridemia.

As for changing the policy, Nordestgaard said it went smoothly in Denmark.

“It could be implemented tomorrow with no problems at all," Nordestgaard said to Reuters. “Today, the key players for keeping the fasting procedure are the laboratories drawing the blood. They simply could change the procedure tomorrow, and then nobody would fast anymore. That is what we did in Denmark–and patients, clinicians and laboratories were all happy with the change.”

The American College of Cardiology’s guidelines recommend fasting before lipid panels in most cases.