No fasting needed: new cholesterol testing guidelines

Physicians traditionally tell their patients to fast prior to a cholesterol profile blood test, and although this is a simple test, many patients do not look forward to it. This means fasting overnight, and making an early morning trip to your doctor’s office or the nearest lab facility.

However, new international guidelines are no longer recommending it. The European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recommend that "nonfasting blood samples be routinely used for the assessment of plasma lipid profiles" (total, LDL, and HDL cholesterol and triglycerides) in a joint statement that was published online April 26, 2016 in the European Heart Journal.

Basically, it was previously thought that fasting for eight to 12 hours before having blood drawn for a cholesterol test gave a more accurate assessment of total cholesterol, harmful LDL cholesterol, protective HDL cholesterol, and triglycerides, a type of fat-carrying particle.

Dr J Michael Garziano of Brigham and Women’s Hospital in Boston, MA, in an accompanying editorial wrote: "The incremental gain in information of a fasting profile is exceedingly small for total- and HDL-cholesterol values and likely does not offset the logistic impositions placed on our patients, the laboratories, and our ability to provide timely counseling to our patients. This, in my opinion, tips the balance toward relying on nonfasting lipid profiles as the preferred practice."

The international committee, however add the caveat that doctors should repeat a nonfasting lipid profile test with a fasting test if plasma triglyceride levels are above 440mg/dL, and refer any dangerous levels to a specialist familiar with lipid disorders. High triglycerides can cause pancreatitis, and can be a harbinger of heart disease, hypothyroidism, kidney disease, and certain genetic lipid disorder.

This new recommendation is a win-win for patients and physicians. Patient can have their blood drawn when it’s most convenient for them, and diabetic patients no longer have to worry about adjusting their medications to accommodate fasting. For physicians this means patients can have their blood work done during their visit, and not be lost to follow up.

At Elevated Healthcare, our self pay rate for a lipid panel is $4.00. We also offer in house cholesterol monitoring with a single finger stick. This is part of our wellness plan and is included with our DPC membership.