Fasting vs. Non-fasting Lipid Panel for ASMD Evaluation

General Recommendations for Lipid Testing

The American College of Cardiology recommends that non-fasting lipid panels are generally adequate to document baseline lipid levels prior to initiation of statin therapy in individuals with clinical atherosclerotic cardiovascular disease (ASCVD), including those with ASMD 1, 2, 3
Fasting and non-fasting total cholesterol (TC) and HDL-C levels have similar prognostic value and associations with cardiovascular disease outcomes 2, 3

The American College of Cardiology suggests that when an initial non-fasting lipid profile reveals triglyceride levels ≥400 mg/dL, a repeat lipid profile in the fasting state should be performed to accurately assess fasting triglyceride levels and baseline LDL-C 1, 2, 4
In adults with a family history of premature ASCVD or genetic hyperlipidemia, a fasting lipid profile is reasonable for initial evaluation to aid in identifying familial lipid disorders 2, 3

The standard calculation method for LDL-C is the Friedewald formula: LDL-C = (TC) – (triglycerides/5) – (HDL-C) 2, 3
For adults with an LDL-C level less than 70 mg/dL, measurement of direct LDL-C or modified LDL-C estimate is reasonable to improve accuracy over the Friedewald formula 1, 2
The unreliability of the Friedewald-calculated LDL-C levels increases at lower levels of LDL-C, particularly <70 mg/dL, especially when triglycerides are elevated 2, 3

Either fasting or non-fasting lipid panel is acceptable for initial evaluation of ASMD patients 1, 2
If initial non-fasting triglycerides ≥400 mg/dL, a fasting lipid panel should be ordered 1, 2
If a patient has a family history of premature ASCVD or genetic hyperlipidemia, a fasting lipid panel is reasonable 2, 3

Relying solely on calculated LDL-C in patients with very low LDL-C levels (<70 mg/dL) and elevated triglycerides can lead to inaccurate assessment 2, 3
Failing to repeat a fasting lipid panel when non-fasting triglycerides are ≥400 mg/dL 1, 2