The Future of Low-Density Lipoprotein Cholesterol in an Era of Nonfasting Lipid Testing and Potent Low-Density Lipoprotein Lowering

Article, see p 10 Lipid testing plays a major role in cardiovascular risk stratification and management in clinical practice. Fasting samples have long been the standard for assessing low-density lipoprotein cholesterol (LDL-C) and triglycerides because fasting is believed to reduce variability and to allow more accurate derivation of the commonly used Friedewald-calculated LDL-C. In 2009, the Danish guidelines recommended nonfasting lipid testing across Denmark. In 2014, the US Department of Veterans Affairs, the Joint British Societies, and the National Clinical Guideline Center practice guidelines recommended nonfasting lipids for cardiovascular risk assessment. In 2016 to 2017, several additional clinical guidelines and expert consensus statements1–3 from Europe, Canada, and the United States have also recommended nonfasting lipid testing for most routine clinical evaluations (Figure). As more of the worldwide medical community moves toward obtaining nonfasting lipids for routine testing,3 the time is opportune for reassessing whether Friedewald LDL-C or other methods for determining LDL-C could result in improved accuracy of LDL-C, whether assessed nonfasting or fasting.Figure. Timeline of countries and the respective guidelines advocating nonfasting lipid tests as preferred or acceptable alternative to fasting lipids. AACE/ACE indicates American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease; CCSG, Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult; CHEP, Canadian Hypertension Education Program; EAS/EFLM, European Atherosclerotic Society/European Federation of Clinical Chemistry and Laboratory Medicine joint consensus statement; JBS, Joint British Societies guidelines on prevention of cardiovascular disease in clinical practice; NICE, National Institute for Health and Care Excellence cardiovascular disease: risk assessment and reduction, including lipid modification clinical guideline; and VA DOD, Veterans Affairs/Department of Defense clinical practice guideline for the management of dyslipidemia for cardiovascular risk reduction.In their …