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Letter to the Editor
Can non-fasting and fasting lipid profile be mutually exclusive? An Indian perspective
  1. Sudhanshu Shekhar Pati1,
  2. Arvind K Singh2
  1. 1Department of Biochemistry, Ispat General Hospital, Rourkela, Odisha, India
  2. 2Department of Internal Medicine, Ispat General Hospital, Rourkela, Odisha, India
  1. Correspondence to Dr. Sudhanshu Shekhar Pati, Department of Biochemistry, Ispat General Hospital, Rourkela, India; sudhanshushekhar.pati{at}gmail.com, sspati{at}rediffmail.com

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Sir,

Lipid has been measured in fasting blood sample as a convention.1 In the recent past there is a growing compulsion for estimating lipid in non-fasting samples in different parts of the world. There is no consensus so far for non-fasting lipid estimation to replace fasting sample at least in India.

The most important reason among others for preferring fasting lipid profiles is the increase in triglyceride concentration seen in random blood sample. Low-density lipoprotein (LDL) cholesterol is often calculated by the Friedewald2 equation, which includes the triglyceride concentration. Calculated LDL cholesterol has been thought to be affected substantially by food intake. In India due to high carbohydrate diet, triglyceride values are comparatively high, posing a different challenge to the laboratories estimating LDL by Friedewald equation. Majority of randomized lipid-lowering trials have used fasting lipid measurements, and in order to follow evidence-based practice fasting blood sampling has often been the standard in lipid estimation for risk stratification.

However there is also a school of thought advocating for non-fasting sample for its ease, citing reasons like recent population-based studies using random, non-fasting blood sampling providing a robust evidence base. The 2013 American College of Cardiology/American Heart Association guidelines do not require fasting for atherosclerotic cardiovascular disease risk estimation; however, they do recommend a fasting lipid panel before statin initiation to calculate LDL cholesterol and for individuals with …

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