Non-Fasting Lipid Profile Interpreter
Non-Fasting Lipid Profile Interpreter
Check a routine lipid profile against the 2016 EAS/EFLM joint consensus: whether a non-fasting sample is acceptable, which results cross its desirable-concentration flags, when a repeat fasting sample is worth taking, and which values are extreme enough to refer at once. Several results can be flagged together, and the page counts and lists them all.
Is a non-fasting sample acceptable, and what should be flagged?
Lipid profile + fasting state → flags, repeat or referNon-fasting sample from an adult: total cholesterol 6.1, HDL 1.2, triglycerides 2.4, LDL 3.9 mmol/L.
What the page computes
Remnant cholesterol = total cholesterol − HDL cholesterol − LDL cholesterol
Headline = the number of the six results that reach their EAS/EFLM flag for this fasting state
An extreme value, or a non-fasting triglyceride above 5 mmol/L (440 mg/dL), takes over the headline label
- flag
- a desirable-concentration cut-point at which the laboratory report should draw attention, not a treatment goal
- fasting cut-offs
- differ from non-fasting only for triglycerides, remnant cholesterol and non-HDL cholesterol
- unit columns
- the consensus pairs are rounded, not converted, so each unit is checked against its own printed figure
Worked example
Non-fasting sample from an adult: total cholesterol 6.1, HDL 1.2, triglycerides 2.4, LDL 3.9 mmol/L.
Non-fasting is acceptable; nothing here needs the patient to come back fasting
Non-HDL = 6.1 − 1.2 = 4.9; remnant = 6.1 − 1.2 − 3.9 = 1.0 mmol/L
No extreme values: LDL 3.9 is below 5, triglycerides 2.4 are below 10, and below the 5 mmol/L repeat-fasting trigger
Flags: triglycerides 2.4 ≥ 2 · total cholesterol 6.1 ≥ 5 · LDL 3.9 ≥ 3 · remnant 1.0 ≥ 0.9 · non-HDL 4.9 ≥ 3.9 → five flags
HDL 1.2 is above 1, so not flagged → 5 of 6 results flagged
Flags at desirable concentration cut-points (EAS/EFLM 2016)
| Result | Non-fasting | Fasting |
|---|---|---|
| Triglycerides | ≥ 2 mmol/L (≥ 175 mg/dL) | ≥ 1.7 mmol/L (≥ 150 mg/dL) |
| Total cholesterol | ≥ 5 mmol/L (≥ 190 mg/dL) | Same |
| LDL cholesterol | ≥ 3 mmol/L (≥ 115 mg/dL) | Same |
| Remnant cholesterol | ≥ 0.9 mmol/L (≥ 35 mg/dL) | ≥ 0.8 mmol/L (≥ 30 mg/dL) |
| Non-HDL cholesterol | ≥ 3.9 mmol/L (≥ 150 mg/dL) | ≥ 3.8 mmol/L (≥ 145 mg/dL) |
| HDL cholesterol | ≤ 1 mmol/L (≤ 40 mg/dL) | Same |
| Apolipoprotein B | ≥ 1.0 g/L (≥ 100 mg/dL) | Same |
| Apolipoprotein A1 | ≤ 1.25 g/L (≤ 125 mg/dL) | Same |
| Lipoprotein(a) | ≥ 50 mg/dL (80th percentile) | Same |
Extreme values: refer at once (EAS/EFLM 2016)
| Result | Cut-off | Suggests |
|---|---|---|
| Triglycerides | > 10 mmol/L (> 880 mg/dL) | Chylomicronaemia syndrome, high risk of acute pancreatitis |
| LDL cholesterol | > 13 mmol/L (> 500 mg/dL) | Homozygous familial hypercholesterolaemia |
| LDL cholesterol, adults | > 5 mmol/L (> 190 mg/dL) | Heterozygous familial hypercholesterolaemia |
| LDL cholesterol, children | > 4 mmol/L (> 155 mg/dL) | Heterozygous familial hypercholesterolaemia |
| Lipoprotein(a) | > 150 mg/dL (> 99th percentile) | Very high cardiovascular risk |
| LDL cholesterol or apolipoprotein B | < 0.3 mmol/L (< 10 mg/dL) | Genetic abetalipoproteinaemia |
| HDL cholesterol or apolipoprotein A1 | < 0.2 mmol/L (< 10 mg/dL) | Genetic hypoalphalipoproteinaemia |
Why the fasting sample stopped being the default
For decades a lipid profile meant an overnight fast. The 2016 joint consensus of the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine, led by Nordestgaard, reversed that. Large population studies showed that after ordinary meals triglycerides rise modestly, total, LDL and non-HDL cholesterol change very little, and non-fasting values predict cardiovascular risk at least as well as fasting ones. So the consensus recommends non-fasting samples routinely, which is simpler for patients, avoids early-morning queues and hypoglycaemia in people with diabetes, and costs nothing in accuracy for the decisions that matter.
It also asked laboratories to do something they had not done consistently: flag results at desirable-concentration cut-points, and flag extreme values for immediate referral. The flags are the same whether or not the patient has fasted for total cholesterol, LDL cholesterol, HDL cholesterol, the apolipoproteins and Lp(a). Only three differ: triglycerides (2 mmol/L non-fasting, 1.7 fasting), remnant cholesterol (0.9 against 0.8) and non-HDL cholesterol (3.9 against 3.8). The mg/dL figures the consensus prints are rounded pairings rather than exact conversions, so this page checks each unit against its own column.
There are occasions when fasting still helps. The consensus suggests considering a repeat fasting sample when a non-fasting triglyceride is above 5 mmol/L (440 mg/dL), and fasting may be worth arranging for patients followed for known hypertriglyceridaemia, recovering from hypertriglyceridaemic pancreatitis, or starting drugs that can cause severe hypertriglyceridaemia, and when other tests on the same request need a fasting or morning sample. Calculated LDL-C is the result most affected by a non-fasting sample, which is why non-HDL cholesterol, calculated with the non-HDL cholesterol calculator, is the steadier number.
A flag is not a treatment decision. It tells the reader that a value is above a desirable concentration; what to do about it depends on the patient’s cardiovascular risk, which the LDL target by risk category interpreter turns into a goal. An extreme value is different: it means a probable inherited disorder or a pancreatitis risk, and the right response is referral.
Frequently asked questions
Do I need to fast before a cholesterol test?
Usually not. The 2016 EAS/EFLM joint consensus recommends non-fasting lipid profiles routinely. Fasting may be considered when a non-fasting triglyceride is above 5 mmol/L (440 mg/dL), in known hypertriglyceridaemia, after hypertriglyceridaemic pancreatitis, when starting drugs that can cause severe hypertriglyceridaemia, or when other tests need a fasting sample.
Which lipid results change with fasting?
Mainly triglycerides, which rise modestly after food. The consensus sets different fasting and non-fasting flags only for triglycerides, remnant cholesterol and non-HDL cholesterol. Total, LDL and HDL cholesterol, the apolipoproteins and Lp(a) use the same flag either way.
What lipid values need urgent referral?
In the consensus: triglycerides above 10 mmol/L (880 mg/dL), LDL cholesterol above 13 mmol/L (500 mg/dL) or above 5 mmol/L (190 mg/dL) in adults and 4 mmol/L (155 mg/dL) in children, Lp(a) above 150 mg/dL, and very low LDL cholesterol or HDL cholesterol suggesting a genetic disorder.
Is a flagged result the same as needing treatment?
No. Flags are desirable-concentration cut-points meant to make a result noticed. Whether to treat depends on the patient’s overall cardiovascular risk and the goal for that risk category.
Related calculators
References
- Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points — a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J. 2016;37(25):1944–1958.
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–188.
Medical Disclaimer: The tools and content provided here are for educational and reference purposes only. They are not intended to substitute for professional medical advice, diagnosis, or treatment. Clinical decisions should always be based on the comprehensive assessment of a qualified healthcare professional.