Nonfasting lipid testing: all the good reasons to do it, and potential physician and patient behaviors preventing its implementation

PURPOSE OF REVIEW: The purpose of this report is to summarize evidence supporting the use of nonfasting lipid testing for cardiovascular risk assessment, the potential reasons nonfasting lipid testing predicts cardiovascular risk better than fasting measurement, and to provide a preliminary survey of the status of adoption of nonfasting lipid testing by individual physicians and patients. RECENT FINDINGS: There is increased awareness of the importance of remnant lipoprotein cholesterol, which is increased after eating, as a key factor predicting risk for ischemic vascular disease. Nonfasting lipid measurement is now recommended in guidelines and consensus statements worldwide, but has not yet been adopted in many countries. Preliminary evidence suggests physician's practice of requesting a fasting glucose along with a lipid profile is decreasing over time, but still limits implementation of nonfasting lipid testing. Patient's perception of the optimal conditions for lipid testing as well as their preferred time of day to perform the test may also be limiting adoption of nonfasting measurements. SUMMARY: Nonfasting testing is now accepted as the preferred method of lipid measurement for cardiovascular risk prediction and lipid target achievement. Further acceptance of nonfasting lipid testing requires increased awareness by physicians and patients of the rationale for this recommendation.