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Updated: Aug 13, 2026
Cholesterol Efflux Assay
Published on: March 6, 2012
Blood cholesterol screening influence of fasting state on cholesterol results and management decisions
S R Craig1, R V Amin, D W Russell
1University of Iowa-Des Moines Internal Medicine Residency Program, Iowa Methodist Medical Center, Des Moines, USA. craigs@ihs.org
Insights
Screening adults for total and high-density lipoprotein (HDL) cholesterol using nonfasting blood tests is appropriate for primary prevention of heart disease. Nonfasting results closely align with fasting tests, ensuring accurate risk assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Chemistry
Background:
- Accurate cholesterol assessment is crucial for primary prevention of coronary heart disease (CHD).
- Fasting blood tests are traditionally used for lipid profiling, but nonfasting tests may offer greater convenience.
- Understanding the comparability of fasting versus nonfasting lipid levels is essential for clinical practice guidelines.
Purpose of the Study:
- To compare fasting and nonfasting total cholesterol and high-density lipoprotein (HDL) cholesterol values in adults.
- To evaluate the concordance of CHD risk classification based on nonfasting versus fasting lipid profiles.
Main Methods:
- A cross-sectional study involving 181 adult patients at a community hospital internal medicine clinic.
- Total and HDL cholesterol were measured twice for each patient within 7 days: once nonfasting and once after a minimum 12-hour fast.
- Patients were categorized into desirable, borderline-high, and high cholesterol risk groups based on both fasting and nonfasting results.
Main Results:
- Nonfasting and fasting total cholesterol showed small, statistically insignificant clinical differences.
- Nonfasting HDL cholesterol levels were comparable to fasting HDL levels.
- Classification agreement for desirable and high cholesterol groups was high (86.7% and 89.5%).
- Agreement for the borderline-high HDL cholesterol group, critical for management decisions, was 95% between fasting and nonfasting tests.
- A small fraction of patients were reclassified to lower-risk groups by nonfasting assessments, potentially impacting monitoring intensity.
Conclusions:
- Nonfasting screening for total and HDL cholesterol is suitable for guiding primary prevention decisions for CHD.
- The study supports the clinical utility of nonfasting lipid profiles in routine adult health assessments.
- Findings were consistent across subgroups, including older men and women.
Objective:
To compare fasting and nonfasting total and high-density lipoprotein (HDL) cholesterol values in adults and to determine how closely classification into risk groups for coronary heart disease based on nonfasting blood tests compares with classification based on fasting studies.
Design:
Cross-sectional study.
Setting:
A community hospital general internal medicine clinic.
Patients:
One hundred eighty-one patients at least 20 years of age receiving medical care at a community hospital general internal medicine clinic.
Interventions:
Total and HDL cholesterol levels were measured twice in each patient within 7 days, once while not fasting and once after a minimum 12-hour fast.
Measurements And Main Results:
Fasting and nonfasting total and HDL cholesterol values were compared, patients were classified into desirable, borderline-high, and high cholesterol groups on the basis of fasting and nonfasting blood studies. There were small, statistically significant but clinically insignificant differences in fasting and nonfasting results for total cholesterol. Nonfasting HDL cholesterol levels were similar to fasting HDL levels. The agreement in classification of patients into desirable and high-cholesterol groups between fasting and non-fasting blood testing was 86.7% and 89.5%, respectively. In the borderline-high group, for whom levels of HDL cholesterol are important in determining subsequent management, there was 95% agreement between fasting and nonfasting HDL cholesterol results. Only a small fraction of the patients were classified into lower-risk groups by the nonfasting assessment, creating the potential for less-rigorous monitoring and treatment of their cholesterol status than if fasting results were utilized. These findings were confirmed in this study also for the subgroups of men aged 35 years and older and women aged 45 years and older.
Conclusions:
Screening nonfasting adults for total and HDL cholesterol is appropriate for making decisions about primary prevention of coronary heart disease.
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