Very often we come across this situation ! MUST the patient be Fasting for a Lipid profile ? The answer, certainly depends upon what we want to measure. ! Surprised. ? Need not be! Let me explain ! Eating raises plasma triglycerides but only has a minimal impact on total cholesterol or HDL-C or apo-B. But LDL-C is a calculated number that depends on the level of plasma triglycerides and therefore requires a Fasting specimen. Yes , the patient must be Fasting if we want LDL-C. A Fasting sample is needed for the classical lipid profile ( total cholesterol, triglycerides, HDL-C and LDL-C ) because the treatment goals and proven benefits of treatment are targeted at LDL-C. But the patient need not fast if we want total cholesterol, HDL-C, non- HDL-C, or apo-B. Total cholesterol and HDL-C are the only Measurements we need to know to determine non- HDL-C. And non HDL-C includes All of the Cholesterol in all of the potentially atherogenic lipoproteins containing apo-B ( any lingering Chylomicron remnants, VLDL-C, IDL-C, LDL-C and Lp (a) ). Non HDL-C is useful Measure to consider when the triglycerides are in the range of 200 - 499 , but then cannot be calculated when the triglycerides exceed 500.

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Dear Kiran, I am happy that you asked this question ! I shall make it simple. Generally, as a cost effective approach, a Lipid profile in a laboratory is derived from three Measured values, namely Total Cholesterol, Triglycerides and HDL-C. In this case, Friedwald's equation is put into use. LDL-C concentrations are derived by this equation: LDL-C= TC-(HDL-C+TG/5) TG/5= VLDL-C Non HDL-C= TC- HDL-C Non HDL-C when exceeds 130 mg/dl in a known diabetic with other CV risk factors is considered atherogenic. This formula has its limitations.This cannot be applied in Non Fasting sample or even if collected in a Fasting state but Triglycerides exceed 500. Let me remind you that even though VLDL-C is named as a kind of Cholesterol but contains, in reality more of Triglyceride nature. My original post was to highlight the importance of estimated non HDL-C Measure which can be taken as a Cardiovascular risk factor to target , in absence of LDL-C levels which have much stronger atherogenic evidence in the causation of CVDs

Dear Chakradhar,thanks for raising current issue.Truly said,idea behind is not to leave any patient without testing lipid profile as incidence of chd due to dyslipidemia is very high.However,if need arises it may be tested fasting. It may be in pipe line to test lipid profile levels at the time of entry at college levels with a motive to prevent chd as much as possible.

Thank you Sir, You are Right, The lipids are the most underrated risk factor.
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Thanks, Dr (s ) ,Nath, Pal, Nanavaty.

Nice info.

My pleasure! DrPatel.
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useful information

Thank you, Dr Suvarchala !
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Nice info.

Wow.. This is nice. Thanks for sharing sir.

Thanks for useful information

Nice information, thanks.

Thanks Dr Pradeep
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Nice information.

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