The People's Perspective on Medicine

No Need to Fast for a Cholesterol Test

For purposes of predicting heart attacks and other cardiovascular problems, a nonfasting cholesterol test works as well one taken while fasting.
Test tube with blood sample for LDL-Cholesterol (LDL-C) test

If your doctor has ever ordered a cholesterol test to help determine your risk of a heart attack, you were probably warned not to eat or drink anything before the blood draw. However, perhaps you could have had breakfast before the test without affecting its usefulness (JAMA Internal Medicine, May 28, 2019).

Does It Matter Whether You Fast for a Cholesterol Test?

In a new study, researchers analyzed data from a previous trial. More than 8,000 people participated in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid-Lowering Arm. Originally, researchers had conducted this randomized controlled trial, known as ASCOT-LLA, for another purpose (Lancet, April 5, 2003). Usually scientists consider that a disadvantage. On the other hand, the data linked cholesterol test results to heart attacks, strokes and other problems.

A nonfasting lipid panel predicted heart attacks and other cardiovascular complications about as well as traditional fasting blood samples. The investigators were pleased since people find it easier to get to the lab if they don’t need to fast. So, if a laboratory technician asks whether you had anything to eat before your cholesterol test, don’t panic. You can say that it doesn’t make any difference.

In the original study, half of the volunteers took atorvastatin to lower their cholesterol and half took placebo. Those taking atorvastatin (Lipitor) had fewer cardiac events.

The researchers conclude

“These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy.”

Learn More:

You can learn more about the factors that contribute to heart disease in Show 1147: How Do You Control Your Cholesterol? In this interview, Dr. Steve Nissen, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic, describes the Reynolds Risk Calculator. In addition, he discusses who needs to take a statin and why he doesn’t send his patients for coronary calcium testing. 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
Cholesterol Control & Heart Health

Download the guide: Heart disease is still a top killer, and high cholesterol is an important risk factor. 8 pages on the pros and cons of statins as well as non-statin drugs for cholesterol.

Cholesterol Control & Heart Health
  • Mora S et al, "Association of nonfasting vs fasting liid levels with risk of major coronary events in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid-Lowering Arm." JAMA Internal Medicine, May 28, 2019. doi:10.1001/jamainternmed.2019.0392
  • Sever PS et al, "Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial." The Lancet, April 5, 2003. DOI: 10.1016/S0140-6736(03)12948-0
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I unexpectedly had my test yesterday, and having read your recent report, I lied and said that I had had only a cup of black coffee. Actually I had consumed a cup of coffee with lactic milk and xylitol. Of course, none of the lab techs had heard of this JAMA report when I mentioned it.

It’s so difficult to choose whether to take statins, or not! I’ve read so much that points to it being prescribed needlessly, very often, and I’ve suffered from the aches and pains associated with it, too. Since my doctor permitted be to stop taking it, my cholesterol levels increased slightly but are still acceptable. Reducing sugar and carbs in my diet seem to work just as well. I think my levels originally increased along with my blood pressure because of my hypothyroid condition, now properly managed. I plan to wean myself off of BP meds, also, with a view to healing with food.

I love “hearing” this! One of the things I always hate is not being able to eat breakfast before I go in for a test, and cholesterol is a big one now that I’m 67!

But what I’d also like to know is more about cholesterol in general. Mine is high right now but everything else is really good. My doctor said she would not put me on medication because of that, but quite honestly, I’m not going to take medication anyway. I’ve made a few changes to my diet, but I was already careful, and I’m very active and at a low weight. I think some things change with age, and I feel as though doctors want to keep everything at a certain level no matter what.

For my last blood test at my yearly check up, I did it without fasting. Unhappily, my numbers were all up in the results. My gastroenterologist suggested I redo the tests a couple of months later, while fasting. I did, and the numbers were down again. Which would be more accurate? I don’t know but it was disturbing to me.

Whenever I have a blood test that includes cholesterol the phlebotomist asks me if I had anything to eat. She will not draw blood if I say “yes”.

My family doctor, who thinks outside the box, told me years ago it was not necessary to fast. Just be consistent. Never have fasted.

Your advice to tell the lab person when asked if fasting prior to a cholesterol blood test that “it does not make any difference” is a bit simplistic. In my experience, LabCorp will not perform the draw if the patient admits to not fasting. They will not perform the draw if one does not play by their rules. I have tried it and am no push over in challenging authority. ‘You want the draw? Come back when you have fasted.’

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