Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Apo A1 Triglycerides Cholesterol HDL Remnants LDL Lipoproteins HDL cholesterol Remnant cholesterol LDL cholesterol ApoB or non-HDL cholesterol Alternative Triglycerides Lipids Lp(a) total mass Lp(a) Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Lipids, lipoproteins, and apolipoproteins as part of standard and expanded lipid profiles. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology.

Nordestgaard 2016 Fasting Nonfasting Lipoprotein lipase Chylomicron Chylomicron remnant VLDL IDL LDL Triglycerides Cholesterol

Total cholesterol Triglycerides LDL cholesterol HDL cholesterol Non-HDL cholesterol Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Fasting time, hours Mean, mg/dL Children, N=12,744 US National Health and Nutrition Examination Survey

Mean concentrations of lipids and lipoproteins as a function of the fasting period following the last meal in children from the US general population. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. US National Health and Nutrition Examination Survey

Total cholesterol Triglycerides LDL cholesterol HDL cholesterol Total cholesterol Triglycerides LDL cholesterol HDL cholesterol Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Calgary Laboratory Services in Canada

Mean concentrations of lipids and lipoproteins as a function of the period of fasting following the last meal in men and women from the Canadian general population. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. Calgary Laboratory Services in Canada

N=92,285 Triglycerides Total cholesterol LDL cholesterol Remnant cholesterol NonHDL cholesterol Lipoprotein(a) Apolipoprotein B HDL cholesterol Apolipoprotein A No change mmol/Lmg/dL Decreased Maximal mean change after habitual food intake Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Copenhagen General Population Study

Maximal mean changes at 1–6 h after habitual food intake of lipids, lipoproteins, and apolipoproteins as part of standard and expanded lipid profiles in individuals in the Danish general population. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. Copenhagen General Population Study

Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

NonfastingFasting N= 5436 N= 470 R 2 = 0.84 MesLDL-C = 0.95 * calLDL-C R 2 = 0.87 MesLDL-C = 0.97 * calLDL-C Bias: -0.1 (95%CI: -0.9;0.6) Bias: -0.1 (95%CI: -0.8;0.6) Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Copenhagen City Heart Study

Comparison of calculated low-density lipoprotein cholesterol using the Friedewald equation with low-density lipoprotein cholesterol measured directly using random non-fasting and fasting lipid profiles. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. Copenhagen City Heart Study

N=92, (1.23;1.53) 1.33(1.19;1.49) 1.45(1.29;1.62) 1.35(1.21;1.51) 1.57(1.41;1.75) 1.18(1.03;1.37) 1.60(1.43;1.78) 0.61(0.55;0.68) 0.72(0.65;0.80) 1.74(1.46;2.09) 1.78(1.50;2.11) 2.04(1.72;2.43) 1.71(1.43;2.05) 2.28(1.91;2.72) 1.62(1.33;2.01) 2.29(1.92;2.74) 0.49(0.41;0.59) 0.60(0.50;0.71) Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Copenhagen General Population Study

Risk of ischaemic heart disease and myocardial infarction for highest vs. lowest quintile of random non-fasting lipids, lipoproteins, and apolipoproteins as part of standard and expanded lipid profiles in individuals in the general population. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. Copenhagen General Population Study

Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

All > Diabetes No 4711 Yes 418 N TGs, mmol/L 5538 < Nonfasting Fasting Copenhagen hospital patients Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

LDL cholesterol, mmol/L All > Diabetes No 4711 Yes 418 N Triglycerides, mmol/L 5538 < All > Diabetes No 3066 Yes 622 N LDL, mmol/L 4141 < Nonfasting Fasting Nonfasting Fasting Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Copenhagen hospital patients

Comparison of concentrations of plasma triglycerides and low-density lipoprotein cholesterol measured in the non-fasting and fasting states in the same patients. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. Copenhagen hospital patients

Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Total cholesterol 72% Fraction of population 92,000 nonfasting samples from the Copenhagen General Population Study Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Total cholesterol 72% LDL cholesterol 60% Remnant cholesterol 27% Non-HDL cholesterol 50% HDL cholesterol 10% Triglycerides 27% Lipoprotein(a) 20% ApoB 59% Fraction of population ApoA1 9% Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26 Copenhagen General Population Study

Proportion of non-fasting individuals in the general population with flagged abnormal concentrations in laboratory reports using desirable concentration cut-points as shown in Table 5. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology. Copenhagen General Population Study

Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Separate referral to lipid specialist at Pancreatitis risk? HoFH? HeFH? Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

 LDL  Remnant cholesterol  Nonfasting /fasting TG Chylo- microns  TG Nordestgaard 2015  CVD  Pancreatitis  CVD(  CVD)

Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Atherosclerosis Myocardial infarction Angina pectoris Elevated LDL cholesterol Mutations in LDL receptor, apolipoproteinB or PCSK9 Liver with only 50% functional LDL receptors Coronary heart disease Heterozygous familial hypercholesterolaemia Nordestgaard et al. EAS Consensus. Eur Heart J 2013; 34: (open access) LDLR>95% APOB2-5% PCSK9<1%

35yrs 53yrs 48yrs 55yr 12.5yrs Start high dose statin Start low dose statin Threshold for CHD Female sex Smoking Hypertension Diabetes  Triglycerides  HDL-C  Lipoprotein(a) Without FH Homozygous FHHeterozygous FH Age in years Coronary disease & death before age 20 Untreated coronary disease before age 55/60 Nordestgaard et al. EAS Consensus. Eur Heart J 2013; 34: (open access)

Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Lipoprotein(a) apolipo- protein(a) LDL-like particle Koschinsky et al. Cur Opin Lipidol 2004;15: KIV-2 copy number variant: 2 to >40 repeats

Lipoprotein(a) consists of an LDL-like particle to which apolipoprotein(a) is covalently linked. Nordestgaard B G et al. Eur Heart J 2010;31: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author For permissions please

Copenhagen General Population Study Low number of Kringle IV-2 repeats High number of Kringle IV-2 repeats Nordestgaard 2010

Typical distributions of lipoprotein(a) levels in the general population. Nordestgaard B G et al. Eur Heart J 2010;31: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author For permissions please Copenhagen General Population Study

Key university hospitals start using nonfasting lipid profiles National societies for cardiology, endocrinology, atheroslerosis, pediatrics, clinical chemistry, general practice and others adapt nonfasting lipid profiles Clinical chemistry laboratories no longer require fasting before lipid profile testing Journalists at key medias are invited to bring the story that fasting is no longer routinely required for lipid profile testing Key university hospitals start using desirable concentration cut-points to indicate abnormal concentrations as in Table 4 National societies for clinical chemistry, cardiology, endocrinology, atheroslerosis, pediatrics, general practice and other adapt desirable concentration cut-points Clinical chemistry laboratories use desirable concentration cut-points for lipid profile testing National societies enforce strategy Nonfasting lipid profilesLaboratory reporting on abnormal concentrations Implementation strategies in individual countries, states, and provinces for Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26

Suggested implementation strategies in individual countries, states, and/or provinces for use of non-fasting lipid profiles and for flagging in laboratory reports of abnormal values based on desirable concentration cut-points. Børge G. Nordestgaard et al. Eur Heart J 2016;eurheartj.ehw152 © The Author Published by Oxford University Press on behalf of the European Society of Cardiology.

Disclosures Supported by unrestricted educational grants to EAS and EFLM from Merck, Roche Diagnostics, and Denka Seiken. These companies were not present at the Joint Consensus Panel meetings, had no role in the design or content of the joint consensus statement, and had no right to approve or disapprove of the final document. Funding to pay the Open Access publication charges for this article was provided by the European Atherosclerosis Society and the European Federation of Clinical Chemistry and Laboratory Medicine. Nordestgaard et al. EAS EFLM joint Consensus Panel. Eur Heart J 2016; online April 26