Hypercholesterolaemia : from inauspicious to appropriate to detrimental

Abstract

Hypercholesterolaemia is a chronic disease that affects up to 53% of the global population.1 Lifestyle modification and early diagnosis plays an important role in the management of this condition. Various cholesterol screening tests are available, and it is generally accepted that a fasting finger-prick cholesterol test administered by the local pharmacist or primary healthcare provider should not exceed a value of 4.9 mmol/l. However, these screening tests measure the amount of total cholesterol (TC), and rarely differentiate between the individual lipoprotein components. Target values for the different cholesterol components have been well established.2 Although current practice guidelines stipulate that the patient should be in a fasting state for at least six hours before any formal laboratory assessment necessitating a lipogram is performed, a recent cross-sectional study involving 9 319 patients from Denmark showed a very small change in fasting versus non-fasting levels.3 The difference after three hours of fasting was a decrease in TC of −0.2 mmol/l, low-density lipoprotein (LDL) cholesterol of − 0.1mmol/l and −0.1 mmol/l for high-density (HDL) lipoprotein. There was a decreased level of 0.3 mmol/l in the triglycerides after six hours, thereby justifying the six-hour fasting rule.