Blood cholesterol screening: influence of fasting state, biological variation and the single cholesterol assay on total cholesterol level

Postprandial changes in plasma total cholesterol (TC) are minimal and there is essentially no difference between fasting vs random TC concentrations, as reflected in the small diurnal coefficient of variation (CV) for TC of 2.5%. Similarly, a cholesterol-rich meal within the last 24 hours lacked an impact on plasma TC. Thus, random specimens are acceptable in blood cholesterol screening. The intraindividual biological CV (CVb) for plasma TC as measured over a long period was estimated from the data of several published studies to be 6.0%, which, when combined with a probable analytical CV (CVa) of 5% during screening, gave a total intraindividual CV (CVt) of about 8% for the single cholesterol assay. There is consensus that 'high TC values' acquired during screening should be confirmed under the conventional laboratory setting capable of CVa of 3% or less.