Non-fasting is ok for most patients, but a fasting panel is preferred:
when monitoring response to lipid-lowering therapy. in patients ≥20 years of age with initial triglycerides ≥400 mg/dL when screening for familial lipid disorders How do I assess cardiovascular risk to help decide if a patient needs a statin for primary prevention?
In patients <20 years of age, check lipids to rule out familial hypercholesterolemia if suspected.
Adults 40 to 75 years of age with diabetes and an LDL ≥70 mg/dL can be started on a statin without risk assessment, but it is reasonable to use the pooled cohort equations to estimate 10-year ASCVD risk (see below).
In adults 20 to 39 years of age with diabetes that is longstanding (≥10 years for type 2 or ≥20 years for type 1), with albuminuria (≥30 mcg/mg creatinine), eGFR <60 mL/min/1.73 m2, ABI <0.9, retinopathy, or neuropathy, starting a statin may be reasonable without assessing risk.
In patients 20 to 39 years of age, assess lipid profile, family history of premature ASCVD, A1C, blood pressure, tobacco use, weight, exercise, and diet. The pooled cohort equations can be used to estimate lifetime risk of ASCVD (see below) for patients ≥21 years of age.
In patients 40 to 75 years of age without diabetes, screen for smoking, and elevated blood pressure, LDL, and A1C (if indicated). Calculate 10-year ASCVD risk (see below). Screen for risk-enhancing factors (see footnote a).