A patient with a total cholesterol of 230 mg/dL on non-fasting labs asks what to do next. What is the appropriate next step?

• A. Referral to a cardiologist
• B. Reassurance
• C. Obtain a fasting lipid panel including LDL and HDL
• D. Start a statin therapy

Answer: (C)

When a patient’s lipids are first elevated, you need more than a total cholesterol number to guide management. The key is to obtain a full lipid panel that includes LDL and HDL (and triglycerides) because LDL is the main driver of atherosclerotic risk and triglycerides can affect the accuracy of LDL calculations, especially in nonfasting samples. A fasting lipid panel provides a clearer picture of the atherogenic profile and allows you to calculate ASCVD risk to decide whether lifestyle measures alone are enough or if pharmacotherapy, such as a statin, is warranted. Reassurance based only on total cholesterol is not appropriate, and starting treatment isn’t justified without the detailed lipid values and risk assessment.