Establishing non-fasting lipid reference intervals and clinical decision limits in a senegalese adult cohort

Abstract Non-fasting lipid profiling is now widely recommended; however, reference intervals (RIs) are notably lacking in sub-Saharan Africa, particularly for emerging lipid biomarkers (non-HDL-C, sdLDL-C, TRL-C). This study aimed to establish these values in Senegal and propose pragmatic clinical decision thresholds. As part of the SEN-GENOME project, we conducted a study involving 746 adults, including a reference subgroup of 241 strictly healthy individuals. Non-fasting specimens were collected to analyse conventional and emerging lipid parameters using the Sampson-NIH equation. RIs were calculated in accordance with the CLSI EP28-A3c protocol. The upper reference limit for triglycerides 2.73 mmol/L confirms the clinical tolerance of the non-fasting state. However, the statistical RIs (2.5–97.5th percentiles) for total cholesterol and LDL-C significantly exceeded the NCEP ATP III risk thresholds. Furthermore, the general population’s values exhibited a marked metabolic drift compared to the healthy reference group. Strict reliance on statistical RIs risks normalising atherogenic profiles. We advocate for the adoption of clinical decision thresholds based on the median (optimal threshold) and the 75th percentile (alert threshold) for extended lipid profiling. This approach, including emerging lipid parameters, is essential for improving early cardiovascular risk detection.