The Association for Diagnostics and Laboratory Medicine (ADLM, formerly AACC) has published guidance for standardizing lipid testing, reporting, and interpretation.
Published September 3 in The Journal of Applied Laboratory Medicine, the recommendations are important for clinicians and clinical laboratory professionals in the management of atherosclerotic cardiovascular disease (ASCVD) risk through lipid assessment. Currently, preanalytical requirements, reference intervals, testing methods, nomenclature, and ordering and reporting workflows vary from lab to lab, according to the authors.
"Low-density lipoprotein cholesterol (LDL-C), for example, can be assessed by a wide variety of analytical methods and calculations, each of which has unique limitations or biases," stated lead author Jing Cao, PhD, from the Department of Pathology at the University of Texas Southwestern Medical Center and colleagues from the Mayo Clinic in Rochester, MN, Yale School of Medicine, Washington University School of Medicine in St. Louis, and the National Heart, Lung, and Blood Institute (NHLBI).
"Unfortunately, ambiguous nomenclature in laboratory information systems (LISs) and electronic health records (EHRs) thwart interoperability of LDL-C and other lipid measurements," the authors continued. "Some laboratories provide reference intervals as age- and sex-specific normal values, whereas other laboratories report clinical decision thresholds from various clinical guidelines.
"Finally, there is even less consensus on how to measure and report modern lipoprotein biomarkers like lipoprotein(a) [Lp(a)], apolipoprotein B (apo B), and lipoprotein particle number," Cao and colleagues said. "It is our goal that adoption of these recommendations will not only facilitate communication and education among laboratorians but also improve clarity for clinicians and patients."
The document addresses several questions, including:
- What components should be included in the lipid panel?
- What are the expectations for method results agreement and allowable error for lipids?
- How should lipid panel test results be reported by clinical laboratories?
- When should LDL cholesterol be measured and what are the limitations?
- Which reference methods are preferred for studies?
- What is the best way to calculate LDL-C?
- What is LP(a) and how is it measured?
- Does Lp(a) influence the results of the basic lipid panel?
- What is apo B and how should it be reported?
Read the full guidance and individual recommendations for clinicians and laboratorians here.
