NEW YORK – The Association for Diagnostics and Laboratory Medicine released on Tuesday a new guidance on measuring and reporting lipid and lipoprotein levels.
According to the authors, the guidance is intended as a tool for clinical laboratories to improve the standardization of clinical lipid testing as well as improving clarity around such testing for clinicians and patients.
The guidance notes that while blood lipid and lipoprotein testing are essential tools for managing atherosclerotic cardiovascular disease (ASCVD) risk, "there remains significant heterogeneity in pre-analytical requirements, reference intervals, methods, nomenclature and ordering/reporting workflows."
Lipoprotein measurements are made using a variety of approaches, each of which may have their own particular biases or limitations. Additionally, a lack of standardized nomenclature across laboratory information systems and electronic health records presents challenges to using test records across systems, according to the authors, who also note that for newer lipoprotein markers like lipoprotein(a), apolipoprotein B, and lipoprotein particle number, "there is even less consensus" on measurement and reporting practices.
The authors provide a series of recommendations for clinical labs and clinicians to follow when ordering, performing, and using lipid and lipoprotein testing, including recommendations around what standard lipid panels should report; how the components of a panel should be named; and how the specific calculation and measurement methods used should be reported.
The guidance also recommends "greater use" of apolipoprotein B testing, noting that when it is discordant with LDL-C or non-HDL-C measurements, "it has been shown to be a better predictor of ASCVD events" and that current evidence supports its use "particularly as a risk-enhancing factor when monitoring lipid-lowering therapy."
Additionally, the guidance highlights limitations of point-of-care lipid testing including higher imprecision compared to standard lab-based testing and the possibility of interferences from skin lotions when using fingerstick blood samples.