Progress in blood lipid reporting practices by clinical laboratories in North America. Changes from 1985 to 1990

In an attempt to assess the impact of the National Cholesterol Education Program recommendations and to provide follow-up to a 1985 survey of blood lipid reporting practices in 152 academic clinical laboratories in North America, the same laboratories were resurveyed regarding current blood lipid-reporting practices. All 97 laboratories that responded to our survey routinely measured serum total cholesterol, while 94% measured high-density lipoprotein cholesterol, 99% measured triglycerides, 26% apolipoproteins A1 and B, and a single laboratory measured apolipoprotein E. There was a marked downward shift in reference ranges for serum total cholesterol used by laboratories in 1990 compared with 1985. Of the laboratories responding to both surveys, 90% lowered their reported reference values. Changes in the sources of reference ranges were also noted. The percent of laboratories using reference ranges based on age and sex fell from 52% to 21% and from 31% to 10%, respectively. The number of laboratories designating patient risk for coronary heart disease rose from 31% to 72%. Currently, 61% of laboratories designating risk use the National Cholesterol Education Program guidelines for serum total cholesterol. The use of other risk designations, including high-density lipoprotein--cholesterol, total cholesterol to high-density lipoprotein cholesterol ratio, low-density lipoprotein cholesterol, and apolipoproteins changed only modestly during the 5-year interval. The current reporting patterns reflect simplified and more uniform practices apparently in response to the National Cholesterol Education Program.