Reference ranges and ideal patient values for blood cholesterol. Can there be reconciliation?

Reference ranges for blood cholesterol levels reflect the nationwide epidemic of "silent" hypercholesterolemia. As such, reference ranges for cholesterol levels without accompanying designation of levels associated with increased coronary risk are misleading and falsely comforting to physicians and patients. In a recent continent-wide study of 108 academically based clinical laboratories, highly variable reference ranges were observed, the ranges having been derived from a vast assortment of sources. Fewer than one half of the laboratories made any attempt to specify levels of risk associated with elevated cholesterol levels. An algorithm for the expression of coronary risk based on blood lipid levels and other quantifiable risk factors is presented as an alternative to available modes of laboratory lipid reporting.