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Screening for dyslipidemia. Practice parameter
1Department of Pathology, Rockingham Memorial Hospital, Harrisonburg, Virginia, USA.
Insights
Screening for lipid disorders using total cholesterol and HDL-C is recommended for adults starting at age 20. Further lipoprotein analysis is advised for individuals with specific risk factors or elevated cholesterol levels to assess coronary heart disease risk.
Area of Science:
- Clinical Chemistry
- Cardiovascular Disease Prevention
- Laboratory Medicine
Background:
- Serum lipid disorders are key indicators for coronary heart disease (CHD) risk.
- Specialty societies recommend screening to identify at-risk individuals.
- Optimal screening tests should accurately identify patients benefiting from intervention.
Purpose of the Study:
- To define appropriate initial screening tests for dyslipidemia in healthy outpatients.
- To outline the required accuracy and precision for these laboratory tests.
- To provide recommendations for lipid screening based on current guidelines.
Main Methods:
- Review of current recommendations from specialty societies and the National Cholesterol Education Program (NCEP).
- Analysis of appropriate lipid panels for initial screening and follow-up.
- Specification of analytical performance requirements for total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) assays.
Main Results:
- Total serum cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) are recommended initial screening tests.
- NCEP guidelines suggest TC and HDL-C screening for adults every 5 years from age 20.
- Lipoprotein analysis is recommended for specific adult and pediatric populations based on TC levels, HDL-C levels, and risk factors.
Conclusions:
- TC and HDL-C are the primary screening tests for dyslipidemia.
- NCEP guidelines provide age-specific recommendations for lipid screening and follow-up analysis.
- Standardized, accurate, and precise laboratory methods are crucial for reliable lipid disorder screening.
Abstract:
Screening for serum lipid disorders is recommended by numerous specialty societies to identify patients at risk for coronary heart disease (CHD). The best screening tests will identify patients at highest risk for CHD who would benefit from intervention. This report discusses an appropriate test panel to use as the initial screen on a healthy outpatient population, and the required accuracy and precision of the tests from the Laboratory Medicine perspective. Controversy exists regarding which methods to use and at what age testing should begin. The following parameters will be modified as studies continue and new tests are developed. The recommendations are as follows: (1) Total serum cholesterol (TC) and high density lipoprotein-cholesterol (HDL-C) are presently the recommended screening tests for dyslipidemia in the general population; (2) The National Cholesterol Education Program (NCEP) recommends measuring TC and HDL-C in adults with a single sample at 5-year intervals beginning at age 20; (3) The NCEP recommends measuring TC in children with at least one parent having TC > or = 6.24 mmol/L (> or = 240 mg/dL); (4) The NCEP recommends a lipoprotein analysis consisting of a 12-hour fasting TC, HDL-C, triglyceride, and estimated low density lipoprotein-cholesterol (LDL-C) in adults with the following results: (a) TC > or = 6.24 mmol/L (> or = 240 mg/dL); (b) borderline TC of 5.20-6.23 mmol/L (200-239 mg/dL) and HDL-C < 0.91 mmol/L (< 35 mg/dL) or two or more risk factors; (c) desirable TC of < 5.20 mmol/L (< 200 mg/dL), but HDL-C < 0.91 mmol/L (< 35 mg/dL); (5) The NCEP recommends a lipoprotein analysis in children with documented CHD in a parent or grandparent, or in children that have a TC of > or = 5.20 mmol/L (> or = 200 mg/dL); (6) Two or three separate lipoprotein analyses should be done to confirm the LDL-C result before therapeutic intervention. Specimens should be tested from 1 to 8 weeks apart and the results averaged to account for physiologic variability; (7) Enzymatic methods are preferred for TC determination, and should be standardized and traceable to the reference method and materials at the Centers for Disease Control and Prevention (CDC); (8) The analytic method for TC should have a bias against the reference method of < 3% and a within laboratory reproducibility of < 3% coefficient of variation; (9) Chemical precipitation methods are preferred for HDL-C determination.(ABSTRACT TRUNCATED AT 250 WORDS)