Understanding Lipid Measurement Error to Improve Cardiovascular Risk

The National Cholesterol Education Program (NCEP) introduced lipid guidelines in 1988 to provide guidance to clinicians caring for patients with elevated blood cholesterol.(1) Each iteration of the guidelines reflects progress made in understanding not only the benefits of a healthy lifestyle and improved nutrition but also the importance of analyzing the lipid profile and other risk factors to guide appropriate risk reduction.(2) However, the current analytical performance standards set by the expert panels of the NCEP for parameters of the lipid profile have not been changed since their publication in 1990 and 1995.(3-5) The adequacy of these specifications is addressed in important observations made by Cole et al. from the Lipoprotein Metabolism Laboratory at the National Heart Lung and Blood Institute (NHLBI) of the NIH in the accompanying article to this editorial.(6)These authors extracted lipid panel data for 8506 individuals from the National Health and Nutrition Survey (NHANES) database.They focused on those 40 to 75 years of age and excluded those with diabetes, triglycerides greater than 400 mg/dL (4.52 mmol/L), or those on lipid lowering therapy.They then used the lipid data to classify subjects into 4 risk groups derived from the 2018 American Heart Association (AHA)-American College of Cardiology (ACC)-MultiSociety guidelines and based on estimated 10-year atherosclerotic heart disease (ASCVD) risk using the Pooled Cohort Equations.( 7)The authors specifically looked at analytical bias, imprecision at the allowable limits, and biological variability to determine the impact of laboratory measurements on clinical misclassification.They then systematically evaluated the impact of altered bias