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Klinisk Biokemi i Norden · 2 2017
mmol/L(100mg/dL)(high risk) or <3.0 mmol/L(115mg/
dL)(moderate risk)
17,38
. These different values are
classified according to the presence or absence of co-
morbidities (atherosclerotic cardiovascular disease,
diabetes, chronic kidney disease) and other risk factors
(age, gender, hypertension, smoking). This personali-
zed reporting of desirable values is difficult to imple-
ment in laboratory reports because usually the clinical
conditions and risk factors of the individual patient are
not known to the laboratory professional. We there-
fore propose a simplified system of flagging abnormal
values based on desirable concentration cut-points for
moderate risk only, which may be complemented by
more detailed information on risk stratified cut-offs in
footnotes on the laboratory report or by references to
web-based information of the same laboratory. Using
such flagging emphasize the importance of harmoni-
zation and standardization in laboratory medicine, and
a responsibility of EAS and EFLM to communicate to
laboratories when updates of cut-points are necessary
as guidelines for cardiovascular disease prevention
are revised.
According to the flagging of abnormal values based
on desirable concentration cut-points proposed in
Table 3, the following percentages of adults in the gene-
ral population of a typical Western or Northern Euro-
pean country will have flagged test results in nonfas-
ting lipid profiles: 27%will have triglycerides ≥2mmol/
L(175mg/dL), 72% total cholesterol ≥5mmol/L(190mg/
dL), 60% LDL cholesterol ≥3mmol/L(115mg/dL), 27%
calculated remnant cholesterol ≥0.9mmol/L(35mg/
dL), 50% calculated nonHDL cholesterol ≥3.9mmol/
L(150mg/dL), 20% lipoprotein(a) ≥50mg/dL(80
th
per-
centile), 59% apolipoproteinB ≥1.0g/L(100mg/dL), 10%
HDL cholesterol ≤1mmol/L(40mg/dL), and 9% will
have apolipoproteinA1 ≤1.25g/L(125mg/dL).
Implementation of recommendations
Each country should adopt strategies for implementing
routine use of nonfasting rather than fasting lipid pro-
files as well as flagging of abnormal values based on
desirable concentration cut-points rather than using
traditional reference intervals. Ideally, there should
be one standard for reporting lipid profiles in each
country as also accreditation bodies should be aware
of the present consensus statement. The strategy might
differ from country to country based on existing local
practice.
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