A Message from the Laboratory Community to the National Cholesterol Education Program Adult Treatment Panel IV

Abstract

The National Cholesterol Education Program (NCEP)5. Adult Treatment Panel IV (ATP IV) is poised to release its guidelines on the detection, evaluation, and treatment of high blood cholesterol in adults for comments by the scientific and medical communities. We briefly summarize the current status of lipid and lipoprotein testing in the US. Since its inception in 1985, the NCEP has recognized the value of accurate and precise lipid and lipoprotein testing for the effective implementation of its mission to lower morbidity and mortality from coronary heart disease in the US by reducing the percentage of Americans with high blood cholesterol. The NCEP Laboratory Standardization Panel and the Working Group on Lipoprotein Measurement were established to assess the status of lipid and lipoprotein testing, develop means to improve these measurements, and create analytical performance goals to meet clinical needs. This program provided a comprehensive approach to the measurement of total cholesterol, triglycerides, HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C). The recommendations developed by this panel and working group were based on data and information generated by the CDC Lipid Standardization Program. The latter program also helped in implementing the NCEP recommendations by providing for standardization of lipid measurements performed for patient care and ensuring accurate measurements in research studies (1, 2). The resulting improvements in the accuracy and precision of these laboratory measurements allowed the effective implementation of NCEP guidelines and enabled the monitoring of its success (3, 4). In the 1980s and 1990s, clinical laboratories measured HDL-C by precipitating apolipoprotein B containing lipoproteins and assaying the cholesterol component of HDL in the supernatant. LDL-C concentrations were estimated with the Friedewald calculation (5). Laboratory methods have evolved over the past 2 decades, and according to a recent College of American Pathologists (CAP) survey, nearly all clinical …