Canadian Society of Clinical Chemists Harmonized Clinical Laboratory Lipid Reporting Recommendations on the Basis of the 2021 Canadian Cardiovascular Society Lipid Guidelines

Abstract

There is limited guidance on laboratory reporting and interpretation of lipids and lipoproteins used in cardiovascular risk stratification. This contributes to inconsistencies in lipid reporting across clinical laboratories. Recently, the Canadian Cardiovascular Society (CCS) published the 2021 CCS Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. A subcommittee of the Working Group on Reference Interval Harmonization (hRI-WG) of the Canadian Society of Clinical Chemists (CSCC) has developed harmonized lipid reporting recommendations that are aligned with the 2021 CCS guidelines, in order to improve the standardization of lipid assessment and clinical decision making. The proposed harmonized lipid reporting recommendations were critically reviewed by a broad range of laboratory and clinical experts across Canada. Feedback from approximately 30 expert reviewers was reviewed by the hRI-WG lipid subcommittee, and consensus decisions were incorporated into the 2021 Harmonized Lipid Reporting Recommendations. In this position statement, we provide six recommendations for laboratory reporting of lipid parameters. These recommendations include implementing the new NIH equation to replace the Friedewald equation for calculating low-density lipoprotein cholesterol (LDL-C), offering Lp(a), either as an in-house or send-out test, and using assays that report Lp(a) in molar units (nmol/L). We also developed a harmonized lipid reporting format with interpretive comments that includes flagging results based on screening treatment decision thresholds in a primary prevention setting. Overall, harmonized lipid reporting will help bridge the gap between clinical guideline recommendations and clinical laboratory reporting and interpretation, and it will improve cardiovascular risk assessment across Canada.