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Clinical Chemistry 44: 1650-1658, 1998;
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Right arrow Lipids, Lipoproteins, and Cardiovascular Risk Factors
(Clinical Chemistry. 1998;44:1650-1658.)
© 1998 American Association for Clinical Chemistry, Inc.

Lipids and Lipoproteins

Assessment of current National Cholesterol Education Program guidelines for total cholesterol, triglyceride, HDL-cholesterol, and LDL-cholesterol measurements

Samuel P. Caudilla, Gerald R. Cooper, S. Jay Smith, and Gary L. Myers

1 Environmental Health Laboratory Sciences Division, National Center for Environmental Health, National Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, F25, Atlanta, GA 30341-3724.
a Author for correspondence. Fax 770-488-4192; e-mail spc1{at}cdc.gov.

We examine the effect of systematic bias and random error, quality control, and intraperson biological variation on the National Cholesterol Education Program (NCEP) clinical classifications for reported lipid measurements. We consider misclassification to occur if a true lipid homeostatic set point is within a desirable range but the reported lipid value is in a high-risk range, or if a true lipid homeostatic set point is in a high-risk range but the reported lipid value is in a desirable range. To evaluate the overall adequacy of the NCEP guidelines to ensure correct patient classification, we construct operating characteristic curves for total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. We demonstrate that if laboratories are meeting the NCEP guidelines for inherent bias and analytic precision and are using standard quality-control (QC) procedures incorporating at least two QC samples per analytical run from each of two QC pools (for a total of 4 QC samples), the current NCEP guidelines are adequate to ensure (probability >0.90) correct patient classifications regardless of the size of the systematic bias of the laboratory or increased random analytic error. Thus we suggest that at least two concentrations of QC material be included in the QC scheme to ensure that the measurement system is operating within desired specifications across the entire range of desirable and high-risk lipid concentrations and to ensure with high probability that patients are correctly classified.




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