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Efforts to Align Results With the Centers for Disease Control, and Feasibility of Meeting National Cholesterol Education Program Guidelines

Bruce M. McManus, MD, PhD; Attila B. Toth; Joshua A. Engel; Gary L. Myers, PhD; Herbert K. Naito, PhD; Janet E. Wilson; Gerald R. Cooper, MD, PhD

JAMA. 1989;262(1):83-88.

Abstract
The National Cholesterol Education Program has recommended that all laboratories be consistent, precise, and accurate in the reporting and measurement of blood cholesterol levels. In a follow-up to a 1984 survey study, we assessed the changes in reporting procedures for measurements of blood lipid levels in 16 clinical laboratories in Nebraska. Using human serum reference materials of known cholesterol concentrations provided by the Centers for Disease Control, we also assessed the precision and accuracy of measurement of blood cholesterol levels in clinical laboratories in Nebraska. Fourteen of the 16 laboratories restudied in 1987 had altered the reference range for total serum cholesterol since 1984,86% of whom lowered the upper limit of the reference range. Eleven of 16 laboratories expressed reference ranges for total serum cholesterol in terms of patient age in 1987, while only 7 of 20 did in 1984. Gender-based reference ranges increased from 0 to 5 from 1984 to 1987. Similar trends were seen in the reporting of high-density lipoprotein cholesterol and triglyceride concentrations. Reporting procedures varied greatly; only 1 laboratory used National Cholesterol Education Program risk levels for measuring total serum cholesterol levels. Fifteen laboratories met the National Cholesterol Education Program recommendation for precision (coefficient of variation, 5%) and 78% of laboratories obtained results that satisfied the current recommendation for accuracy (within 5% of "true value," as determined by the Centers for Disease Control).

(JAMA. 1989;262:83-88)

Author Affiliations
From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha (Dr McManus, Messrs Toth and Engel, and Ms Wilson); Clinical Chemistry Standardization Activity, Centers for Disease Control, Atlanta, Ga (Drs Myers and Cooper); and Section on Lipids, Nutrition, and Metabolic Diseases, Department of Biochemistry, The Cleveland Clinic Foundation, Cleveland, Ohio (Dr Naito).

Footnotes
Reprint requests to Cardiovascular Registry, University of Nebraska Medical Center, 42nd and Dewey avenues, Omaha, NE 68105 (Dr McManus).

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