The joint consensus panel of the European
Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic
lipoproteins. Total
cholesterol (TC),
triglycerides (TG),
high-density lipoprotein cholesterol (HDLC),
LDL cholesterol (LDLC), and calculated non-HDLC (=total - HDLC) constitute the primary
lipid panel for estimating risk of atherosclerotic
cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDLC is the primary target of
lipid-lowering
therapies. For on-treatment follow-up, LDLC shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations.
Lipoprotein(a) [Lp(a)]-
cholesterol is part of measured or calculated LDLC and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDLC declines poorly upon
statin treatment. Residual risk of ASCVD even under optimal
LDL-lowering treatment should be also assessed by non-HDLC or
apolipoprotein B (
apoB), especially in patients with mild-to-moderate
hypertriglyceridemia (2-10 mmol/L). Non-HDLC includes the assessment of remnant
lipoprotein cholesterol and shall be reported in all standard
lipid panels. Additional
apoB measurement can detect elevated
LDL particle (LDLP) numbers often unidentified on the basis of LDLC alone. Reference intervals of
lipids,
lipoproteins, and
apolipoproteins are reported for European men and women aged 20-100 years. However, laboratories shall flag abnormal
lipid values with reference to therapeutic decision thresholds.