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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.

To effectively implement the Canadian Cardiovascular Society (CCS) Guidelines for dyslipidemia management into clinical laboratories, clear recommendations for lipid reporting are essential. In this study, the Canadian Society of Clinical Chemists (CSCC) Working Group on Reference Interval Harmonization (hRI) surveyed Canadian laboratories on adult lipid reporting practices to set a foundation for the development and implementation of harmonized lipid reporting across Canada. Key aspects of the survey asked laboratories: what reporting parameters were in place to assess lipid results; what interpretative comments were provided; whether non-fasting lipids were permitted and, if so, what strategy was used to document fasting status; and whether there was interest in implementing a harmonized lipid report. A total of 101 laboratories were represented by 24 respondents, as many responses were submitted by laboratory networks. There was at least one response from nine Canadian provinces and representation across five testing platforms. Upper and lower limits for lipid parameters and referenced source of limits varied substantially across laboratories, with only 56% of laboratories (9 respondents) referencing the 2016 CCS Guidelines. Eighty-six percent of laboratories (19 respondents) report non-fasting lipids, although the method of documenting non-fasting status varied. Overall, 36% of laboratories (8 respondents) reported interest in implementing a harmonized lipid report. Assessment of current lipid reporting practices supports the need for harmonized lipid reporting across Canada. Development of a harmonized lipid report for the adult population, consistent with up-to-date Canadian guidelines, will improve continuity of lipid test interpretation across Canada and improve clinical decision making.

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