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. European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently published recommendations on the quantification of atherogenic lipoproteins in nonfasting and fasting blood samples [1, 2]. This article summarizes the consensus-based recommendations of this expert panel which aimed to provide appropriate guidance on the pre-analytical, analytical, and post-analytical phases of laboratory testing of atherogenic lipoproteins. The key recommendations are given in Table 1. Based on the Copenhagen General Population Study [3], reference nonfasting concentrations for lipids and (apo)lipo- proteins are reported for 54.129 European women and 42.126 European men aged 20—100 years and not on lipid-lowering therapy in Tables 2 and 3.
