Accuracy of Cholesterol Measurements

Jay L. Bock, MD, PHD
Arch Intern Med. 1991;151(8):1677. doi:10.1001/archinte.1991.00400080155042.
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To the Editor.—  Proper use of clinical laboratory tests is often impeded by overestimation of their intrinsic accuracy and precision. Dujovne and Harris1 in their editorial in the August issue of the ARCHIVES emphasized that test variability must be carefully considered in the diagnosis and treatment of hyperlipidemia. Unfortunately, the editorial itself contained a serious overestimate of routine analytic accuracy. The authors advised physicians to test their laboratory's cholesterol measurements by periodically splitting a patient sample and sending one aliquot to a Centers for Disease Control standardized laboratory. They stated that "if the samples vary by more than 5%, the physician should change laboratories..."The expectation of agreement within 5% is unfounded. The Laboratory Standardization Panel of the National Cholesterol Education Program have discussed at length the degree of bias and analytic imprecision tolerable in routine cholesterol measurements.2 They specifically recommended that deviation of a particular measurement up


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