Risk factors

The return of reference ranges not popular

Cardiologists are ‘vehemently’ opposed to a change in lipid profile reporting that would see the return of general population reference intervals added to patient reports.

The revised report will include non-HDL cholesterol, total cholesterol-to-HDL ratio, a reference to a risk calculator and a table with the current target lipid ranges for patients at high or moderate risk of cardiovascular disease.

Professor David Sullivan, from the Royal College of Pathologists Australia, told a CSANZ 2017 workshop that patients would also start to receive reference intervals, which would indicate when they were even modestly above the population level.

The advice to change lipid profile reporting comes from an international panel convened by the European Atherosclerosis Society, which includes Australian and US experts.

But cardiologists said the recommendation to reintroduce reference intervals was irresponsible.

“In a country where 50% of deaths are cardiovascular giving people some reassurance that they are in the middle of the reference range is really just nonsense,” said one delegate.

“I think it’s a disservice to the community,” added another audience member.

“Providing reference intervals is quite difficult if you don’t have a concept of the absolute risk. I think that could give some people false anxiety and others false reassurance,” noted yet another concerned delegate.

But Professor Sullivan defended the move saying there would be a very clear consideration of prevalence and that would flag a warning.

“The European cut point is a total cholesterol of five a non-HDL-C of four and a LDL-C of three … in terms of population prevalence they come down to 70%, 60%, and 50% so your preferred indicator is still identifying 50% of the population. It’s not a reassurance; it’s an orientation towards being more active,” he argued.

“I think it does serve to realign people towards a consideration of their CV risk. I think there is a case for it,” he concluded.

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