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January 19, 1990

Therapy for Hypercholesterolemia; Standardization of Cholesterol Measurements

Author Affiliations

University of Wisconsin Madison

University of Wisconsin Madison

JAMA. 1990;263(3):375-376. doi:10.1001/jama.1990.03440030058021

To the Editor.—  Drs Blum and Levy1 present a detailed and timely review of current approaches to evaluation and treatment of hypercholesterolemia. A short but important section addresses laboratory issues, where they correctly emphasize the need for accurate and precise lipid measurements. Three aspects of their discussion are misleading, however. The authors state that half of all cholesterol measurements made in the United States are suboptimal; they argue that the primary problem is bias (inaccuracy); and they imply that inaccuracy can be overcome simply by use of available reference materials and that laboratories can demonstrate their accuracy by the successful determination of cholesterol levels in these materials.Their conclusion that half of all cholesterol measurements are suboptimal is based on proficiency testing data, where reference materials are sent to participating laboratories, who return their data for calculation. Several proficiency testing series indeed have shown biases on similar materials for