Canadian Society of Clinical Chemists Harmonized Pediatric Lipid Reporting Recommendations for Clinical Laboratories

Detecting dyslipidemia early is important because atherosclerosis originates in childhood and early treatment can improve outcomes. In 2022, CCS/CPCA published a Clinical Practice Update to detect, evaluate, and manage pediatric dyslipidemia. However, guidance on its translation into clinical laboratories is lacking. The Canadian Society of Clinical Chemists (CSCC) Working Group on Reference Interval Harmonization (hRI-WG) Lipid Team aims to aid guideline implementation and promote harmonized pediatric lipid reporting across Canada. The 2022 CCS/CPCA Clinical Practice Update, 2011 NHLBI Integrated Guidelines, and new data analysis (Canadian pediatric reference values from the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) and retrospective patient data from large community laboratories) were incorporated to develop five key recommendations. These include recommendations to 1) offer both non-fasting and fasting lipid testing; 2) offer a lipid panel including total cholesterol, LDL-C, HDL-C, non-HDL-C and triglycerides, with ApoB and Lp(a) available as individually orderable tests; 3) flag total cholesterol, LDL-C, and non-HDL-C results ≥95th percentile, and HDL-C results <10th percentile, as recommended by CCS/CPCA/NHLBI and validated by CALIPER, and flag ApoB and non-fasting triglyceride results ≥95th percentile based on CALIPER, and do not flag Lp(a) results but mention the adult cut-off in the interpretive comments; 4) implement interpretive comments listed in the current report; and 5) implement the NIH LDL-C equation. The CSCC hRI-WG Lipid Team will support clinical laboratories to implement these recommendations using knowledge translation strategies. Harmonizing pediatric lipid reporting across Canadian clinical laboratories will optimize clinical decision-making and improve cardiovascular risk management in youth.