The impact of different point-of-care testing lipid analysers on cardiovascular disease risk assessment

Abstract

Aims: Lipid point-of-care testing (POCT) analysers are being used to screen target populations to identify individuals at high risk of developing cardiovascular disease (CVD) as part of the National Health Service (NHS) Health Checks programme. We evaluated the performance of the Cholestech LDX and CardioChek PA POCT analysers against laboratory methods in CVD risk assessment.

Methods: Ten-year QRISK2, Joint British Societies' II (JBSII), and Framingham CVD risk scores were calculated for subjects recruited from Wolverhampton City PCT community NHS Health Check clinics. CVD risk scores derived using POCT capillary whole blood total cholesterol and HDL-cholesterol measurements were compared with those derived from the laboratory analysis of paired venous serum samples. Data from subjects with diabetes, overt CVD, and those who did not meet the risk algorithm age criteria were excluded.

Results: All subjects classified as high risk (risk score >20%) by the three risk algorithms on the basis of the laboratory results were correctly identified by the LDX. One (2.2%) and four (7.0%) moderate-risk subjects were misclassified by the LDX as high risk, using the JBSII and Framingham risk algorithms, respectively. The CardioChek identified all subjects classed as high risk by QRISK2, but failed to identify 6/31 (19.4%) and 3/19 (15.8%) of subjects classed as high risk by the Framingham and JBSII algorithms, respectively. The CardioChek, however, did not misclassify any moderate-risk subjects as high risk.

Conclusions: Identification of subjects at risk of CVD depends on the cardiovascular risk algorithm and also on the performance of the POCT device.