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Falsely Low LDL Cholesterol Results

values for circulating 25(OH)D (see Table 1) were provided. The survey asked which patients should receive treatment with vitamin D. We e-mailed the survey to providers who were selected because they had ordered 1 or more 25(OH)D determinations in the preceding year. Only practicing healthcare providers received this survey; physicians-intraining were excluded. In one scenario, the total 25(OH)D result was 16 ng/mL; all responding healthcare providers (45 physicians, 12 physicians assistants and nurse practitioners) correctly identified this as vitamin D deficiency in need of vitamin D treatment (Table 1). However, for the scenario reporting 25(OH)D3 5 ng/mL and 25(OH)D2 40 ng/mL, 13 (23%) interpreted these results to indicate either vitamin D deficiency or vitamin D3 deficiency requiring vitamin D treatment (Table 1). The important objective in assessing vitamin D status is to obtain a measure of the total circulating 25(OH)D, whether from a validated RIA, HPLC, or LC-MS assay. To achieve this objective, there is no advantage to reporting circulating 25(OH)D2 and 25(OH)D3 separately. Moreover, the results of this survey suggest that reporting 25(OH)D2, 25(OH)D3, and total 25(OH)D can confuse practicing healthcare providers, thereby leading to incorrect clinical decisions. We believe that, until a specific advantage for separate reporting of these metabolites is identified, laboratory reports should be limited to total circulating 25(OH)D or, if individual metabolites are listed, such reports must indicate clearly that the total circulating 25(OH)D is the measurement that should be used in clinical decisionmaking about vitamin D status. The above recommendation does not diminish the important observation of D2 and D3 differing effects on maintenance of circulating 25(OH)D. Moreover, we acknowledge that there may be physiologic differences between D2 and D3. However, such theoretical differences have not been established and current dogma is that circulating 25(OH)D2 and 25(OH)D3 have equal clinical efficacy.