Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease

Abstract

Background and ObjectivesLow-density lipoprotein cholesterol (LDL-C), an established cardiovascular risk factor, can be generally determined by calculation from total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. The aim of this study was to compare LDL-C estimations using various formulas with directly measured LDL-C in a community-based group and hospital-based group among the Korean population.Subjects and MethodsA total of 1498 participants were classified into four groups according to triglyceride concentrations as follows: <100, 100–199, 200–299, and ≥300 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, de Cordova, and Anandaraja formulas and directly measured using a homogenous enzymatic method. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Passing & Bablok regression, and Bland-Altman plots were used to evaluate the performance of six formulas.ResultsThe Friedewald formula had the highest accuracy (ICC=0.977; 95% confidence interval 0.974-0.979) of all the triglyceride ranges, while the Vujovic formula had the highest accuracy (ICC=0.876; 98.75% confidence interval 0.668–0.951) in people with triglycerides ≥300 mg/dL. The mean difference was the lowest for the Friedewald formula (0.5 mg/dL) and the percentage error was the lowest for the Vujovic formula (30.2%). However, underestimation of the LDL-C formulas increased with triglyceride concentrations.ConclusionThe accuracy of the LDL-C formulas varied considerably with differences in triglyceride concentrations. The Friedewald formula outperformed other formulas for estimating LDL-C against a direct measurement and the Vujovic formula was suitable for hypertriglyceridemic samples; it could be used as an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.

Analysis of LDL-C Measurement Using Direct and Friedewald Formula in Type 2 Diabetes Mellitus Patients

“…Evaluation of several formulas for estimating LDL-C is suggested and compare them with a direct method as alternating of Friedewald Formula which seems not ideal to be used in type 2 DM population. [14][15][16][17]…”

Impact of glucose and lipid markers on the correlation of calculated and enzymatic measured low‐density lipoprotein cholesterol in diabetic patients with coronary artery disease

“…FE as the most widely applied method in clinical practice is recommended in several guidelines related to the therapy of dyslipidemia. 11,12,15,16 It assumes the ration of the mass of TG to very low-density lipoprotein cholesterol (VLDL-C) to be relatively constant. 8 However, in the real world, the ratios are variable in different individuals leading to less accuracy of FE, especially in the population with TG > 4.5 mmol/L and non-fasting state.…”

Subclinical atherosclerosis in psoriatic disease: relation to endocan, TNF‐α, age of onset, and body fat

“…The Friedewald formula was used to estimate the low‐density lipoprotein (LDL) levels. This is a widely accepted simple, inexpensive, and accurate alternative to direct measurement outperforming other formulae in the estimation of LDL . Glucose level was measured using the glucose oxidase method.…”