Evaluation of four different equations for calculating LDL-C with eight different direct HDL-C assays

Oliveira, Marcelol Jose Andrade; Deventer, Hendrick E. van; Bachmann, Lorin M.; Warnick, G. Russell; Nakajima, Katsuyuki; Nakamura, M; Sakurabayashi, Ikunosuke; Kimberly, Mary M.; Shamburek, Robert D.; Korzun, William J.; Myers, Gary L.; Miller, W. Greg; Remaley, Alan T.

doi:10.1016/j.cca.2013.04.009

Cited by 49 publications

(33 citation statements)

References 21 publications

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“…However, a subsequent analysis of 597 healthy subjects showed better agreement of the Friedewald formula with a directly measured LDL-C [24]. Another recent study compared four formulae in 164 subjects including those with dyslipidemias and co-morbidities and found that the Friedewald equation had the best overall performance for calculating LDL-C [33].…”

Section: Resultsmentioning

confidence: 96%

“…Therefore, the accuracy of calculated LDL-C can be affected by errors from any of these measurements. The aforementioned study also compared calculated LDL-C formulae with 8 directly measured HDL-C assays using homogenous methods and demonstrated that the optimum equation for calculating LDL-C depends on which direct HDL-C assay is used [33]. It was shown that the Daiichi 2-phase method used in our study to measure HDL-C had the third lowest percentage misclassifications using the Friedewald formula, and the second lowest with the Chen formula in a recent study comparing eight HDL-C assays.…”

Section: Resultsmentioning

confidence: 99%

“…The Friedewald formula was previously shown to incorrectly estimate LDL-C at the lowest TG levels [8,10] de Cordova (Wako) [33].…”

Section: Resultsmentioning

confidence: 99%

“…Formulae have reported poorer performance in low-and high TG values, and it has been suggested to use direct measurements of LDL-C instead of calculations in hypertriglyceridaemic samples [4,33]. Measurements of LDL-C are further complicated by LDL-C being a multiple molecular particle aggregate of protein, cholesterol and other lipids [34].…”

Section: Resultsmentioning

confidence: 99%

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Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients

Martins

Olorunju

Murray

et al. 2015

Clinica Chimica Acta

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Highlights• We evaluated the Friedewald Equation and three other recently developed formulae.• The de Cordova, Chen & Hattori formulae were used in patients with co-morbidities.• More than 14 000 lipid profiles were compared with direct measurement of LDL-C.• The Hattori formula showed the best performance over all lipid values.• Alternative formulae should be implemented in hospitalized patients. Conclusions: We observe favorable correlations of the de Cordova formula withFriedewald at low TG values. However, the Hattori formula appears to be best for application in hospitalized patients, even at extreme lipid values.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

“…The Friedewald formula was previously shown to incorrectly estimate LDL-C at the lowest TG levels [8,10] de Cordova (Wako) [33].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients

Martins

Olorunju

Murray

et al. 2015

Clinica Chimica Acta

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“…The Friedewald equation uses total cholesterol (TC), HDL cholesterol (HDL-C), and triglycerides (TG) to calculate LDL-C [LDL-C ϭ TC Ϫ HDL-C Ϫ (TG/5)]. Data advocating other LDL-C quantitative methods have suggested that this calculation [termed in this manuscript as Friedewald calculated LDL-C (LDL-C F )] misclassifies cardiovascular risk in many patients, particularly those with hypertriglyceridemia (3)(4)(5)(6). Misclassification has been attributed to the TG/5 ratio used in the Friedewald equation, which represents an estimation of VLDL-C based on the average ratio of TG:cholesterol present in VLDL lipoproteins.…”

mentioning

confidence: 99%

Validation of a Proposed Novel Equation for Estimating LDL Cholesterol

et al. 2014

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BACKGROUND Aggressive LDL cholesterol (LDL-C)-lowering strategies are recommended for primary and secondary prevention of cardiovascular events. A newly derived equation for LDL-C estimation was recently published that addressed limitations in the commonly used Friedewald LDL-C calculation method. The novel method was reported to classify patients with superior concordance to measured LDL-C compared to the Friedewald method, particularly in patients with LDL-C <70 mg/dL. METHODS We evaluated the performance of the novel method within an independent cohort of 23 055 patients with LDL-C measured by the gold standard β-quantification reference method. RESULTS Overall Friedewald underestimated and the novel method overestimated measured LDL-C. Both estimations significantly deviated from the reference method when LDL-C was <70 mg/dL. Overall, the Friedewald and novel calculations correctly classified 77% and 78% of patients, respectively. The largest discrepancy in classification was observed in individuals with measured LDL-C <70 mg/dL. For this group the novel calculation would reclassify 8.7% of patients as >70 mg/dL compared to the Friedewald equation. CONCLUSIONS We compared both novel and Friedewald estimated LDL-C against the LDL-C reference method; in contrast, the prior study relied on validation of a subset of samples by β-quantification to allow the use of the vertical autoprofile method for LDL-C measurement. We conclude that the novel method has some benefits but it is unclear whether improvements over the Friedewald calculation are substantive enough to justify making the change in routine clinical practice and to improve patient outcomes.

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A New Equation for Calculation of Low-Density Lipoprotein Cholesterol in Patients With Normolipidemia and/or Hypertriglyceridemia

et al. 2020

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IMPORTANCE Low-density lipoprotein cholesterol (LDL-C), a key cardiovascular disease marker, is often estimated by the Friedewald or Martin equation, but calculating LDL-C is less accurate in patients with a low LDL-C level or hypertriglyceridemia (triglyceride [TG] levels Ն400 mg/dL). OBJECTIVE To design a more accurate LDL-C equation for patients with a low LDL-C level and/or hypertriglyceridemia. DESIGN, SETTING, AND PARTICIPANTS Data on LDL-C levels and other lipid measures from 8656 patients seen at the National Institutes of Health Clinical Center between January 1, 1976, and June 2, 1999, were analyzed by the β-quantification reference method (18 715 LDL-C test results) and were randomly divided into equally sized training and validation data sets. Using TG and non-high-density lipoprotein cholesterol as independent variables, multiple least squares regression was used to develop an equation for very low-density lipoprotein cholesterol, which was then used in a second equation for LDL-C. Equations were tested against the internal validation data set and multiple external data sets of either β-quantification LDL-C results (n = 28 891) or direct LDL-C test results (n = 252 888). Statistical analysis was performed from August 7, 2018, to July 18, 2019. MAIN OUTCOMES AND MEASURES Concordance between calculated and measured LDL-C levels by β-quantification, as assessed by various measures of test accuracy (correlation coefficient [R 2 ], root mean square error [RMSE], mean absolute difference [MAD]), and percentage of patients misclassified at LDL-C treatment thresholds of 70, 100, and 190 mg/dL. RESULTSCompared with β-quantification, the new equation was more accurate than other LDL-C equations (slope, 0.964; RMSE = 15.2 mg/dL; R 2 = 0.9648; vs Friedewald equation: slope, 1.056; RMSE = 32 mg/dL; R 2 = 0.8808; vs Martin equation: slope, 0.945; RMSE = 25.7 mg/dL; R 2 = 0.9022), particularly for patients with hypertriglyceridemia (MAD = 24.9 mg/dL; vs Friedewald equation: MAD = 56.4 mg/dL; vs Martin equation: MAD = 44.8 mg/dL). The new equation calculates the LDL-C level in patients with TG levels up to 800 mg/dL as accurately as the Friedewald equation does for TG levels less than 400 mg/dL and was associated with 35% fewer misclassifications when patients with hypertriglyceridemia (TG levels, 400-800 mg/dL) were categorized into different LDL-C treatment groups. CONCLUSIONS AND RELEVANCEThe new equation can be readily implemented by clinical laboratories with no additional costs compared with the standard lipid panel. It will allow for more accurate calculation of LDL-C level in patients with low LDL-C levels and/or hypertriglyceridemia (TG levels, Յ800 mg/dL) and thus should improve the use of LDL-C level in cardiovascular disease risk management.

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Evaluation of four different equations for calculating LDL-C with eight different direct HDL-C assays

Cited by 49 publications

References 21 publications

Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients

Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients

Validation of a Proposed Novel Equation for Estimating LDL Cholesterol

A New Equation for Calculation of Low-Density Lipoprotein Cholesterol in Patients With Normolipidemia and/or Hypertriglyceridemia

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