Comparison of Low-Density Lipoprotein Cholesterol Assessment by Martin/Hopkins Estimation, Friedewald Estimation, and Preparative Ultracentrifugation

Martin, Seth S.; Giugliano, Robert P.; Murphy, Sabina A.; Wasserman, Scott M.; Stein, Evan A.; Češka, Richard; López‐Miranda, José; Georgiev, B.; Lorenzatti, Alberto; Tikkanen, Matti J.; Sever, Peter; Keech, Anthony; Pedersen, Terje R.; Sabatine, Marc S.

doi:10.1001/jamacardio.2018.1533

Cited by 116 publications

(100 citation statements)

References 17 publications

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“…As Friedewald equation is prone to underestimate LDL-C particularly in patients with very-low LDL-C, the FOURIER trial evaluating evolocumab in patients with known cardiovascular disease used preparative ultracentrifugation method for LDL-C estimation when Friedewald LDL-C was observed to be at 40 mg/dL 36) . Recently, Martin and colleagues have investigated the accuracy of LDL-C measurements in the FOURIER trial, specifically in PCSK9 inhibitor-treated patients achieving very-low LDL-C levels 40 mg/dL; their results showed that Martin method more closely resembled ultracentrifugation than the Friedewald approach, suggesting it should be the preferred method to estimate LDL-C levels in such intensively treated patients 38) . Our findings are in line with these results showing significant upward discordance using the two novel LDL-C equations compared to Friedewald estimates in similar patients at high cardiovascular risk and very-low LDL-C under 40 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Novel Equations for Estimating Low-Density Lipoprotein Cholesterol in Patients Undergoing Coronary Angiography

Zafrir

Saliba

Flugelman

2020

JAT

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The importance of precisely quantifying low-density lipoprotein cholesterol (LDL-C) has become more pronounced over the years, with the rise of metabolic syndrome in the population and the reduction in LDL-C treatment goals. This study aims to compare two novel equations indirectly estimating LDL-C and assess their compatibility with Friedewald formula, in a population with high cardiovascular risk. Methods: This study is a retrospective analysis of the lipid profiles of 10,006 patients who underwent coronary angiography. LDL-C was calculated using Friedewald, Martin, and Sampson equations, and the compatibility between estimations was compared using methods of concordance and reclassification. Results: Our findings show that Martin and Sampson equations displayed high rates of upward LDL-C reclassification (10.8% and 7.5%, respectively) when compared with Friedewald equation. In comparison to the Sampson method, Martin also reclassified 3.8 % of patients to a higher LDL-C category. The magnitude of discordance between LDL-C estimates was more pronounced in hypertriglyceridemic patients, and this increased progressively with the reduction in LDL-C. The proportion of patients with LDL-C 70 mg/dL reclassified to a higher LDL-C category reached 44% (Sampson vs. Friedewald), 65% (Martin vs. Friedewald), and 37% (Martin vs. Sampson) in those with triglyceride levels between 200 and 399 mg/dL. Conclusions: Both Martin and Sampson LDL-C estimates displayed significant proportion of upward discordance with reclassification to higher LDL-C categories compared to Friedewald formula, particularly in patients with elevated triglycerides and low LDL-C, a population in whom more accurate estimation of LDL-C is required. Further studies are warranted to validate the recently developed Sampson equation with comparison to Martin method that tended to more significantly overestimate LDL-C. laboratories around the world. Friedewald equation has been often used to estimate LDL-C concentration in clinical practice since the 1970s 2). LDL-C is calculated indirectly by Friedewald equation as total cholesterol (TC) minus high-density lipoprotein cholesterol (HDL-C) minus triglycerides (TG)/5 in milligrams per deciliter. However, the equation has been observed to underestimate LDL-C when compared to ultracentrifugation or methods of direct LDL-C measure-Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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Section: Discussionmentioning

confidence: 99%

Comparison of Novel Equations for Estimating Low-Density Lipoprotein Cholesterol in Patients Undergoing Coronary Angiography

Zafrir

Saliba

Flugelman

2020

JAT

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“…The novel Martin-Hopkins formula improves the accuracy of cLDLC at various conditions including very low LDLC < 1.8 mmol/L and in nonfasting samples [47,48]. We recommend to use it preferably in the range of TG concentrations 2.0−4.5 mmol/L wherein the Friedewald equation is less accurate [47].…”

Section: Calculated Ldlcmentioning

confidence: 99%

Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM

Langlois

Nordestgaard

Langsted

et al. 2019

Clinical Chemistry and Laboratory Medicine (CCLM)

138

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The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), LDL cholesterol (LDLC), and calculated non-HDLC (=total – HDLC) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDLC is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDLC shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a) [Lp(a)]-cholesterol is part of measured or calculated LDLC and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDLC declines poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDLC or apolipoprotein B (apoB), especially in patients with mild-to-moderate hypertriglyceridemia (2–10 mmol/L). Non-HDLC includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apoB measurement can detect elevated LDL particle (LDLP) numbers often unidentified on the basis of LDLC alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20–100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.

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“…12 A novel method of calculating LDL-C, the Martin-Hopkins equation, was developed in 2013 and uses an adjustable factor for the TG:VLDL-C ratio, which allows for more accurate estimation of LDL-C, particularly in setting of hypertriglyceridemia (150-399 mg/dL). 12,13 This equation compares favorably among men and women [mean age of 59 years (interquartile range [IQR]: 49-69)] against results derived using ultracentrifugation (correlation coefficient of 0.99; overall concordance in classification of LDL-C by guideline categories of 91.7%). 12,13 Mehta et al showed improved concordance with LDL-C and secondary measures of cardiovascular risk, specifically apoB and non-HDL-C, using Martin-Hopkins equation compared with the Friedewald equation.…”

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confidence: 99%

“…12,13 This equation compares favorably among men and women [mean age of 59 years (interquartile range [IQR]: 49-69)] against results derived using ultracentrifugation (correlation coefficient of 0.99; overall concordance in classification of LDL-C by guideline categories of 91.7%). 12,13 Mehta et al showed improved concordance with LDL-C and secondary measures of cardiovascular risk, specifically apoB and non-HDL-C, using Martin-Hopkins equation compared with the Friedewald equation. 14 Because hypertriglyceridemia is more common in HIVinfected versus HIV-uninfected people, 15 inaccuracy of cal-culated LDL-C using the Friedewald equation may be an important clinical issue for PWH.…”

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confidence: 99%

Short Communication: Comparison of Calculated Low-Density Lipoprotein Cholesterol (LDL-C) Values in HIV-Infected and HIV-Uninfected Men Using the Traditional Friedewald and the Novel Martin–Hopkins LDL-C Equations

Schneider

Sarkar

Margolick

et al. 2020

AIDS Research and Human Retroviruses

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Comparison of Low-Density Lipoprotein Cholesterol Assessment by Martin/Hopkins Estimation, Friedewald Estimation, and Preparative Ultracentrifugation

Abstract: ClinicalTrials.gov Identifier: NCT01764633.

Cited by 116 publications

References 17 publications

Comparison of Novel Equations for Estimating Low-Density Lipoprotein Cholesterol in Patients Undergoing Coronary Angiography

Comparison of Novel Equations for Estimating Low-Density Lipoprotein Cholesterol in Patients Undergoing Coronary Angiography

Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM

Short Communication: Comparison of Calculated Low-Density Lipoprotein Cholesterol (LDL-C) Values in HIV-Infected and HIV-Uninfected Men Using the Traditional Friedewald and the Novel Martin–Hopkins LDL-C Equations

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