Comparison of low-density lipoprotein cholesterol level calculated using the modified Martin/Hopkins estimation or the Friedewald formula with direct homogeneous assay measured low-density lipoprotein cholesterol

Abstract

Introduction: Low-density lipoprotein cholesterol (LDL-C) represents the primary lipoprotein target for reducing cardiovascular risk (CV). The aim of our study is to compare the direct and the calculated LDL-C levels in the range below 1.8 mmol/l and 2.6 mmol/l depending on triglycerides, and to evaluate the variation in remnant lipoprotein cholesterol. Material and methods: We investigated 14 906 lipid profiles from fasting blood samples of Hungarian individuals with triglycerides < 4.5 mmol/l. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and direct LDL-C were measured by the enzymatic assay. We calculated LDL-C by Friedewald's formula (F-LDL-C) and by using the new Martin/Hopkins estimation (MH-LDL-C). Results: For F-LDL-C below 1.8 mmol/l, MH-LDL-C was 58% between 1.8 and 2.59 mmol/l when TG was in the range 2.3-4.5 mmol/l. For F-LDL-C below 2.6 mmol/l, the MH-LDL-C concordance was 73% in the same TG range (2.3-4.5 mmol/l. If MH-LDL-C was less than 1.8 mmol/l or between 1.8 and 2.59 mmol/l, the difference between non-HDL-C (TC-HDL-C = AC: atherogenic cholesterol) and (MH)LDL-C was less than 0.8 mmol/l in the TG range below 2.3 mmol/l. The remnant lipoprotein cholesterol values were on average 0.5 mmol/l lower by the Martin/Hopkins estimation compared to the Friedewald's calculation if the TG was above 2.3 mmol/l. Conclusions: The Friedewald equation tends to underestimate LDL-C levels in very high and high-risk settings. Our analysis supports the conclusion that in Hungarian patients, LDL-C estimation using the Martin/Hopkins formula, which is validated by the beta-quantification method, yields a more accurate LDL-C value than that calculated by the Friedewald formula.

Comparison of LDL-C calculation by Martin, Sampson and old Friedewald methods in real data and synthetic data set

“…Nakoniec, Martin-Hopkins rovnica je menovite doporučovaná už aj v niektorých národných klinických guidelinoch, postupne odvodzovaných od uvedených dvoch európskych guidelinov, napr. v poľskom (4), a podporu jej vyslovujú aj maďarskí autori (5).…”

Comparison of measured LDL cholesterol with calculated LDL-cholesterol using the Friedewald and Martin-Hopkins formulae in diabetic adults at Charlotte Maxeke Johannesburg Academic Hospital/NHLS Laboratory

“…It is agreed that accurate measurement of LDL-C is pivotal in ensuring correct assessment of patients’ cardiovascular risk and treatment of dyslipidemia, targeted at lowering their LDL concentration [ 25 ]. In 2021, ESC the published guidelines recommending that patients be first categorized according to the Systemic Coronary Risk Estimation 2 (SCORE2) and Systemic Coronary Risk Estimation 2-Older Persons (SCORE2-OP).…”

Assessing the Practical Differences in LDL-C Estimates Calculated by Friedewald, Martin/Hopkins, or NIH Equation 2: An Observation Cross-Sectional Study

“…A good deal of external validations confirm that Martin/Hopkins equation outperforms others in accuracy. 11 24 26 27 28 29 30 31 32 33 34 35 36 …”

“…Many external validation studies have been conducted and showed superiority of the Martin/Hopkins 11 24 26 27 28 29 30 31 32 33 34 35 36 or NIH Equation 2 25 27 37 38 in relation to the Friedewald formula. Here, the purpose of this study was to assess the practical differences 39 40 in LDL-C estimates calculated by Friedewald, Martin/Hopkins, or NIH equation 2 in a population-based, random-sampled, noninstitutionalized general U.S. sample.…”