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

Dintshi, Mogomotsi; Kone, Ngalulawa; Khoza, Siyabonga

doi:10.1371/journal.pone.0277981

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…Their analysis found a mean difference of -23.0 mg/dl, with limits of agreement ranging from -72.4 mg/dl to 26.4 mg/dl [17] . Dintshi et al (2022) compared measured LDL-C with calculated values using both the Friedewald and Martin-Hopkins formulae in diabetic adults. Their study revealed a mean positive bias of 14% for the Friedewald formula and 10.24% for the Martin-Hopkins formula, highlighting substantial differences between measured and calculated LDL-C values [18] .…”

Section: Discussionmentioning

confidence: 99%

“…Dintshi et al (2022) compared measured LDL-C with calculated values using both the Friedewald and Martin-Hopkins formulae in diabetic adults. Their study revealed a mean positive bias of 14% for the Friedewald formula and 10.24% for the Martin-Hopkins formula, highlighting substantial differences between measured and calculated LDL-C values [18] . Similarly, Kannan et al (2014) found a strong positive correlation (r = 0.89) between LDL-C calculated using the Friedewald formula and directly measured LDL-C.…”

Section: Discussionmentioning

confidence: 99%

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A comparative analysis of direct LDL measurement and calculated LDL: Assessing accuracy and clinical implications

Sahi,

Pandya,

Modi

2024

Int. J. Adv. Biochem. Res.

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Background: Accurate assessment of low-density lipoprotein cholesterol (LDL-C) is crucial for managing atherosclerotic cardiovascular disease (ASCVD) risk. Traditional methods like the Friedewald equation have limitations, especially in hypertriglyceridemic or non-fasting conditions. Direct LDL-C measurement offers potential for greater accuracy. Methodology: This prospective observational study, conducted from 2023 to 2024 at Pacific Medical College and Hospital, involved 110 patients aged 18-65 years. Ethical approval was obtained. Participants, not on lipid-lowering medications, provided blood samples after a 12-hour fast. Trained phlebotomists collected blood samples following standardized procedures. LDL-C levels were calculated using the Friedewald equation and directly measured using specialized assays. Participants were categorized based on triglyceride levels for comparative analysis. Results: Significant differences in LDL-C levels were observed between calculated and direct measurement methods, especially in patients with high triglyceride levels. Group 3, with triglyceride levels exceeding 400 mg/dL, showed substantial disparities. The Bland-Altman analysis demonstrated acceptable agreement between methods, albeit with slight bias. Conclusion: Meticulous selection of LDL-C measurement methods is crucial, particularly in patients with metabolic abnormalities. Triglyceride levels significantly influence LDL-C estimation accuracy. Alternative methods like direct LDL-C measurement, especially in patients with elevated triglyceride levels, can enhance cardiovascular risk management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comparative analysis of direct LDL measurement and calculated LDL: Assessing accuracy and clinical implications

Sahi,

Pandya,

Modi

2024

Int. J. Adv. Biochem. Res.

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“…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 …”

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Wang,

Rahman,

Hou

et al. 2023

J Lipid Atheroscler

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Objective Low-density lipoprotein-cholesterol (LDL-C) remains a clinically important cholesterol target in primary prevention of atherosclerotic cardiovascular disease. The present study aimed to assess the practical differences among three equations utilized for the estimation of LDL-C: the Friedewald, the Martin/Hopkins, and the NIH equation 2. Methods Blood lipid measurements from 4,556 noninstitutionalized participants, aged 12 to 80, were obtained from the 2017-2020 National Health and Nutrition Examination Survey study. We 1) assessed the differences between three calculated LDL-C estimates, 2) examined the correlations between LDL-C estimates using correlation coefficients and regression, and 3) investigated the degree of agreement in classifying individuals into the LDL-C category using weighted Kappa and percentage of agreement. Results The differences in LDL-C estimates between equations varied by sex and triglyceride levels ( p <0.001). Overall, the mean of absolute differences between Friedewald and Martin/Hopkins was 3.17 mg/dL (median=2.0, 95% confidence interval [CI] [3.07–3.27]). The mean of absolute differences between Friedewald and NIH Equation 2 was 2.08 mg/dL (median=2.0, 95% CI [2.03–2.14]). Friedewald correlated highly with Martin/Hopkins (r=0.991, rho=0.989) and NIH Equation 2 (r=0.998, rho=0.997). Cohen’s weighted Kappa=0.92 between Friedewald and Martin/Hopkins, and 0.95 between Friedewald and NIH equation 2. The percentage of agreement in classifying individuals into the same LDL-C category was 93.0% between Friedewald and Martin/Hopkins, and 95.4% between Friedewald and NIH equation 2. Conclusion Understanding the practical differences in LDL-C calculations can be helpful in facilitating decision-making during a paradigm shift.

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“…First and foremost, the equation does not account for interindividual variances in the triglyceride (TG):very-low-density lipoprotein cholesterol (VLDL-C) (TG:VLDL-C) ratio 17 ; it is based on a presumption that this ratio is constantly 5:1, when in fact, it is highly variable through different TG and non-high-density lipoprotein cholesterol (non-HDL-C) levels 14 , 17 ; the Lipid Research Clinics Prevalence Study reported a mean TG:VLDL-C ratio that ranges from 5.2 to 8.9 18 . Therefore, it is invalid at TG levels > 4.5 mmol/L 19 ; particularly observed in diabetes mellitus (DM) and metabolic disorders 20 . Some studies have also questioned its accuracy with TG levels < 4.5 mmol/L and at optimal TG levels (< 0.80 mmol/L) 20 – 22 .…”

Section: Introductionmentioning

confidence: 99%

A novel equation for the estimation of low-density lipoprotein cholesterol in the Saudi Arabian population: a derivation and validation study

Nuwaylati,

Awan

2024

Sci Rep

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Low-density lipoprotein cholesterol (LDL-C) is typically estimated by the Friedewald equation to guide atherosclerotic cardiovascular disease (ASCVD) management despite its flaws. Martin–Hopkins and Sampson-NIH equations were shown to outperform Friedewald’s in various populations. Our aim was to derive a novel equation for accurate LDL-C estimation in Saudi Arabians and to compare it to Friedewald, Martin–Hopkins and Sampson-NIH equations. This is a cross-sectional study on 2245 subjects who were allocated to 2 cohorts; a derivation (1) and a validation cohort (2). Cohort 1 was analyzed in a multiple regression model to derive an equation (equationD) for estimating LDL-C. The agreement between the measured (LDL-CDM) and calculated levels was tested by Bland–Altman analysis, and the biases by absolute error values. Validation of the derived equation was carried out across LDL-C and triglyceride (TG)-stratified groups. The mean LDL-CDM was 3.10 ± 1.07 and 3.09 ± 1.06 mmol/L in cohorts 1 and 2, respectively. The derived equation is: LDL-CD = 0.224 + (TC × 0.919) – (HDL-C × 0.904) – (TG × 0.236) – (age × 0.001) – 0.024. In cohort 2, the mean LDL-C (mmol/L) was estimated as 3.09 ± 1.06 by equationD, 2.85 ± 1.12 by Friedewald, 2.95 ± 1.09 by Martin–Hopkins, and 2.93 ± 1.11 by Sampson-NIH equations; statistically significant differences between direct and calculated LDL-C was observed with the later three equations (P < 0.001). Bland–Altman analysis showed the lowest bias (0.001 mmol/L) with equationD as compared to 0.24, 0.15, and 0.17 mmol/L with Friedewald, Martin–Hopkins, and Sampson-NIH equations, respectively. The absolute errors in all guideline-stratified LDL-C categories was the lowest with equationD, which also showed the best classifier of LDL-C according to guidelines. Moreover, equationD predicted LDL-C levels with the lowest error with TG levels up to 5.63 mmol/L. EquationD topped the other equations in estimating LDL-C in Saudi Arabians as it could permit better estimation when LDL-C is < 2.4 mmol/L, in familial hyperlipidemia, and in hypertriglyceridemia, which improves cardiovascular outcomes in high-risk patients. We recommend further research to validate equationD in a larger dataset and in other populations.

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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

Cited by 5 publications

References 34 publications

A comparative analysis of direct LDL measurement and calculated LDL: Assessing accuracy and clinical implications

A comparative analysis of direct LDL measurement and calculated LDL: Assessing accuracy and clinical implications

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

A novel equation for the estimation of low-density lipoprotein cholesterol in the Saudi Arabian population: a derivation and validation study

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