Measuring LDL-cholesterol: what is the best way to do it?

Abstract

Purpose of review Cholesterol on low-density lipoproteins (LDL-C) is one of the main drivers of atherosclerotic cardiovascular disease (ASCVD) and hence its measurement is critical in the management of patients at risk. Although LDL-C has routinely been either calculated by the Friedewald equation or measured with direct assays, these methods have limitations, particularly for patients with dyslipidaemias, low LDL-C, and hypertriglyceridemia. The focus of this review will be recent advances in the measurement of LDL for ASCVD risk management. Recent findings We first describe the recent recommendations on how LDL-C is used in ASCVD risk assessment and management. We then review the current approaches to the measurement of LDL-C and recent developments on new more accurate equations for calculating LDL-C. Finally, we present new and emerging LDL assays that may be superior to LDL-C for risk assessment, such as LDL particle number and small dense LDL-C, and several LDL-based lipid tests in early development. Summary LDL-C is valuable in ASCVD risk management but recent improvements in its measurement and the development of other LDL-related tests may further improve its value.

Comparison of the effectiveness of Martin’s equation, Friedewald’s equation, and a Novel equation in low-density lipoprotein cholesterol estimation

“…Additionally, Martin’s equation has been further validated in LDL-C estimation by numerous studies, when LDL-C levels < 70 mg/dL and TG levels are > 150 mg/dL 6 , 8 , 12 . However, both the Friedewald and Martin equations were developed and validated for patients with serum TG levels < 400 mg/dL; MLDL also remains imperfect, particularly in cases with severe hypertriglyceridemia 13 . Sampson et al recently developed a new method for the calculation of LDL-C using β-quantification LDL-C values and multiple least squares regressions analysis.…”

“…According to 2019 ESC/EAS guidelines, the level of plasma TG, in addition to LDL-C, should be assessed in individuals who may have a higher risk of ASCVD; East Asians, who have higher TG and lower LDL-C levels than Caucasians, may have underestimated ASCVD risk, leading to the erroneous conclusion of non-eligibility for prophylactic statin treatment 4 , 13 , 22 . Moreover, recent studies performed in Asian populations showed that serum TG was a better predictor of CVD than LDL-C, suggesting the possibility of the stronger importance of hypertriglyceridaemia over LDL-C in Asians than in Westerners 16 – 18 , 24 , 29 .…”

Shift work, and particularly permanent night shifts, promote dyslipidaemia: A systematic review and meta-analysis

“…Even if methodological quality of the included studies was evaluated by subjective assessments (STROBE and NOS), overall methodological quality was reasonably good without major comparability bias between exposed and non-exposed groups, with a large volume of data available and consistency for the main outcomes of interest. We also want to acknowledge that we were not able to increase the number of studies with c-LDL using the formula of Friedewald (LDL = total cholesterol -(triglycerides/5 + HDL)) [134], as we did not have access Fig. 4.…”

Comparison of the Japan Society of Clinical Chemistry reference method and CDC method for HDL and LDL cholesterol measurements using fresh sera

“…Therefore, there remains a problem in quantitatively measuring LDL-C by separating the lipid fraction of high TG samples using the ultracentrifugation method, including the CDC-BQ method and our method. Recently, several new equations have been devised that can measure high TG samples as an inexpensive and easy alternative to the traditional Friedewald equation for LDL-C measurements [ 28 , 29 ]. In the future, we hope to develop a better LDL-C measurement method by accumulating clinical evidence regarding the relationship between various LDL-C measurement methods and cardiovascular disease.…”