LDL-cholesterol calculation methods and their influence on the indications for cholesterol-lowering treatment - 21/07/26
, Charlotte Durand-Maugard b , Agnès Boullier b , Rachel Desailloud a , Antoine Galmiche b , Abdallah Al-Salameh a Highlights |
• | Cardiovascular diseases are the leading cause of mortality worldwide and dyslipidemia is one of the major cardiovascular risk factors. |
• | The Friedewald equation has known limitations at high triglyceride and low LDL-c levels. |
• | Alternatives (the Martin-Hopkins and Sampson-NIH equations) have been proposed recently. |
• | This study compared LDL-cholesterol estimates derived from these 3 equations with directly measured LDL-cholesterol and assessed whether the choice of equation would affect clinical management. |
• | Cardiovascular diseases are the leading cause of mortality worldwide. Dyslipidemia is one of the major cardiovascular risk factors. Cholesterol levels are essential in cardiovascular risk estimation scores. |
Abstract |
Introduction |
The Friedewald equation is problematic at high triglyceride or low LDL-c levels. Alternatives, such as the Martin-Hopkins or Sampson-NIH equations, have been proposed. This study aims to compare LDL-c estimates derived from these 3 equations with directly measured LDL-c and to assess whether the choice of equation affects clinical management.
Methods |
LDL-c levels calculated on the 3 equations were compared with measured LDL values. Comparisons were stratified by total triglyceride (TG) (0–400 mg/dL, 400–800 mg/dL and > 800 mg/dL) and LDL-c levels (below or above 70 mg/dL). Random samples were selected from each category (TG 0–400 mg/dL, TG 400–800 mg/dL and LDL-c < 70 mg/dL) and the misclassification rates attributable to each equation were determined in subjects in secondary prevention.
Results |
In subjects with TG 0–400 mg/dL, the misclassification rate was 4.4% on Sampson-NIH, 4.9% on Martin-Hopkins and 6.4% on Friedewald. In subjects with TG 400–800 mg/dL, rates were 7.4%, 3.7% and 14.8%, respectively. In subjects with LDL-c < 70 mg/dL, rates were 14.7%, 14.7% and 17.6%, respectively.
Conclusion |
This study demonstrated that the 3 methods performed very well in subjects with TG 0–400 mg/dL, relatively well for TG 400–800 mg/dL and less well for LDL-c < 70 mg/dL. However, the Sampson and Martin-Hopkins equations were less prone to therapeutic misclassification errors than the Friedewald equation.
Le texte complet de cet article est disponible en PDF.Keywords : LDL-c, Cardiovascular disease, Friedewald equation, Martin-Hopkins equation, Sampson equation, Dyslipidemia treatment
Plan
Vol 87 - N° 4
Article 102560- juillet 2026 Retour au numéro
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