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. 2016 Sep;46(5):688-698.
doi: 10.4070/kcj.2016.46.5.688. Epub 2016 Sep 28.

Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease

Hansol Choi  1 , Jee-Seon Shim  2 , Myung Ha Lee  3 , Young Mi Yoon  2 , Dong Phil Choi  2 , Hyeon Chang Kim  3
Affiliations

Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease

Hansol Choi et al. Korean Circ J. 2016 Sep.

Abstract

Background and objectives: Low-density lipoprotein cholesterol (LDL-C), an established cardiovascular risk factor, can be generally determined by calculation from total cholesterol, high-density lipoprotein cholesterol, and triglyceride concentrations. The aim of this study was to compare LDL-C estimations using various formulas with directly measured LDL-C in a community-based group and hospital-based group among the Korean population.

Subjects and methods: A total of 1498 participants were classified into four groups according to triglyceride concentrations as follows: <100, 100-199, 200-299, and ≥300 mg/dL. LDL-C was calculated using the Friedewald, Chen, Vujovic, Hattori, de Cordova, and Anandaraja formulas and directly measured using a homogenous enzymatic method. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Passing & Bablok regression, and Bland-Altman plots were used to evaluate the performance of six formulas.

Results: The Friedewald formula had the highest accuracy (ICC=0.977; 95% confidence interval 0.974-0.979) of all the triglyceride ranges, while the Vujovic formula had the highest accuracy (ICC=0.876; 98.75% confidence interval 0.668-0.951) in people with triglycerides ≥300 mg/dL. The mean difference was the lowest for the Friedewald formula (0.5 mg/dL) and the percentage error was the lowest for the Vujovic formula (30.2%). However, underestimation of the LDL-C formulas increased with triglyceride concentrations.

Conclusion: The accuracy of the LDL-C formulas varied considerably with differences in triglyceride concentrations. The Friedewald formula outperformed other formulas for estimating LDL-C against a direct measurement and the Vujovic formula was suitable for hypertriglyceridemic samples; it could be used as an alternative cost-effective tool to measure LDL-C when the direct measurement cannot be afforded.

Keywords: Cholesterol; Friedewald formula; Low-density lipoprotein cholesterol; Triglyceride.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1. Flow chart of study participants. LDL-C: low-density lipoprotein cholesterol, TG: triglycerides.
Fig. 2
Fig. 2. Bland-Altman plots of estimated formulas against directly-measured LDL-C. The mean difference represents the estimation of bias between the two observations and the percentage error represents the proportion between the magnitude of measurement and error in measurement. LDL-C: low-density lipoprotein cholesterol.
Fig. 3
Fig. 3. Passing & Bablok regression of estimated formulas against directly-measured LDL-C. The dotted line represents the line of identity. No significant deviation from linearity. LDL-C: low-density lipoprotein cholesterol.
See this image and copyright information in PMC

References

    1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on Detection, Evaluation, and Treatment of high blood cholesterol in adults (Adult Treatment Panel III) JAMA. 2001;285:2486–2497. - PubMed
    1. European Association for Cardiovascular Prevention & Rehabilitation. Reiner Z, Catapano AL, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Eur Heart J. 2011;32:1769–1818. - PubMed
    1. Son JI, Chin SO, Woo JT The Committee for Developing Treatment Guidelines for Dyslipidemia, Korean Society of Lipidology and Atherosclerosis (KSLA) Treatment guidelines for dyslipidemia: summary of the expanded second version. J Lipid Atheroscler. 2012;1:45–59.
    1. Bachorik PS, Ross JW. National Cholesterol Education Program recommendations for measurement of low-density lipoprotein cholesterol: executive summary. The National Cholesterol Education Program Working Group on Lipoprotein Measurement. Clin Chem. 1995;41:1414–1420. - PubMed
    1. Anandaraja S, Narang R, Godeswar R, Laksmy R, Talwar KK. Low-density lipoprotein cholesterol estimation by a new formula in Indian population. Int J Cardiol. 2005;102:117–120. - PubMed

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