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. 2018 Jul 1;25(7):643-652.
doi: 10.5551/jat.44396. Epub 2018 May 23.

Validity of a Novel Method for Estimating Low-Density Lipoprotein Cholesterol Levels in Cardiovascular Disease Patients Treated with Statins

Takeshi Sonoda  1 , Takuro Takumi  1 , Masaaki Miyata  1 , Daisuke Kanda  1 , Ippei Kosedo  1 , Satoshi Yoshino  1 , Mitsuru Ohishi  1
Affiliations

Validity of a Novel Method for Estimating Low-Density Lipoprotein Cholesterol Levels in Cardiovascular Disease Patients Treated with Statins

Takeshi Sonoda et al. J Atheroscler Thromb. .

Abstract

Aim: The Friedewald equation is the standard method for estimating low-density lipoprotein cholesterol (LDL-C) levels [LDL-C(F)] and fixes the ratio of triglyceride (TG) to very LDL-C at 5. However, this has been reported to underestimate LDL-C, particularly in patients with LDL-C ＜70 mg/dL. A novel method for LDL-C estimation [LDL-C(M)] using an adjustable factor instead of a fixed value of 5 has recently been proposed. The purpose of this study was to validate LDL-C(M) in Japanese patients with cardiovascular disease (CVD) treated with statins.

Methods: In 385 consecutive CVD patients treated with statins, LDL-C(M) and LDL-C(F) levels were compared with directly measured LDL-C [LDL-C(D)].

Results: Mean LDL-C(D), LDL-C(F), and LDL-C(M) were 81.7±25.5, 76.4±24.6, and 79.9±24.5 mg/dL, respectively. In all patients, both LDL-C(F) and LDL-C(M) were significantly correlated with LDL-C(D) [LDL-C(F) vs. LDL-C(D): R=0.974, p＜0.001; LDL-C(M) vs. LDL-C(D): R=0.987, p＜0.001]. In patients with LDL-C(D) ＜70 mg/dL, LDL-C(M) showed a better correlation with LDLC(D) compared with LDL-C(F) [LDL-C(M) vs. LDL-C(D): R=0.935, p＜0.001; LDL-C(F) vs. LDLC(D): R=0.868, p＜0.001]. In contrast, the correlation of LDL-C(D) with LDL-C(M) or LDL-C(F) was similar in patients with LDL-C(D) ≥70 mg/dL.

Conclusions: In Japanese patients with CVD treated with statins, LDL-C level estimated by this novel method might be more accurate than those estimated using the Friedewald equation for LDL-C levels ＜70 mg/dL.

Keywords: Cardiovascular disease; Friedewald equation; Low-density lipoprotein cholesterol; Martin method; Statin.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Median TG:VLDL-C ratios disaggregated by non-HDL-C and TG levels (180-cell table). TG, triglyceride; VLDL-C, very low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; cited from Reference #11.
Fig. 2.
Fig. 2.
Comparison of correlation between LDL-C(D) and LDL-C(F) or LDL-C(M) levels. (A) LDL-C(D) versus LDL-C(F). (B) LDL-C(D) versus LDL-C(M). Upper panels indicate linear regression analysis, whereas lower panels indicate Bland–Altman plots. CI, confidence interval; LDL-C, low-density lipoprotein cholesterol; LDL-C(D), LDL-C measured by direct assay; LDL-C(F), LDL-C calculated using the Friedewald formula; LDL-C(M), LDL-C calculated using the Martin method.
Fig. 3.
Fig. 3.
Comparison of correlation between LDL-C(D) and LDL-C(F) or LDL-C(M) levels in patients with LDL-C(D) < 70 mg/dL (n = 124) and LDL-C(D) ≥ 70 mg/dL (n = 261). (A) LDL-C(D) versus LDL-C(F) in patients with LDL-C(D) < 70 mg/dL. (B) LDL-C(D) versus LDL-C(M) in patients with LDL-C(D) < 70 mg/dL. (C) LDL-C(D) versus LDL-C(F) in patients with LDL-C(D) ≥ 70 mg/dL. (D) LDL-C(D) versus LDL-C(M) in patients with LDL-C(D) ≥ 70 mg/dL. Upper panels indicate linear regression analysis, whereas lower panels indicate Bland–Altman plots. CI, confidence interval; LDL-C, low-density lipoprotein cholesterol; LDL-C(D), LDL-C measured by direct assay; LDL-C(F), LDL-C calculated using the Friedewald formula; LDL-C(M), LDL-C calculated using the Martin method.
Fig. 4.
Fig. 4.
The effect of TG level (TG < 150 mg/dL and TG ≥ 150 mg/dL) on correlation between LDL-C(D) and LDL-C(F) or LDL-C(M). In patients with LDL-C(D) ≥ 70 mg/dL and TG < 150 mg/dL, LDL-C(D) versus LDL-C(F) (A) or LDL-C(M) (B). In patients with LDL-C(D) ≥ 70 mg/dL and TG ≥ 150 mg/dL, LDL-C(D) versus LDL-C(F) (C) or LDL-C(M) (D). In patients with LDL-C(D) < 70 mg/dL and TG < 150 mg/dL, LDL-C(D) versus LDL-C(F) (E) or LDL-C(M) (F). In patients with LDL-C(D) ≥ 70 mg/dL and TG ≥ 150 mg/dL, LDL-C(D) versus LDL-C(F) (G) or LDL-C(M) (H). Upper panels indicate linear regression analysis, whereas lower panels indicate Bland–Altman plots. CI, confidence interval; LDL-C, low-density lipoprotein cholesterol; LDL-C(D), LDL-C measured by direct assay; LDL-C(F), LDL-C calculated using the Friedewald formula; LDL-C(M), LDL-C calculated using the Martin method.
Fig. 5.
Fig. 5.
Comparison of concordance between LDL-C(D) and LDL-C(F) and that between LDL-C(D) and LDL-C(M) disaggregated by LDL-C(D) level. LDL-C, low-density lipoprotein cholesterol; LDL-C(D), LDL-C measured by direct assay; LDL-C(F), LDL-C calculated using the Friedewald formula; LDL-C(M), LDL-C calculated using the Martin method.
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