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. 2022 Oct 7;9(10):342.
doi: 10.3390/jcdd9100342.

Comparison of Estimated LDL Cholesterol Equations with Direct Measurement in Patients with Angiographically Confirmed Coronary Artery Disease

Boqun Shi  1   2   3 , Hao-Yu Wang  1   2   3 , Dong Yin  1   2   3 , Chenggang Zhu  1   2   3 , Lei Feng  1   2   3 , Hongjian Wang  1   2   3 , Lei Jia  1   2   3 , Rui Fu  1   2   3 , Chenxi Song  1   2   3 , Zhou Zhou  3   4 , Yahui Lin  3   4 , Weihua Song  1   2   3 , Ke-Fei Dou  1   2   3
Affiliations

Comparison of Estimated LDL Cholesterol Equations with Direct Measurement in Patients with Angiographically Confirmed Coronary Artery Disease

Boqun Shi et al. J Cardiovasc Dev Dis. .

Abstract

Background and aims: Our goals in the study were to (1) quantify the discordance in LDL-C levels between equations (the Friedewald, Sampson, and Martin/Hopkins equations) and compare them with direct LDL-C (dLDL-C); and (2) explore the proportion of misclassified patients by calculated LDL-C using these three different equations. Methods: A total of 30,349 consecutive patients with angiographically confirmed coronary artery disease (CAD) were prospectively enrolled. Concordance was defined as if the LDL-C was <1.8 mmol/L with each pairwise comparison of LDL-C equations. Estimated LDL-C that fell into the same category as dLDL-C at the following levels: <1.4, 1.4 to 1.7, 1.8 to 2.5, 2.6 to 2.9, and ≥3.0 mmol/L was considered to have been correctly categorized. Results: The concordance was 96.3% (Sampson vs. Martin/Hopkins), 95.0% (Friedewald vs. Sampson), and 91.4% (Friedewald vs. Martin/Hopkins), respectively. This proportion fell to 82.4% in those with hypertriglyceridemia (TG ≥ 1.7 mmol/L). With an accurate classification rate of 73.6%, the Martin/Hopkins equation outperformed the Sampson equation (69.5%) and the Friedewald equation (59.3%) by a wide margin. Conclusions: Comparing it to the validated Martin/Hopkins equation, the Friedewald equation produced the lowest levels of LDL-C, followed by the Sampson equation. In the classification of LDL-C, the Martin/Hopkins equation has also been shown to be more accurate. There is a significant difference between the equations and the direct measurement method, which may lead to overtreatment or undertreatment.

Keywords: LDL-C.

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Conflict of interest statement

Authors state no conflict of interest.

Figures

Figure 1
Figure 1
Direct LDL-C and LDL-C equation comparison. (A) Friedewald LDL-C vs. Sampson LDL-C. (B) Friedewald LDL-C vs. Martin/Hopkins LDL-C. (C) Martin/Hopkins LDL-C vs. Sampson LDL-C. (D) Direct LDL-C vs. Friedewald LDL-C. (E) Direct LDL-C vs. Martin/Hopkins LDL-C. (F) Direct LDL-C vs. Sampson LDL-C. LDL-C = low-density lipoprotein cholesterol.
Figure 2
Figure 2
LDL-C equation concordance and discordance at 1.8 mmol/L as the LDL-C cut point. (A) Concordance and discordance in all patients. (B) Concordance and discordance in patients with TG ≥ 1.7mmol/L. (C) Concordance and discordance in patients with diabetes. LDL-C = low-density lipoprotein cholesterol.
Figure 3
Figure 3
Percentage of patients that were incorrectly classified by direction and estimated LDL-C subgroup. (A) Overall. (B) LDL-C subgroup 1: <1.4 mmol/L. (C) LDL-C subgroup 2: 1.4–1.7 mmol/L. (D) LDL-C subgroup 3: 1.8–2.5 mmol/L. (E) LDL-C subgroup 4: 2.6–2.9 mmol/L. (F) LDL-C subgroup 5: ≥3.0 mmol/L. LDL-C = low-density lipoprotein cholesterol.
Figure 4
Figure 4
Residual error plots for LDL-C by various equations. (A) Direct LDL-C vs. Friedewald LDL-C. (B) Direct LDL-C vs. Martin/Hopkins LDL-C. (C) Direct LDL-C vs. Sampson LDL-C. LDL-C = low-density lipoprotein cholesterol. TG = triglyceride.
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