LDL-C Estimation Equation Performance Characteristics Highlight Value of Preferentially Using Non-HDL Cholesterol or Directly Measured Apolipoprotein B

Limitations of the Friedewald equation when triglyceride (TG) is elevated or low-density lipoprotein-cholesterol (LDL-C) is low have motivated development of the Martin-Hopkins and Sampson-National Institutes of Health (NIH) alternatives. We compared the 3 over a broad range of total cholesterol (TC), TG, and high-density lipoprotein-cholesterol (HDL-C). With high TC and TG, Sampson-NIH yields similar or lower LDL-C than Friedewald. At levels of LDL-C commonly used to stratify therapy, the alternate LDL-C values may create variance in clinical decisions. These observations reinforce the value of directly measured apolipoprotein B or consideration of non-HDL-C to overcome limitations of all 3 methods.

Automated summary

The limitations of the Friedewald equation in cases of elevated triglyceride (TG) or low-density lipoprotein-cholesterol (LDL-C) have led to the development of alternative methods such as Martin-Hopkins and Sampson-National Institutes of Health (NIH). A comparison of the three methods across a wide range of total cholesterol (TC), TG, and high-density lipoprotein-cholesterol (HDL-C) levels showed that Sampson-NIH yields similar or lower LDL-C values than Friedewald when TC and TG are high. However, the use of alternate LDL-C values may introduce variability in clinical decisions at commonly used LDL-C levels for treatment stratification. These findings highlight the importance of directly measuring apolipoprotein B or considering non-HDL-C to overcome the limitations of all three methods.