J Lab Med Qual Assur.
2008 Dec;30(2):233-235.
Factors Affecting the Difference between the Low-Density Lipoprotein Cholesterol Concentrations Measured Directly and Calculated Using the Friedewald Formula
- Affiliations
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- 1Department of Laboratory Medicine, Asan Medical Center and University of Ulsan College of Medicine1, Seoul, Korea. wkmin@amc.seoul.kr
- 2Department of Laboratory Medicine, Kangnam St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Abstract
- BACKGROUND
National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) is the guideline for detection evaluation, and treatment of high blood cholesterol in adults. The risk of coronary heart disease (CHD) is assessed by the presence of CHD risk equivalents and the number of risk factors. LDL-cholesterol is the goal of treatment for hyperlipidemia. Contents: The most common approach for determining LDL-cholesterol level in clinical laboratory is to calculate it based on Friedewald formula. For accurate risk assessment by the calculated LDL-cholesterol, good analytical performances of total cholesterol, HDL-cholesterol and triglyceride are prerequisite. Even if the analytical performance of these three analytes are within the acceptable criteria, pooled imprecision and bias of the calculated LDL-cholesterol could not meet the criteria for LDL-cholesterol. Even under conditions satisfying the requirements of Friedewald formula, the calculated LDL-cholesterol level was lower than the directly measured level and the difference was dependent on the level of triglyceride, LDL-cholesterol and total cholesterol. When evaluatingpatients with hyperlipidemia, Friedewald calculation may underestimate the risk for coronary heart disease which may lead to inappropriate treatment option.
CONCLUSIONS
When evaluating patients with hyperlipidemia, direct measurement of LDL-cholesterol appears to be better than Friedewald calculation.
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