Korean J Intern Med.  2020 Jan;35(1):150-159. 10.3904/kjim.2017.233.

Validation of the Friedewald formula for estimating low density lipoprotein cholesterol: the Korea National Health and Nutrition Examination Survey, 2009 to 2011

• Lee J
• Jang S
• Jeong H
• Ryu OH

• KMID: 2501996
• DOI: http://doi.org/10.3904/kjim.2017.233

Abstract

Background/Aims
The aim of this study is to compare Friedewald-estimated and directly measured low density lipoprotein cholesterol (LDL-C) values and assess the concordance in guideline risk classification between the two methods.
Methods
The data were derived from the 2009 to 2011 Korea National Health and Nutrition Examination Survey. We included subjects with triglyceride (TG) levels < 400 mg/dL. Analysis was done for 6,454 subjects who had all lipid panels— total cholesterol, directly measured LDL-C, high density lipoprotein cholesterol (HDL-C), and TG.
Results
The subjects ranged in age from 10 to 87 years old. The mean age was 41.5 ± 17.3 years. For subjects with TG < 400 mg/dL, overall concordance in guideline risk classification was 79.1%. The Friedewald formula tended to underestimate LDL-C more at higher TG or lower HDL-C levels. Especially, the percent of subjects who were misclassified into a lower risk category was 31% when TG were 200 to 299 mg/dL; and 45.6% when TG were 300 to 399 mg/dL. A greater underestimation of LDL-C occurred at higher TG and lower Friedewald-estimated LDL-C levels. Of subjects with a Friedewald-estimated LDL-C < 70 mg/dL, 55.4% had a directly measured LDL-C ≥ 70 mg/dL when TG were 200 to 399 mg/dL.
Conclusions
The Friedewald equation tends to underestimate LDL-C in highrisk subjects such as hypertriglyceridemia and hypo-HDL-cholesterolemia. For these individuals accurate assessment of LDL-C is crucial, and therefore additional evaluation is warranted.

Keyword

Cholesterol, LDL; Friedewald formula; Validation