J Lipid Atheroscler.
2023 Sep;12(3):252-266. 10.12997/jla.2023.12.3.252.
Assessing the Practical Differences in LDL-C Estimates Calculated by Friedewald, Martin/Hopkins, or NIH Equation 2: An Observation CrossSectional Study
- Affiliations
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- 1Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- 2Department of Biomedical Engineering/Mechanical Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- 3Department of Biomedical Sciences Lab Programs, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- 4Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- KMID: 2546558
- DOI: http://doi.org/10.12997/jla.2023.12.3.252
Abstract
Objective
Low-density lipoprotein-cholesterol (LDL-C) remains a clinically important cholesterol target in primary prevention of atherosclerotic cardiovascular disease. The present study aimed to assess the practical differences among three equations utilized for the estimation of LDL-C: the Friedewald, the Martin/Hopkins, and the NIH equation 2.
Methods
Blood lipid measurements from 4,556 noninstitutionalized participants, aged 12 to 80, were obtained from the 2017-2020 National Health and Nutrition Examination Survey study. We 1) assessed the differences between three calculated LDL-C estimates, 2) examined the correlations between LDL-C estimates using correlation coefficients and regression, and 3) investigated the degree of agreement in classifying individuals into the LDL-C category using weighted Kappa and percentage of agreement.
Results
The differences in LDL-C estimates between equations varied by sex and triglyceride levels (p<0.001). Overall, the mean of absolute differences between Friedewald and Martin/ Hopkins was 3.17 mg/dL (median=2.0, 95% confidence interval [CI] [3.07–3.27]). The mean of absolute differences between Friedewald and NIH Equation 2 was 2.08 mg/dL (median=2.0, 95% CI [2.03–2.14]). Friedewald correlated highly with Martin/Hopkins (r=0.991, rho=0.989) and NIH Equation 2 (r=0.998, rho=0.997). Cohen’s weighted Kappa=0.92 between Friedewald and Martin/Hopkins, and 0.95 between Friedewald and NIH equation 2. The percentage of agreement in classifying individuals into the same LDL-C category was 93.0% between Friedewald and Martin/Hopkins, and 95.4% between Friedewald and NIH equation 2.
Conclusion
Understanding the practical differences in LDL-C calculations can be helpful in facilitating decision-making during a paradigm shift.
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