LDLC estimation database.xlsx

Background: The most commonly used method for low-density lipoprotein cholesterol (LDLC) estimation is the Friedewald equation, which has notable limitations. However, more accurate methods have been proposed. This study investigates the advantages and limitations of these methods and identifies the contexts in which each equation is most or least applicable. Methods: A cohort of 222 individuals underwent a standard lipid profile, directly measured LDLC (dLDLC). LDLC was also estimated using the Friedewald, Martin-Hopkins, and Sampson equations. The differences (�lta) between estimated and measured LDLC were analyzed in relation to dLDLC, high-density lipoprotein cholesterol (HDLC), and triglyceride levels. Results: The �lta was significantly lower (p<0.0001) for the Martin-Hopkins (-8.8±9.8) and Sampson (-9.5±9.2) equations compared to Friedewald (-12.2±9.2). All equations increasingly underestimated LDLC as dLDLC levels decreased. �lta of the Martin-Hopkins equation showed significant positive correlations with dLDLC (≤130mg/dL) and triglycerides, and a significant negative correlation with HDLC. In a subgroup of 30 individuals with extreme �lta values, patterns of gross underestimation were observed, particularly when low LDLC, low triglycerides, and high HDLC coincided. Conclusions: The Martin-Hopkins equation is a superior method for LDLC estimation and a valuable tool of precision medicine. However, clinicians and laboratory professionals must be aware of its limitations and recognize patterns that could lead to significant LDLC underestimation. We propose an algorithm for clinical laboratories to provide personalized LDLC assessments.