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Is calculated LDL-C by using the new modified Friedewald equation better than the standard Friedewald equation?
Wilai Puavilai1, Donpichit Laoragpongse
1Department of Medicine, Rajavithi Hospital, Bangkok, Thailand.
Insights
A new modified Friedewald equation improves LDL-C calculation accuracy for patients with high triglyceride levels. This revised formula offers better LDL-C estimates when triglycerides exceed 200 mg/dL, aiding cardiovascular risk assessment.
Area of Science:
- Clinical Chemistry
- Cardiovascular Medicine
- Biochemistry
Background:
- Coronary Heart Disease (CHD) patients require LDL-C levels below 100 mg/dL for reduced major coronary events.
- Direct LDL-C measurement is accurate but costly.
- The Friedewald equation for calculating LDL-C shows decreased accuracy with triglyceride levels above 300 mg/dL.
Purpose of the Study:
- To assess the correlation between directly measured LDL-C and calculated LDL-C using the Friedewald equation.
- To develop and validate a modified Friedewald equation for improved LDL-C calculation, particularly when triglyceride levels are elevated.
Main Methods:
- Analyzed 1079 fasting serum samples.
- Compared directly measured LDL-C (dm LDL) with LDL-C calculated by the standard Friedewald (sf LDL) and a new modified Friedewald equation (mf LDL).
- The modified equation adjusts the triglyceride subtraction factor for triglyceride levels over 200 mg/dL.
Main Results:
- Excellent correlation (within +/- 10%) between dm LDL and sf LDL when triglycerides < 200 mg/dL.
- sf LDL accuracy declined significantly with higher triglyceride levels (200-399 mg/dL).
- mf LDL demonstrated superior correlation with dm LDL compared to sf LDL for triglyceride levels of 200-399 mg/dL (91.6% vs 72.3% and 83.3% vs 58.3% within +/- 10%).
- mf LDL showed good correlation (75.0%) even with triglyceride levels of 400-499 mg/dL.
Conclusions:
- The standard Friedewald equation is reliable for LDL-C calculation when triglycerides are below 200 mg/dL.
- A modified Friedewald equation is proposed for improved LDL-C estimation in patients with triglyceride levels ranging from 200-499 mg/dL.
- Further validation of the modified Friedewald equation, especially in dyslipidemic populations, is recommended.
Abstract:
The patients who have CHD or CHD risk equivalents should have LDL-C level less than 100 mg/dL because of the great reduction of risk for major coronary events. Direct measurement of LDL-C is the most accurate but is expensive. But with the practical use of the Friedewald equation for calculating LDL-C, the authors noticed that the accuracy declined with triglyceride level being higher than 300 mg/dL. The authors determined the correlation of direct measurement of LDL-C with calculation LDL-C from the Friedewald equation and postulated the new modified Friedewald equation for calculating LDL-C by using 1/6 triglyceride to minus. From a total of 1079 fasting serum samples analysis, and determining the correlation of LDL-C from the direct measurement (dm LDL) while calculating LDL-C from equations of the standard Friedewald (sf LDL), and the new modified Friedewald (mf LDL), by using 1/6 triglyceride to minus instead of 1/5 triglyceride, if triglyceride was over 200 mg/dL. The authors found an excellent correlation within 0 +/- 10% difference of dm LDL and sfLDL if triglyceride was less than 200 mg/dL, but sf LDL is less accurate when the triglyceride level is high, and mf LDL has better correlation with dm LDL within 0 +/- 10% that sf LDL vs mf LDL, 72.3% vs 91.6% (p = 0.0001), and 58.3% vs 83.3%, (p = 0.01) when the triglyceride level is 200-299, and 300-399 mg/dL respectively. It is shown that sf LDL has more underestimation than mf LDL when compared with dm LDL (more than 10 mg/dL) as 26.9% vs 2.5% (p < 0.0001) and 41.6% vs 5.6% (p = 0.0003 ) with triglyceride of 200-299, and 300-399 mg/dL respectively, although mf LDL showed overestimation of more than 10 mg/dL difference with dm LDL as sf LDL vs mf LDL of 0.8% vs 5.8% (p = 0.03), and 0.0% vs 11.1% (p=0.03) if the triglyceride is in the range of 200-299 and 300-399 mg/dL respectively, even with a triglyceride level of 400-499 mg/dL, mfLDL still has good correlation with dm LDL up to 75.0%. The authors conclude that the standard Friedewald equation is excellent for LDL calculation if triglyceride is less than 200 mg/dL, but the accuracy is declined when triglyceride is over 200 mg/dL, the authors offer a new modified Friedewald equation to calculate LDL-C if triglyceride is in the range of 200-499 mg/dL which has a better correlation with direct measured LDL-C. However this new modified Friedewald equation needs to be testified again especially with dyslipidemic patient sera.
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