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Comparison of Three Methods for LDLC Calculation for Cardiovascular Disease Risk Categorisation in Three Distinct
Cathy J Sun1, Christopher McCudden2, Diane Brisson3
1Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Insights
Newer equations for calculating low-density-lipoprotein cholesterol (LDLC) can reclassify cardiovascular disease (CVD) risk. The Martin-Hopkins (M-LDLC) and Sampson-NIH (S-LDLC) equations offer improved accuracy over the Friedewald equation (F-LDLC), especially in patients with high triglycerides.
Area of Science:
- Clinical Chemistry
- Cardiovascular Medicine
- Biochemistry
Background:
- The Friedewald equation for calculating low-density-lipoprotein cholesterol (F-LDLC) has limitations.
- The Martin-Hopkins (M-LDLC) and Sampson-National Institutes of Health (S-LDLC) equations were developed as alternatives.
- Accurate LDLC calculation is crucial for cardiovascular disease (CVD) risk stratification.
Purpose of the Study:
- To compare the M-LDLC and S-LDLC equations against the F-LDLC equation.
- To assess the impact of using M-LDLC and S-LDLC on CVD risk classification according to Canadian Cardiovascular Society (CCS) 2021 guidelines.
- To evaluate the performance of these equations across different patient populations, including those with familial hypercholesterolemia (FH).
Main Methods:
- Lipid profiles from three distinct populations were analyzed: a hospital laboratory, lipid clinic patients without monogenic dyslipidemias, and lipid clinic patients with FH.
- Calculated LDLC values using F-LDLC, M-LDLC, and S-LDLC equations were compared.
- Patient reclassification into CCS 2021 CVD risk categories based on each LDLC calculation method was determined.
Main Results:
- All three LDLC calculation methods showed strong correlation.
- M-LDLC and S-LDLC generally yielded higher values than F-LDLC as triglyceride levels increased (up to ~5 mmol/L) in non-FH populations.
- S-LDLC yielded lower values than F-LDLC in FH patients.
- Switching from F-LDLC to M-LDLC or S-LDLC resulted in reclassification of 3.9% to 7.2% of patients to a different CVD risk category, often to a higher risk category.
Conclusions:
- M-LDLC and S-LDLC equations can significantly alter patient CVD risk stratification compared to F-LDLC.
- The discrepancy between calculated LDLC values increases with higher triglyceride and lower LDLC levels.
- Clinical laboratories should consider adopting M-LDLC or S-LDLC, with a caution against using S-LDLC in FH patients pending further research.
Background:
Limitations of the Friedewald equation for low-density-lipoprotein cholesterol (F-LDLC) calculation led to the Martin-Hopkins (M-LDLC) and Sampson-National Institutes of Health (S-LDLC) equations. We studied these newer calculations of LDLC for correlation and discordance for stratification into the Canadian Cardiovascular Society (CCS) 2021 Dyslipidemia Guidelines' cardiovascular disease (CVD) risk categories.
Methods:
We performed analyses on lipid profiles from 3 populations: records of a hospital biochemistry laboratory (population 1), lipid clinic patients without select monogenic dyslipidemias (population 2A), and lipid clinic patients with familial hypercholesterolemia (FH; population 2B).
Results:
There was very strong correlation among the 3 calculated LDLC. In populations 1 and 2A, M-LDLC and S-LDLC were progressively higher than F-LDLC as triglyceride (TG) levels increased from normal to ∼ 5 mmol/L. In population 2B, M-LDLC was higher than F-LDLC, but S-LDLC was progressively lower than F-LDLC. Using the CCS 2021 guidelines' 4 CVD risk categories, 7.0% (population 2A) to 7.2% (population 1) of cases for M-LDLC vs F-LDLC and 3.9% (population 2A) to 4.4% (population 1) of cases for S-LDLC vs F-LDLC were reclassified to an adjacent CVD risk category, mostly from a lower to a higher risk category.
Conclusions:
Switching from F-LDLC to S-LDLC or M-LDLC can reclassify up to ∼ 4.4% or 7.2% of patients, respectively, to another CCS CVD risk category. The difference between F-LDLC and M-LDLC or S-LDLC is greater with higher TG, and with lower LDLC. We recommend that clinical laboratories switch to reporting results from either M-LDLC or S-LDLC, but S-LDLC should not be used in FH patients, pending further studies.
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