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Performance of equations for calculated LDL-C in hypertriglyceridaemia: Which one correlates best with directly

Nicolene Steyn1, H Muller Rossouw1, Janine Martins1

  • 1Department of Chemical Pathology, Faculty of Health Sciences and National Health Laboratory Service, Tshwane Academic Division, University of Pretoria, Pretoria, South Africa.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|May 4, 2023
PubMed

Insights

The Extended Martin-Hopkins (E-MH) equation better estimates low-density lipoprotein cholesterol (LDL-C) in hypertriglyceridaemia than the S-NIH2 equation. E-MH is less likely to underestimate LDL-C, improving diagnosis for patients needing treatment.

Area of Science:

  • Clinical Chemistry
  • Cardiovascular Diagnostics
  • Lipid Metabolism

Background:

  • Direct measurement of low-density lipoprotein cholesterol (LDL-C) is challenging.
  • Traditional predictive equations for LDL-C have limitations, especially with elevated triglycerides (TG).
  • Newer equations require validation for accuracy in hypertriglyceridaemia.

Purpose of the Study:

  • To compare the accuracy of the Sampson-National Institutes of Health 2 (S-NIH2) and Extended Martin-Hopkins (E-MH) equations for LDL-C estimation.
  • To evaluate these equations against direct LDL-C (dLDL-C) measurements in a large cohort, particularly in individuals with hypertriglyceridaemia.
  • To determine which equation performs better on different laboratory platforms.

Main Methods:

  • Utilized datasets from 64,765 individuals across two platforms (Abbott Architect and Roche Cobas).
  • Compared LDL-C values calculated by S-NIH2 and E-MH equations with dLDL-C assay results.
  • Analyzed performance across different TG levels, focusing on the range of 4.52–9.04 mmol/L.

Main Results:

  • The S-NIH2 equation tended to underestimate LDL-C, while the E-MH equation tended to overestimate it within the 4.52–9.04 mmol/L TG range.
  • Both equations showed better correlation with dLDL-C on the Abbott platform compared to Roche.
  • The E-MH equation demonstrated superior concordance with dLDL-C across both platforms.

Conclusions:

  • The E-MH equation provides a more accurate correlation with dLDL-C than the S-NIH2 equation, even with TG levels up to 9.04 mmol/L.
  • In cases of hypertriglyceridaemia, the E-MH equation is less prone to underestimating LDL-C compared to S-NIH2.
  • Utilizing the E-MH equation may reduce the underdiagnosis of patients requiring LDL-C-lowering treatment.
Abstract

Keywords:
Calculated LDL-cholesterolExtended Martin-Hopkins equationFriedewaldLow-density lipoprotein cholesterol equationSampson/NIHSouth Africa

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