Friedewald formula may be used to calculate non-HDL-C from LDL-C and TG

The Friedewald formula (FF) was originally designed 50 years ago and has been in use to this day despite better methods for estimating LDL cholesterol (LDL-C). Its success was mainly due to its simplicity. Nowadays most laboratories determine or can determine LDL-C by the direct method. The SCORE2 tables, recommended by the European Society of Cardiology, are based on non-HDL cholesterol (non-HDL-C). To calculate its value, one needs to know the values of total cholesterol (TC) and HDL-C. The presented idea is to use the FF to calculate non-HDL-C based on the values of LDL-C and TG instead of TC and HDL-C.

Based on database of 26,914 laboratory results, covering the complete lipid panel, the error regarding non-HDL-C values calculated in both ways (recommended and proposed) was determined. The average error in the LDL-C value calculated with the FF compared to the LDL-C value measured in the laboratory is 9.77%, while for non-HDL-C the error between the calculated and laboratory-determined value amounts to 8.88%. The proposed transformation of the FF also yields a much lower percentage of error calculations. Both LDL-C and non-HDL-C (calculated) in our material are strongly correlated with LDL-C and non-HDL-C (measured) values of r = 0.965 (p < 0.000) and r = 0.962 (p < 0.000), respectively.

Non-HDL-C may be calculated based on the values of LDL-C and TG (without the need to determine the levels of TC and HDL-C). The proposed calculation may greatly reduce the cost of testing, given the price of a complete lipid profile.