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Friedewald and Martin-Hopkins formulae for estimating low-density lipoprotein cholesterol in a Malagasy population
Faralahy H Rakotonjafiniarivo1, Tokinomenjanahary Antsonantenaina1, Mahefa S Rakotomalala1
1Department of Biology, Faculty of Medicine, Antananarivo University, Antananarivo, Madagascar.
Background:
Low-density lipoprotein cholesterol (LDL-C) estimation is commonly used in Madagascar due to cost-effectiveness. However, genetic variability and formula limitations may affect accuracy.
Objective:
To compare LDL-C estimated by the Friedewald and Martin-Hopkins formulae with directly measured LDL-C in a Malagasy population.
Methods:
LDL-C values estimated using both formulae were compared with direct LDL-C in 346 samples from patients ≥ 18 years analysed in a biochemistry laboratory. Samples were divided into four groups based on triglyceride levels: < 1.13 mmol/L; 1.13 mmol/L - 1.69 mmol/L; 1.69 mmol/L - 2.26 mmol/L; ≥ 2.26 mmol/L.
Results:
Both formulae showed a strong, statistically significant correlation with direct LDL-C (r = 0.89). Mean comparison revealed overestimation by both formulae, more pronounced with Friedewald (mean difference 0.15 mmol/L) than Martin-Hopkins (0.21 mmol/L). Differences increased with rising triglyceride levels. Both formulae demonstrated good agreement with direct measurement, acceptable biases and similar limits, but Friedewald had a lower overall percentage error.
Conclusion:
The Friedewald formula showed better correlation, higher concordance and lower mean difference than Martin-Hopkins. Both formulae showed limitations depending on triglyceride concentration.
What This Study Adds:
This study evaluates Friedewald and Martin-Hopkins LDL-C estimation against direct measurement in a Malagasy population, highlighting their validity in Africa and implications for clinical decisions in resource-limited settings.
