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LDL-C Estimation in Ghana: A Comparative Study of 13 Calculation Methods
Samuel Asamoah Sakyi1, Linda Ahenkorah Fondjo1, Raphael Osei Mensah-Bonsu2
1Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, knust.edu.gh.
Background:
Friedewald's equation remains the most widely used method for estimating LDL-C in clinical settings, despite the availability of several homogeneous direct assays. However, its accuracy declines under certain clinical conditions, such as unusually high or low levels of triglycerides and total cholesterol. Recently, several novel population-specific equations have been reported to outperform the Friedewald equation. This study therefore is aimed at evaluating and comparing the accuracy of 13 LDL-C estimation equations within the Ghanaian population.
Methods:
A cross-sectional study was conducted among 976 individuals at Suntreso Government Hospital, Kumasi, Ghana. Fasting venous blood samples were analyzed for lipid profiles. Direct LDL-C was enzymatically measured and compared with values calculated using 13 equations. Performance was assessed with Pearson correlations, Bland-Altman plots, and Wilcoxon signed-rank tests.
Results:
All 13 equations correlated significantly with direct LDL-C (r = 0.563-0.857, p < 0.001), with DeLong, Puavilai, Vujovic, Sampson, Choi, and Martin showing the strongest correlations (r = 0.857). Ahmadi (71.39 mg/dL), Hattori (44.93 mg/dL), Rao (25.8 mg/dL), and Choi (19.58 mg/dL) were the most overestimated LDL-C formulas, while de Cordova (-5.59 mg/dL) underestimated the direct LDL-C measurement. Subgroup analyses by age, triglyceride, and total cholesterol levels revealed that the Friedewald and Chen and Zhang formulas exhibited nonsignificant median differences (p > 0.05) in individuals aged 18-55 years and those with triglyceride levels ≥ 200 mg/dL.
Conclusion:
The Sampson, Martin, and Puavilai equations demonstrated the most reliable and consistent performance across age and lipid subgroups and should be considered preferred methods for LDL-C estimation in clinical and research settings in Ghana. Although Friedewald and Chen and Zhang performed adequately in younger adults and individuals with elevated triglycerides, their overall agreement was weaker, highlighting the broader utility of the Sampson, Martin, and Puavilai equations.
