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Related Experiment Video

Updated: Jun 27, 2026

Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
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Comparison of Four Formulas for Calculating LDL-Cholesterol with the Direct Homogeneous Method.

Bosa Mirjanic-Azaric1,2, Vera Lukić3, Bojana Ivetic2

  • 1Department of Medical Biochemistry, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina.

Biomedicines
|June 26, 2026
PubMed
Summary

The Spasić-Kotur-Vujović formula offers superior accuracy for estimating low-density lipoprotein cholesterol (LDL-C) compared to Friedewald, De Long, and Martin-Hopkins formulas. This finding is crucial for accurate cardiovascular risk assessment in clinical practice.

Keywords:
De Long formulaFriedewald formulaLDL-C estimation equationsLDL-cholesterolMartin–Hopkins formulaSpasić–Kotur–Vujović formula

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Area of Science:

  • Clinical Chemistry
  • Cardiovascular Risk Assessment
  • Lipid Metabolism

Background:

  • Low-density lipoprotein cholesterol (LDL-C) is a key target for cardiovascular disease risk management.
  • Direct LDL-C measurement is available, but estimation formulas are commonly used.
  • The accuracy of LDL-C estimation formulas can vary significantly across different populations and lipid concentrations.

Purpose of the Study:

  • To compare the analytical agreement and clinical classification performance of four LDL-C estimation formulas against direct measurement.
  • To identify the most reliable formula for routine laboratory use in estimating LDL-C.

Main Methods:

  • Lipid profiles from 3935 adult patients were analyzed.
  • Direct LDL-C measurement was performed using a homogeneous assay.
  • Four formulas (Spasić-Kotur-Vujović, Friedewald, De Long, Martin-Hopkins) were evaluated against direct LDL-C using regression and Bland-Altman analyses.

Main Results:

  • The Spasić-Kotur-Vujović formula demonstrated the closest agreement with directly measured LDL-C, showing the lowest bias and narrowest limits of agreement.
  • All formulas exhibited strong correlations (r > 0.956) but systematically underestimated LDL-C, with underestimation increasing at higher lipid levels.
  • Spasić-Kotur-Vujović achieved the highest classification accuracy (70%), outperforming De Long (68%), Martin-Hopkins (61%), and Friedewald (58%).

Conclusions:

  • Clinically significant differences in bias and classification accuracy exist among LDL-C estimation formulas.
  • The Spasić-Kotur-Vujović formula is a more reliable tool for routine LDL-C estimation in this population compared to the others evaluated.
  • Findings are specific to the Abbott Alinity c platform's homogeneous LDL-C assay and may not generalize to all analytical systems.