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Evaluation of current indirect methods for measuring LDL-cholesterol

Objectives Accurately quantifying low-density lipoprotein cholesterol (LDL-C) is crucial for precise cardiovascular disease risk assessment and treatment decisions. The commonly used Friedewald equation (LDL-C FW ) has faced criticism for its tendency to underestimate LDL-C, particularly at high tri...

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Main Authors: Drobnik, Sophia (Author) , Scharnagl, Hubert (Author) , Samani, Nilesh J. (Author) , Braund, Peter S. (Author) , Nelson, Christopher P. (Author) , Hollstein, Tim (Author) , Kassner, Ursula (Author) , Dressel, Alexander (Author) , Drobnik, Wolfgang (Author) , März, Winfried (Author)
Format: Article (Journal)
Language:English
Published: 1. Mai 2025
In: Clinical chemistry and laboratory medicine
Year: 2025, Volume: 63, Issue: 6, Pages: 1099-1108
ISSN:1437-4331
DOI:10.1515/cclm-2025-0024
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1515/cclm-2025-0024
Verlag, lizenzpflichtig, Volltext: https://www.degruyterbrill.com/document/doi/10.1515/cclm-2025-0024/html
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Author Notes:Sophia Drobnik, Hubert Scharnagl, Nilesh J. Samani, Peter S. Braund, Christopher P. Nelson, Tim Hollstein, Ursula Kassner, Alexander Dressel, Wolfgang Drobnik und Winfried März
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Summary:Objectives Accurately quantifying low-density lipoprotein cholesterol (LDL-C) is crucial for precise cardiovascular disease risk assessment and treatment decisions. The commonly used Friedewald equation (LDL-C FW ) has faced criticism for its tendency to underestimate LDL-C, particularly at high triglycerides (TG) or low LDL-C, potentially leading to undertreatment. Newer equations, such as those by Martin and Hopkins (LDL-C MH ) or Sampson (LDL-C SN ), have been proposed as alternatives. Our study aimed to assess the validity of LDL-C FW , LDL-C MH , and LDL-C SN compared to ß-quantification (LDL-C UC ), the reference method recommended by the Lipid Research Clinics. Methods Using data from three studies comprising 5,738 datasets, LDL-C was determined with the four methods in samples with TG up to 5.65mmol/L. We calculated median and mean differences, correlations, and used the Passing and Bablok regression for comparisons. Concordance/discordance analyses were conducted. Results All equations provided generally accurate LDL-C estimations with slight differences among them. At TG<1.69mmol/L, no clinically significant divergences were observed. As TG values increased, LDL-C FW offered the most accurate estimation, followed by LDL-C SN , while LDL-C MH exhibited increasingly strong positive bias. LDL-C FW was not inferior to LDL-C SN and LDL-C MH in terms of concordance/discordance. Conclusions LDL-C FW generally provided reliable estimates of LDL-C in most samples, showing non-inferiority to LDL-C SN or LDL-C MH , thereby confirming its legitimacy for routine use. Since current treatment recommendations are based on studies employing LDL-C FW , its replacement by alternatives is not justified.
Item Description:Online veröffentlicht: 19. Februar 2025
Gesehen am 11.06.2025
Physical Description:Online Resource
ISSN:1437-4331
DOI:10.1515/cclm-2025-0024

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