Comparison of the Friedewald, Martin/Hopkins, and Sampson Equations for Calculating Low-Density Lipoprotein Cholesterol
Öz
Abstract
Background/Aims: Ultracentrifugation, which is the reference method for low-density lipoprotein-cholesterol measurement, has been replaced by direct assays because it is not practical in standard clinical laboratories. However, due to the high cost and limited added value of direct assays, predictive equations are used. In this study, our aim was to compare the predictive performances of the Friedewald, Martin/Hopkins and Sampson equations to a direct assay when the triglyceride level is below 400 mg/dL
Methods: A total of 8,632 lipid profiles analyzed with Abbott Architect c8000 and c400 devices (Abbott Laboratories, Abbott Park, IL,) were included in the study. Those that misclassified patients based on low-density lipoprotein-cholesterol thresholds of 70 mg/dL and 190 mg/dL were identified as clinically relevant errors.
Results: The percentage of results meeting desirable bias specifications (±5.4%) was 52.5%, 58.2%, and 56.2% in the Friedewald, Martin/Hopkins, and Sampson equations, respectively. The percentage of results meeting the total allowable error specifications (±11.8%) was 84%, 89.1% and 87.7% in the Friedewald, Martin/Hopkins and Sampson equations, respectively. The Friedewald, Martin/Hopkins and Sampson equations showed negative proportional biases with a median bias of −2.3%, -1.9% and -0.7%, respectively. When triglyceride level was between 200–399 mg/dL, the median percentage bias was -8.2% for the Friedewald equation which exceeded the desirable bias criteria. The rates of clinically relevant errors for the Friedewald, Martin/Hopkins, and Sampson equations were 6%, 4.9%, and 5.5%, respectively.
Conclusions: Our comparative analysis of LDL-C estimation equations using the Abbott platform within the Turkish population reveals that while the Martin/Hopkins and Sampson equations exhibit only marginal differences in performance, both demonstrate superior accuracy relative to the Friedewald equation. Although the Martin/Hopkins yields marginally preferable outcomes, Sampson equation remains a clinically viable alternative.
Anahtar Kelimeler
Low-Density Lipoprotein Cholesterol, Cardiovascular Disease, Friedewald Equation, Bias
Destekleyen Kurum
none
Proje Numarası
none
Etik Beyan
The study followed the guidelines set forth in the Declaration of Helsinki, and the procedures were approved by the Ethics Committee of Fenerbahçe University (no: 20.2025fbu, date:19.02.2025).
Teşekkür
none
Kaynakça
- 1. Di Cesare M, Perel P, Taylor S, Kabudula C, Bixby H, Gaziano TA, et al. The Heart of the World. Glob Heart. 2024;19(1):11.
- 2. Borén J, Chapman MJ, Krauss RM, Packard CJ, Bentzon JF, Binder CJ, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020;41(24):2313-30.
- 3. Mhaimeed O, Burney ZA, Schott SL, Kohli P, Marvel FA, Martin SS. The importance of LDL-C lowering in atherosclerotic cardiovascular disease prevention: Lower for longer is better. Am J Prev Cardiol. 2024;18:100649.
- 4. Nakamura M, Kayamori Y, Iso H, Kitamura A, Kiyama M, Koyama I, et al. LDL cholesterol performance of beta quantification reference measurement procedure. Clin Chim Acta. 2014;431:288-93.
- 5. Chapman MJ, Goldstein S, Lagrange D, Laplaud PM. A density gradient ultracentrifugal procedure for the isolation of the major lipoprotein classes from human serum. J Lipid Res. 1981;22(2):339-58.
- 6. Islam SMT, Osa-Andrews B, Jones PM, Muthukumar AR, Hashim I, Cao J. Methods of Low-Density Lipoprotein-Cholesterol Measurement: Analytical and Clinical Applications. Ejifcc. 2022;33(4):282-94.
- 7. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
- 8. Martin SS, Giugliano RP, Murphy SA, Wasserman SM, Stein EA, Ceška R, et al. Comparison of Low-Density Lipoprotein Cholesterol Assessment by Martin/Hopkins Estimation, Friedewald Estimation, and Preparative Ultracentrifugation: Insights From the FOURIER Trial. JAMA Cardiol. 2018;3(8):749-53.
- 9. Sampson M, Ling C, Sun Q, Harb R, Ashmaig M, Warnick R, et al. A New Equation for Calculation of Low-Density Lipoprotein Cholesterol in Patients With Normolipidemia and/or Hypertriglyceridemia. JAMA Cardiol. 2020;5(5):540-8.
- 10. Aarsand AK F-CP, Webster C, Coskun A, Gonzales-Lao E, Diaz-Garzon J, Jonker N, Simon M, Braga F, Perich C, Boned B, Marques-Garcia F, Carobene A, Aslan B, Sezer E, Bartlett WA, Sandberg S. The EFLM Biological Variation Database. https://biologicalvariationeu.