Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications

Seth S. Martin, Michael J. Blaha, Mohamed B. Elshazly, Eliot A. Brinton, Peter P. Toth, John W. McEvoy, Parag H. Joshi, Krishnaji R. Kulkarni, Patrick D. Mize, Peter O. Kwiterovich, Andrew P. Defilippis, Roger S. Blumenthal, Steven R. Jones

Research output: Contribution to journalArticle

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Abstract

Objectives: The aim of this study was to compare Friedewald-estimated and directly measured low-density lipoprotein cholesterol (LDL-C) values. Background: LDL-C is routinely estimated by the Friedewald equation to guide treatment; however, compatibility with direct measurement has received relatively little scrutiny, especially at levels <70 mg/dl now targeted in high-risk patients. Methods: We examined 1,340,614 U.S. adults who underwent lipid profiling by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Following standard practice, Friedewald LDL-C was not estimated if triglyceride levels were ≥400 mg/dl (n = 30,174), yielding 1,310,440 total patients and 191,333 patients with Friedewald LDL-C <70 mg/dl. Results: Patients were 59 ± 15 years of age and 52% were women. Lipid distributions closely matched those in the National Health and Nutrition Examination Survey. A greater difference in the Friedewald-estimated versus directly measured LDL-C occurred at lower LDL-C and higher triglyceride levels. If the Friedewald-estimated LDL-C was <70 mg/dl, the median directly measured LDL-C was 9.0 mg/dl higher (5th to 95th percentiles, 1.8 to 15.4 mg/dl) when triglyceride levels were 150 to 199 mg/dl and 18.4 mg/dl higher (5th to 95th percentiles, 6.6 to 36.0 mg/dl) when triglyceride levels were 200 to 399 mg/dl. Of patients with a Friedewald-estimated LDL-C <70 mg/dl, 23% had a directly measured LDL-C ≥70 mg/dl (39% if triglyceride levels were concurrently 150 to 199 mg/dl; 59% if triglyceride levels were concurrently 200 to 399 mg/dl). Conclusions: The Friedewald equation tends to underestimate LDL-C most when accuracy is most crucial. Especially if triglyceride levels are ≥150 mg/dl, Friedewald estimation commonly classifies LDL-C as <70 mg/dl despite directly measured levels ≥70 mg/dl, and therefore additional evaluation is warranted in high-risk patients.

Original languageEnglish (US)
Pages (from-to)732-739
Number of pages8
JournalJournal of the American College of Cardiology
Volume62
Issue number8
DOIs
StatePublished - Aug 20 2013

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LDL Cholesterol
Triglycerides
Therapeutics
Lipids
Nutrition Surveys
Ultracentrifugation

Keywords

  • Friedewald equation
  • low-density lipoprotein cholesterol
  • very low density lipoprotein cholesterol

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Martin, S. S., Blaha, M. J., Elshazly, M. B., Brinton, E. A., Toth, P. P., McEvoy, J. W., ... Jones, S. R. (2013). Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. Journal of the American College of Cardiology, 62(8), 732-739. https://doi.org/10.1016/j.jacc.2013.01.079

Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. / Martin, Seth S.; Blaha, Michael J.; Elshazly, Mohamed B.; Brinton, Eliot A.; Toth, Peter P.; McEvoy, John W.; Joshi, Parag H.; Kulkarni, Krishnaji R.; Mize, Patrick D.; Kwiterovich, Peter O.; Defilippis, Andrew P.; Blumenthal, Roger S.; Jones, Steven R.

In: Journal of the American College of Cardiology, Vol. 62, No. 8, 20.08.2013, p. 732-739.

Research output: Contribution to journalArticle

Martin, SS, Blaha, MJ, Elshazly, MB, Brinton, EA, Toth, PP, McEvoy, JW, Joshi, PH, Kulkarni, KR, Mize, PD, Kwiterovich, PO, Defilippis, AP, Blumenthal, RS & Jones, SR 2013, 'Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications', Journal of the American College of Cardiology, vol. 62, no. 8, pp. 732-739. https://doi.org/10.1016/j.jacc.2013.01.079
Martin, Seth S. ; Blaha, Michael J. ; Elshazly, Mohamed B. ; Brinton, Eliot A. ; Toth, Peter P. ; McEvoy, John W. ; Joshi, Parag H. ; Kulkarni, Krishnaji R. ; Mize, Patrick D. ; Kwiterovich, Peter O. ; Defilippis, Andrew P. ; Blumenthal, Roger S. ; Jones, Steven R. / Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. In: Journal of the American College of Cardiology. 2013 ; Vol. 62, No. 8. pp. 732-739.
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abstract = "Objectives: The aim of this study was to compare Friedewald-estimated and directly measured low-density lipoprotein cholesterol (LDL-C) values. Background: LDL-C is routinely estimated by the Friedewald equation to guide treatment; however, compatibility with direct measurement has received relatively little scrutiny, especially at levels <70 mg/dl now targeted in high-risk patients. Methods: We examined 1,340,614 U.S. adults who underwent lipid profiling by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Following standard practice, Friedewald LDL-C was not estimated if triglyceride levels were ≥400 mg/dl (n = 30,174), yielding 1,310,440 total patients and 191,333 patients with Friedewald LDL-C <70 mg/dl. Results: Patients were 59 ± 15 years of age and 52{\%} were women. Lipid distributions closely matched those in the National Health and Nutrition Examination Survey. A greater difference in the Friedewald-estimated versus directly measured LDL-C occurred at lower LDL-C and higher triglyceride levels. If the Friedewald-estimated LDL-C was <70 mg/dl, the median directly measured LDL-C was 9.0 mg/dl higher (5th to 95th percentiles, 1.8 to 15.4 mg/dl) when triglyceride levels were 150 to 199 mg/dl and 18.4 mg/dl higher (5th to 95th percentiles, 6.6 to 36.0 mg/dl) when triglyceride levels were 200 to 399 mg/dl. Of patients with a Friedewald-estimated LDL-C <70 mg/dl, 23{\%} had a directly measured LDL-C ≥70 mg/dl (39{\%} if triglyceride levels were concurrently 150 to 199 mg/dl; 59{\%} if triglyceride levels were concurrently 200 to 399 mg/dl). Conclusions: The Friedewald equation tends to underestimate LDL-C most when accuracy is most crucial. Especially if triglyceride levels are ≥150 mg/dl, Friedewald estimation commonly classifies LDL-C as <70 mg/dl despite directly measured levels ≥70 mg/dl, and therefore additional evaluation is warranted in high-risk patients.",
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T1 - Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications

AU - Martin, Seth S.

AU - Blaha, Michael J.

AU - Elshazly, Mohamed B.

AU - Brinton, Eliot A.

AU - Toth, Peter P.

AU - McEvoy, John W.

AU - Joshi, Parag H.

AU - Kulkarni, Krishnaji R.

AU - Mize, Patrick D.

AU - Kwiterovich, Peter O.

AU - Defilippis, Andrew P.

AU - Blumenthal, Roger S.

AU - Jones, Steven R.

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Y1 - 2013/8/20

N2 - Objectives: The aim of this study was to compare Friedewald-estimated and directly measured low-density lipoprotein cholesterol (LDL-C) values. Background: LDL-C is routinely estimated by the Friedewald equation to guide treatment; however, compatibility with direct measurement has received relatively little scrutiny, especially at levels <70 mg/dl now targeted in high-risk patients. Methods: We examined 1,340,614 U.S. adults who underwent lipid profiling by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Following standard practice, Friedewald LDL-C was not estimated if triglyceride levels were ≥400 mg/dl (n = 30,174), yielding 1,310,440 total patients and 191,333 patients with Friedewald LDL-C <70 mg/dl. Results: Patients were 59 ± 15 years of age and 52% were women. Lipid distributions closely matched those in the National Health and Nutrition Examination Survey. A greater difference in the Friedewald-estimated versus directly measured LDL-C occurred at lower LDL-C and higher triglyceride levels. If the Friedewald-estimated LDL-C was <70 mg/dl, the median directly measured LDL-C was 9.0 mg/dl higher (5th to 95th percentiles, 1.8 to 15.4 mg/dl) when triglyceride levels were 150 to 199 mg/dl and 18.4 mg/dl higher (5th to 95th percentiles, 6.6 to 36.0 mg/dl) when triglyceride levels were 200 to 399 mg/dl. Of patients with a Friedewald-estimated LDL-C <70 mg/dl, 23% had a directly measured LDL-C ≥70 mg/dl (39% if triglyceride levels were concurrently 150 to 199 mg/dl; 59% if triglyceride levels were concurrently 200 to 399 mg/dl). Conclusions: The Friedewald equation tends to underestimate LDL-C most when accuracy is most crucial. Especially if triglyceride levels are ≥150 mg/dl, Friedewald estimation commonly classifies LDL-C as <70 mg/dl despite directly measured levels ≥70 mg/dl, and therefore additional evaluation is warranted in high-risk patients.

AB - Objectives: The aim of this study was to compare Friedewald-estimated and directly measured low-density lipoprotein cholesterol (LDL-C) values. Background: LDL-C is routinely estimated by the Friedewald equation to guide treatment; however, compatibility with direct measurement has received relatively little scrutiny, especially at levels <70 mg/dl now targeted in high-risk patients. Methods: We examined 1,340,614 U.S. adults who underwent lipid profiling by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Following standard practice, Friedewald LDL-C was not estimated if triglyceride levels were ≥400 mg/dl (n = 30,174), yielding 1,310,440 total patients and 191,333 patients with Friedewald LDL-C <70 mg/dl. Results: Patients were 59 ± 15 years of age and 52% were women. Lipid distributions closely matched those in the National Health and Nutrition Examination Survey. A greater difference in the Friedewald-estimated versus directly measured LDL-C occurred at lower LDL-C and higher triglyceride levels. If the Friedewald-estimated LDL-C was <70 mg/dl, the median directly measured LDL-C was 9.0 mg/dl higher (5th to 95th percentiles, 1.8 to 15.4 mg/dl) when triglyceride levels were 150 to 199 mg/dl and 18.4 mg/dl higher (5th to 95th percentiles, 6.6 to 36.0 mg/dl) when triglyceride levels were 200 to 399 mg/dl. Of patients with a Friedewald-estimated LDL-C <70 mg/dl, 23% had a directly measured LDL-C ≥70 mg/dl (39% if triglyceride levels were concurrently 150 to 199 mg/dl; 59% if triglyceride levels were concurrently 200 to 399 mg/dl). Conclusions: The Friedewald equation tends to underestimate LDL-C most when accuracy is most crucial. Especially if triglyceride levels are ≥150 mg/dl, Friedewald estimation commonly classifies LDL-C as <70 mg/dl despite directly measured levels ≥70 mg/dl, and therefore additional evaluation is warranted in high-risk patients.

KW - Friedewald equation

KW - low-density lipoprotein cholesterol

KW - very low density lipoprotein cholesterol

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