Accuracy and Clinical Impact of Estimating Low-Density Lipoprotein-Cholesterol at High and Low Levels by Different Equations

• Published in: Biomedicines Vol. 10; no. 12; p. 3156
• Main Authors: Sampson, Maureen, Wolska, Anna, Cole, Justine, Zubirán, Rafael, Otvos, James D, Meeusen, Jeff W, Donato, Leslie J, Jaffe, Allan S, Remaley, Alan T
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.12.2022; MDPI
• Subjects: Accuracy; Bias; Biomarkers; cardiovascular disease risk; Cholesterol; Cholesterol, LDL; Health aspects; High density lipoprotein; Lipids; Lipoproteins; Low density lipoprotein; low-density lipoproteins; Medical laboratories; Prevention; Regression analysis; Statins; triglyceride; Triglycerides; United States; United States > US; triglyceride; low-density lipoproteins; cholesterol; cardiovascular disease risk
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines10123156

New more effective lipid-lowering therapies have made it important to accurately determine Low-density lipoprotein-cholesterol (LDL-C) at both high and low levels. LDL-C was measured by the β-quantification reference method (BQ) (N = 40,346) and compared to Friedewald (F-LDL-C), Martin (M-LDL-C), extended Martin (eM-LDL-C) and Sampson (S-LDL-C) equations by regression analysis, error-grid analysis, and concordance with the BQ method for classification into different LDL-C treatment intervals. For triglycerides (TG) < 175 mg/dL, the four LDL-C equations yielded similarly accurate results, but for TG between 175 and 800 mg/dL, the S-LDL-C equation when compared to the BQ method had a lower mean absolute difference (mg/dL) (MAD = 10.66) than F-LDL-C (MAD = 13.09), M-LDL-C (MAD = 13.16) or eM-LDL-C (MAD = 12.70) equations. By error-grid analysis, the S-LDL-C equation for TG > 400 mg/dL not only had the least analytical errors but also the lowest frequency of clinically relevant errors at the low (<70 mg/dL) and high (>190 mg/dL) LDL-C cut-points (S-LDL-C: 13.5%, F-LDL-C: 23.0%, M-LDL-C: 20.5%) and eM-LDL-C: 20.0%) equations. The S-LDL-C equation also had the best overall concordance to the BQ reference method for classifying patients into different LDL-C treatment intervals. The S-LDL-C equation is both more analytically accurate than alternative equations and results in less clinically relevant errors at high and low LDL-C levels.