LDL-C Estimation Equation Performance Characteristics Highlight Value of Preferentially Using Non-HDL Cholesterol or Directly Measured Apolipoprotein B

Limitations of the Friedewald equation when triglyceride (TG) is elevated or low-density lipoprotein-cholesterol (LDL-C) is low have motivated development of the Martin-Hopkins and Sampson-National Institutes of Health (NIH) alternatives. We compared the 3 over a broad range of total cholesterol (TC), TG, and high-density lipoprotein-cholesterol (HDL-C). With high TC and TG, Sampson-NIH yields similar or lower LDL-C than Friedewald. At levels of LDL-C commonly used to stratify therapy, the alternate LDL-C values may create variance in clinical decisions. These observations reinforce the value of directly measured apolipoprotein B or consideration of non-HDL-C to overcome limitations of all 3 methods.