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New modified Friedewald formulae for estimating low-density lipoprotein cholesterol according to triglyceride levels: extraction and validation

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Abstract

Purpose

The most commonly used method for estimating low-density lipoprotein cholesterol (LDLC) is Friedewald formula (FF). This study aims to extract and validate new modified Friedewald formulae for estimating LDLC according to triglyceride (TG) levels in Iranians.

Methods

Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), LDLC, and TG were measured in 5030 fasted subjects. The original FF was used for estimating LDLC. Data were divided into training and validation data sets. For extracting modified Friedewald formulae, linear regression was used with TG as independent and TC, HDLC, and directly measured LDLC (D-LDLC) as dependent variables, respectively. An overall modified formula was extracted for TG concentrations <400 mg/dL. The specific modified formulae were extracted for different TG categories. The performance of the modified formulae was assessed in the validation data set.

Results

The overall derived formula for calculating LDLC was M-LDLC = TC–HDLC–TG/4. The coefficients of TG (specific TG terms) in modified formulae were 2.7, 3.7, 4.6, and 5 for TG <100, 100–200, 200–300, and 300–400 mg/dL, respectively. Compared to the original FF, applying a new modified formula with TG/4 to a validation data set provided a less mean difference (4.03 vs. 10.86 mg/dL), greater kappa coefficient (0.691 vs. 0.505), and better subject classification (80.8 vs. 67.1%). After applying modified formulae with specific TG terms, the difference between M-LDLC and D-LDLC decreased to 1.41 mg/dL.

Conclusions

Modified formulae were developed and validated for LDLC estimation that compared to the original FF, provided more accurate estimation of LDLC and better classification of subjects. These findings shall be useful for preventive, diagnostic, and therapeutic purposes.

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Acknowledgements

This work was supported by the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences (grant number: 704). The authors would like to thank Mr. A. Khoshbakhti for his technical laboratory assistance.

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Authors and Affiliations

  1. Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Asghar Ghasemi

  2. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Samaneh Asgari, Farzad Hadaegh, Iraj Azimzadeh & Maryam Tohidi

  3. Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran

    Masoumeh Kheirandish

  4. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

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  1. Asghar Ghasemi
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Correspondence to Maryam Tohidi.

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Ghasemi, A., Asgari, S., Hadaegh, F. et al. New modified Friedewald formulae for estimating low-density lipoprotein cholesterol according to triglyceride levels: extraction and validation. Endocrine 62, 404–411 (2018). https://doi.org/10.1007/s12020-018-1685-2

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