Skip to main content

Advertisement

Log in

Does LDL-C Estimation Using Anandaraja’s Formula Give a Better Agreement with Direct LDL-C Estimation than the Friedewald’s Formula?

  • Original Article
  • Published:
Indian Journal of Clinical Biochemistry Aims and scope Submit manuscript

Abstract

Estimation of low density lipoprotein cholesterol (LDL-C) is crucial in management of coronary artery disease patients. Though a number of homogenous assays are available for estimation of LDL-C, use of calculated LDL-C by Friedewald’s formula (FF) is common in Indian laboratories for logistic reasons. Recently Anandaraja and colleagues have derived a new formula for calculating LDL-C. This formula needs to be evaluated before it is extensively applied in diagnosis. We measured LDL-C by homogenous method (D-LDL-C) in 515 fasting samples. Friedewald’s and Anandaraja’s formulas were used for calculation of LDL-C (F-LDL-C and A-LDL-C, respectively). The mean LDL-C levels were 123.3 ± 53.2, 112.4 ± 50.2 and 109.2 ± 49.8 mg/dl for D-LDL-C, F-LDL-C and A-LDL-C, respectively. There was a statistically significant difference between the results (P > 0.001) obtained by calculation formulas compared to the measured LDL-C. There was underestimation of LDL-C by 10.8 and 14 mg/dl by Friedewald’s and Anandaraja’s formulas respectively. The Pearson’s correlation between F-LDL-C and D-LDL-C was 0.931 and that between A-LDL-C and D-LDL-C was 0.930. Bland–Altman graphs showed a definite agreement between mean and differences of the calculation formulas and direct LDL-C with 95% of values lying with in ±2 SD limits. The mean percentage difference (calculated as {(Calculated LDL-C)-(D-LDL-C)}/D-LDL-C × 100) for F-LDL-C was maximum (−11.6%) at HDL-C ≥ 60 mg/dl and TG levels of 200–300 mg/dl (−10.4%) compared to D-LDL-C. A-LDL-C results gave highest mean percentage difference at total cholesterol concentrations <100 mg/dl (−37.3%) and HDL-C < 40 mg/dl (−17.1%), respectively. The results of our study showed that FF is better in agreement with D-LDL-C than Anandaraja’s formula for estimation of LDL-C by calculation though both lead to its underestimation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–9.

    Google Scholar 

  2. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group: prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349–57.

    Google Scholar 

  3. Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis. J Am Med Assoc. 2001;285:2481–5.

    Article  CAS  Google Scholar 

  4. Keevil JG, Cullen MW, Gangnon R, McBride PE, Stein JH. Implications of cardiac risk and low density lipoprotein cholesterol distributions in the United States for the diagnosis and treatment of dyslipidemia: data from National Health and Nutrition Examination Survey 1999 to 2002. Circulation. 2007;115:1363–70.

    Article  PubMed  CAS  Google Scholar 

  5. National Cholesterol Education Program (NCEP) Expert panel. Third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and treatment of high cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.

    Google Scholar 

  6. Bachorik PS. Measurement of low density lipoprotein cholesterol. In: Rifai N, Warnick GR, Dominiczak MH, editors. Handbook of lipoprotein testing. Washington: AACC Press; 1997. p. 145–60.

    Google Scholar 

  7. Turkalp I, Cil Z, Ozkazanç D. Analytical performance of a direct assay for LDL-cholesterol: a comparative assessment versus Friedewald’s formula—original investigation. Anadolu Kardiyol Derg. 2005;5:13–7.

    PubMed  Google Scholar 

  8. Friedewald WT, Levy Rl, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.

    PubMed  CAS  Google Scholar 

  9. McNamara JR, Cohn JS, Wilson PW, Schaefer EJ. Calculated values for low density lipoprotein cholesterol in the assessment of lipid abnormalities and coronary disease risk. Clin Chem. 1990;36:36–42.

    PubMed  CAS  Google Scholar 

  10. Rubies-Prat J, Revere RJ, Senti M, et al. Calculated low-density lipoprotein cholesterol should not be used for management of lipoprotein abnormalities in patients with diabetes mellitus. Diabetes Care. 1993;16:1081–6.

    Article  PubMed  CAS  Google Scholar 

  11. Bachorik PS, Ross JW. National Education Program recommendations for measurements of low density lipoprotein cholesterol: executive summary. National Cholesterol Education Program Working Group on Lipoprotein Measurements. Clin Chem. 1995;41:1414–20.

    PubMed  CAS  Google Scholar 

  12. Kamal AHM, Hossain M, Chowdhury S, Mahmud NU. A comparison of calculated with direct measurement of low density lipoprotein cholesterol level. JCMCTA. 2009;20:19–23.

    Google Scholar 

  13. Miller WG, Waymack PP, Anderson FP, Ethridge SF, Jayne EC. Performance of four homogenous direct methods for LDL-cholesterol. Clin Chem. 2002;48:489–98.

    PubMed  CAS  Google Scholar 

  14. Nauck M, Warnick GR, Rifai N. Methods for measurement of LDL-cholesterol: a critical assessment of direct measurement by homogenous assays versus calculation. Clin Chem. 2002;48:236–54.

    PubMed  CAS  Google Scholar 

  15. Sakaue T, Hirano T, Yoshino G, Sakai K, Takeuchi H, Adachi M. Reactions of direct LDL cholesterol assays with pure LDL fraction and LDL: comparison of three homogenous methods. Clin Chim Acta. 2000;295:97–106.

    Article  PubMed  CAS  Google Scholar 

  16. Sahu S, Chawla R, Uppal B. Comparison of two methods of estimation of low density lipoprotein cholesterol. The direct versus Friedewald estimation. Ind J Clin Biochem. 2005;20:54–61.

    Article  CAS  Google Scholar 

  17. Anandaraja S, Narang R, Godeswar R, Laksmy R, Talwar KK. Low density lipoprotein cholesterol estimation by a new formula in Indian population. Int J Cardiol. 2005;102:117–20.

    Article  PubMed  CAS  Google Scholar 

  18. Gasko R. Low density lipoprotein cholesterol estimation by the Anandaraja’s formula-confirmation. Lipids Health Dis. 2006;5:18.

    Article  PubMed  Google Scholar 

  19. Gazi IF, Elisaf M. LDL-cholesterol calculation formulas in patients with or without the metabolic syndrome. Int J Cardiol. 2007;119:414–5.

    Article  PubMed  Google Scholar 

  20. Meiattini F, Prencipe L, Bardeii F, Giannini G, Tarli P. The 4-hydroxybenzoate/4-aminophenazone chromogenic system used in the enzymatic determination of serum cholesterol. Clin Chem. 1978;24:2161–5.

    PubMed  CAS  Google Scholar 

  21. Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem. 1982;28:2077–80.

    PubMed  CAS  Google Scholar 

  22. Rifai N, Bachorik PS, Albers JJ. Lipids, lipoproteins and apolipoproteins. In: Burtis CA, Ashwood ER, editors. Tietz textbook of clinical chemistry. 3rd ed. New Delhi: WB Saunders Company; 1998. p. 809–61.

    Google Scholar 

  23. Nauck M, Graziani MS, Bruton D, et al. Analytical and clinical performance of a detergent based homogenous LDL-cholesterol assay: a multicenter evaluation. Clin Chem. 2000;46:506–14.

    PubMed  CAS  Google Scholar 

  24. Nakanishi N, Matsuo Y, Yoneka H, Nakamura K, Suzuki K, Tatara K. Validity of the conventional indirect methods including Friedewald method for determining serum low density lipoprotein cholesterol level: comparison with the direct homogenous enzymatic analysis. J Occup Health. 2002;42:130–7.

    Article  Google Scholar 

  25. Bairaktari ET, Tzallas C, Kalientzidou M, et al. Evaluation of alternative calculation methods for determining low density lipoprotein cholesterol (LDL-C) in haemodialysis patients. Clin Biochem. 2004;37:937–40.

    Article  PubMed  CAS  Google Scholar 

  26. Wagner AM, Zapico E, Bonet R, Perez A, Oedonez-Llanos J. The effect of VLDL particles on the accuracy of a direct LDL-cholesterol method in type 2 diabetic patients. Clin Biochem. 2003;36:177–83.

    Article  PubMed  CAS  Google Scholar 

  27. Chen Y, Zhang X, Pan B, et al. A modified formula for calculating low density lipoprotein cholesterol values. Lipids Health Dis. 2010;9:52.

    Article  PubMed  Google Scholar 

  28. Faas FH, Earleywine A, Smith WG, Simmons DL. How should low-density lipoprotein cholesterol concentration be determined? J Fam Pract. 2002;51:973–5.

    Google Scholar 

  29. Kamezaki F, Sonoda S, Nakata S, Otsuji Y. A direct measurement for LDL-cholesterol increases hypercholesterolemia prevalence: comparison with Friedewald calculation. J UOEH. 2010;32:211–20.

    PubMed  CAS  Google Scholar 

  30. Vujovic A, Stevulijevic JK, Spasic S, et al. Evaluation of different formulas for LDL-C calculation. Lipids Health Dis. 2010;9:27.

    Article  PubMed  Google Scholar 

  31. Agrawal M, Spencer HJ, Faas FH. Method of LDL cholesterol measurement influences classification of LDL cholesterol treatment goals: clinical research study. J Investig Med. 2010;58:945–9.

    PubMed  CAS  Google Scholar 

  32. Paz E, Hermida J, Bouzas L, Brenlla J, Tutor JC. LDL cholesterol estimation using the Anandaraja’s and Friedewald’s formulas in schizophrenic patients treated with antipsychotic drugs. Clin Biochem. 2008;41:1002–7.

    Article  PubMed  CAS  Google Scholar 

  33. Jun KR, Park HI, Chun S, Park H, Min WK. Effects of total cholesterol and triglyceride on the percentage difference between the low-density lipoprotein cholesterol concentrations measured directly and calculated using the Friedewald formula. Clin Chem Lab Med. 2008;46:371–5.

    Article  PubMed  CAS  Google Scholar 

  34. Grundy SM, Cleeman JI, Merz NB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2005;110:227–39.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shalini Gupta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, S., Verma, M. & Singh, K. Does LDL-C Estimation Using Anandaraja’s Formula Give a Better Agreement with Direct LDL-C Estimation than the Friedewald’s Formula?. Ind J Clin Biochem 27, 127–133 (2012). https://doi.org/10.1007/s12291-011-0186-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12291-011-0186-3

Keywords

Navigation