Dataset Information

Comparison of Estimated LDL Cholesterol Equations with Direct Measurement in Patients with Angiographically Confirmed Coronary Artery Disease.

ABSTRACT: Background and aims: Our goals in the study were to (1) quantify the discordance in LDL-C levels between equations (the Friedewald, Sampson, and Martin/Hopkins equations) and compare them with direct LDL-C (dLDL-C); and (2) explore the proportion of misclassified patients by calculated LDL-C using these three different equations. Methods: A total of 30,349 consecutive patients with angiographically confirmed coronary artery disease (CAD) were prospectively enrolled. Concordance was defined as if the LDL-C was <1.8 mmol/L with each pairwise comparison of LDL-C equations. Estimated LDL-C that fell into the same category as dLDL-C at the following levels: <1.4, 1.4 to 1.7, 1.8 to 2.5, 2.6 to 2.9, and ≥3.0 mmol/L was considered to have been correctly categorized. Results: The concordance was 96.3% (Sampson vs. Martin/Hopkins), 95.0% (Friedewald vs. Sampson), and 91.4% (Friedewald vs. Martin/Hopkins), respectively. This proportion fell to 82.4% in those with hypertriglyceridemia (TG ≥ 1.7 mmol/L). With an accurate classification rate of 73.6%, the Martin/Hopkins equation outperformed the Sampson equation (69.5%) and the Friedewald equation (59.3%) by a wide margin. Conclusions: Comparing it to the validated Martin/Hopkins equation, the Friedewald equation produced the lowest levels of LDL-C, followed by the Sampson equation. In the classification of LDL-C, the Martin/Hopkins equation has also been shown to be more accurate. There is a significant difference between the equations and the direct measurement method, which may lead to overtreatment or undertreatment.

SUBMITTER: Shi B

PROVIDER: S-EPMC9604394 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Comparison of Estimated LDL Cholesterol Equations with Direct Measurement in Patients with Angiographically Confirmed Coronary Artery Disease.

Shi Boqun B Wang Hao-Yu HY Yin Dong D Zhu Chenggang C Feng Lei L Wang Hongjian H Jia Lei L Fu Rui R Song Chenxi C Zhou Zhou Z Lin Yahui Y Song Weihua W Dou Ke-Fei KF

Journal of cardiovascular development and disease 20221007 10

Background and aims: Our goals in the study were to (1) quantify the discordance in LDL-C levels between equations (the Friedewald, Sampson, and Martin/Hopkins equations) and compare them with direct LDL-C (dLDL-C); and (2) explore the proportion of misclassified patients by calculated LDL-C using these three different equations. Methods: A total of 30,349 consecutive patients with angiographically confirmed coronary artery disease (CAD) were prospectively enrolled. Concordance was defined as if ...[more]

PMID: 36286294

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Project description:BackgroundLow-density lipoprotein cholesterol is an important marker highly associated with cardiovascular disease. Since the direct measurement of it is inefficient in terms of cost and time, it is common to estimate through the Friedewald equation developed about 50 years ago. However, various limitations exist since the Friedewald equation was not designed for Koreans. This study proposes a new low-density lipoprotein cholesterol estimation equation for South Koreans using nationally approved statistical data.MethodsThis study used data from the Korean National Health and Nutrition Examination Survey from 2009 to 2019. The 18,837 subjects were used to develop the equation for estimating low-density lipoprotein cholesterol. The subjects included individuals with low-density lipoprotein cholesterol levels directly measured among those with high-density lipoprotein cholesterol, triglycerides, and total cholesterol measured. We compared twelve equations developed in the previous studies and the newly proposed equation (model 1) developed in this study with the actual low-density lipoprotein cholesterol value in various ways.ResultsThe low-density lipoprotein cholesterol value estimated using the estimation formula and the actual low-density lipoprotein cholesterol value were compared using the root mean squared error. When the triglyceride level was less than 400 mg/dL, the root mean squared of the model 1 was 7.96, the lowest compared to other equations, and the model 2 was 7.82. The degree of misclassification was checked according to the NECP ATP III 6 categories. As a result, the misclassification rate of the model 1 was the lowest at 18.9%, and Weighted Kappa was the highest at 0.919 (0.003), which means it significantly reduced the underestimation rate shown in other existing estimation equations. Root mean square error was also compared according to the change in triglycerides level. As the triglycerides level increased, the root mean square error showed an increasing trend in all equations, but it was confirmed that the model 1 was the lowest compared to other equations.ConclusionThe newly proposed low-density lipoprotein cholesterol estimation equation showed significantly improved performance compared to the 12 existing estimation equations. The use of representative samples and external verification is required for more sophisticated estimates in the future.

Project description:Background/Objectives: The currently established equations for calculating low-density lipoprotein cholesterol (LDLc) do not reflect the sex-specific differences in lipid metabolism. We aimed to develop a sex-specific LDLc equation (SSLE) and validate it with three established equations (Friedewald, Sampson-NIH, and ext-Martin-Hopkins) against direct LDLc measurement in Korean adults. Methods: This study included 23,757 subjects (51% male; median age, 51 years) from the 2009-2022 Korean National Health and Nutrition Examination Survey. We developed the SSLE through multiple linear regression incorporating total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), triglycerides (TG), and sex. The validation metrics included Bland-Altman analysis for mean absolute percentage error (MAPE) and agreement of the categorization based on the NCEP ATP-III guidelines, assessed by sex and lipid subgroups. Results: The derived SSLE equation was as follows: for TG < 200 mg/dL, LDLc = 0.963 × TC - 0.881 × HDLc - 0.111 × TG + 0.982 × Sex - 6.958; for TG ≥ 200 mg/dL, LDLc = 0.884 × TC - 0.646 × HDLc - 0.126 × TG + 3.742 × Sex - 3.214 (male = 1, female = 0). The MAPE was similar between males and females for the SSLE (4.6% for both) and ext-Martin-Hopkins (5.0% vs. 4.9%) but higher in males for the Sampson-NIH (5.4% vs. 4.9%) and Friedewald (7.6% vs. 5.7%). In the TG ≥ 400 mg/dL group, the MAPE increased progressively: SSLE (10.2%), ext-Martin-Hopkins (12.0%), Sampson-NIH (12.7%), and Friedewald (27.4%). In the LDLc < 70 mg/dL group, the MAPE was as follows: SSLE (8.0%), Sampson-NIH (8.6%), ext-Martin-Hopkins (9.7%), and Friedewald (12.8%). At TG 200-400 mg/dL, the SSLE revealed very good agreement (κ = 0.801) versus good agreement for other equations (ext-Martin-Hopkins κ = 0.794, Sampson-NIH κ = 0.782, Friedewald κ = 0.696). Conclusions: The novel SSLE demonstrated superior accuracy and agreement in Korean adults. Further validation studies across different ethnic populations are warranted.

Dataset Information

Comparison of Estimated LDL Cholesterol Equations with Direct Measurement in Patients with Angiographically Confirmed Coronary Artery Disease.

Publications

Comparison of Estimated LDL Cholesterol Equations with Direct Measurement in Patients with Angiographically Confirmed Coronary Artery Disease.

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