Medstar Georgetown University Hospital-Washington Hospital Center, Division of Cardiology, Washington, DC, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon, USA.
J Am Coll Cardiol. 2022 Feb 15;79(6):530-541. doi: 10.1016/j.jacc.2021.11.042.
Accurate estimation of low-density lipoprotein cholesterol (LDL-C) is important for guiding cholesterol-lowering therapy. Different methods currently exist to estimate LDL-C.
This study sought to assess discordance of estimated LDL-C using the Friedewald, Sampson, and Martin/Hopkins equations.
Electronic health record data from patients with atherosclerotic cardiovascular disease and triglyceride (TG) levels of <400 mg/dL between October 1, 2015, and June 30, 2019, were retrospectively analyzed. LDL-C was estimated using the Friedewald, Sampson, and Martin/Hopkins equations. Patients were categorized as concordant if LDL-C was <70 mg/dL with each pairwise comparison of equations and as discordant if LDL-C was <70 mg/dL for the index equation and ≥70 mg/dL for the comparator.
The study included 146,106 patients with atherosclerotic cardiovascular disease (mean age: 68 years; 56% male; 91% White). The Martin/Hopkins equation consistently estimated higher LDL-C values than the Friedewald and Sampson equations. Discordance rates were 15% for the Friedewald vs Martin/Hopkins comparison, 9% for the Friedewald vs Sampson comparison, and 7% for the Sampson vs Martin/Hopkins comparison. Discordance increased at lower LDL-C cutpoints and in those with elevated TG levels. Among patients with TG levels of ≥150 mg/dL, a >10 mg/dL difference in LDL-C was present in 67%, 27%, and 23% of patients when comparing the Friedewald vs Martin/Hopkins, Friedewald vs Sampson, and Sampson vs Martin/Hopkins equations, respectively.
Clinically meaningful differences in estimated LDL-C exist among equations, particularly at TG levels of ≥150 mg/dL and/or lower LDL-C levels. Reliance on the Friedewald and Sampson equations may result in the underestimation and undertreatment of LDL-C in those at increased risk.
准确估计低密度脂蛋白胆固醇（LDL-C）对于指导降脂治疗非常重要。目前存在多种估计 LDL-C 的方法。
本研究旨在评估 Friedewald、Sampson 和 Martin/Hopkins 方程估计 LDL-C 的差异。
回顾性分析 2015 年 10 月 1 日至 2019 年 6 月 30 日患有动脉粥样硬化性心血管疾病且三酰甘油（TG）水平<400mg/dL 的患者的电子健康记录数据。使用 Friedewald、Sampson 和 Martin/Hopkins 方程估计 LDL-C。如果每个方程的 LDL-C<70mg/dL 与索引方程一致，如果 LDL-C<70mg/dL 而比较方程≥70mg/dL，则归类为不一致。
研究纳入了 146106 例动脉粥样硬化性心血管疾病患者（平均年龄：68 岁；56%为男性；91%为白人）。Martin/Hopkins 方程始终估计 LDL-C 值高于 Friedewald 和 Sampson 方程。Friedewald 与 Martin/Hopkins 比较的不一致率为 15%，Friedewald 与 Sampson 比较的不一致率为 9%，Sampson 与 Martin/Hopkins 比较的不一致率为 7%。在 LDL-C 切点较低和 TG 水平升高的患者中，不一致率增加。在 TG 水平≥150mg/dL 的患者中，当比较 Friedewald 与 Martin/Hopkins、Friedewald 与 Sampson 和 Sampson 与 Martin/Hopkins 方程时，LDL-C 差值>10mg/dL 的患者分别占 67%、27%和 23%。
方程之间存在 LDL-C 的临床有意义差异，尤其是在 TG 水平≥150mg/dL 和/或 LDL-C 水平较低的情况下。在风险增加的人群中，依赖 Friedewald 和 Sampson 方程可能导致 LDL-C 估计不足和治疗不足。
