Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria and National Health Laboratory Service Tshwane Academic Division.
Department of Public Health Medicine, School of Health System & Public Health, University of Pretoria, Pretoria, South Africa.
Curr Opin Lipidol. 2022 Aug 1;33(4):237-256. doi: 10.1097/MOL.0000000000000833.
The reference method for low-density lipoprotein-cholesterol (LDL-C) quantitation is β-quantification, a technically demanding method that is not convenient for routine use. Indirect calculation methods to estimate LDL-C, including the Friedewald equation, have been used since 1972. This calculation has several recognized limitations, especially inaccurate results for triglycerides (TG) >4.5 mmol/l (>400 mg/dl). In view of this, several other equations were developed across the world in different datasets.The purpose of this review was to analyze the best method to calculate LDL-C in clinical practice by reviewing studies that compared equations with measured LDL-C.
We identified 45 studies that compared these formulae. The Martin/Hopkins equation uses an adjustable factor for TG:very low-density lipoprotein-cholesterol ratios, validated in a large dataset and demonstrated to provide more accurate LDL-C calculation, especially when LDL <1.81 mmol/l (<70 mg/dl) and with elevated TG. However, it is not in widespread international use because of the need for further validation and the use of the adjustable factor. The Sampson equation was developed for patients with TG up to 9 mmol/l (800 mg/dl) and was based on β-quantification and performs well on high TG, postprandial and low LDL-C samples similar to direct LDL-C.
The choice of equation should take into the level of triglycerides. Further validation of different equations is required in different populations.
低密度脂蛋白胆固醇（LDL-C）定量的参考方法是β定量法，这是一种技术要求很高的方法，不便于常规使用。自 1972 年以来，一直使用间接计算方法来估计 LDL-C，包括 Friedewald 方程。该计算有几个公认的局限性，特别是对于甘油三酯（TG）>4.5mmol/l（>400mg/dl）的结果不准确。鉴于此，世界各地在不同的数据集开发了其他几种方程。本综述的目的是通过分析比较与实测 LDL-C 的方程的研究，来评估在临床实践中计算 LDL-C 的最佳方法。
我们确定了 45 项比较这些公式的研究。Martin/Hopkins 方程使用了一个可调节的因素来调整极低密度脂蛋白胆固醇与 TG 的比值，该方程在一个大型数据集进行了验证，并被证明能够更准确地计算 LDL-C，特别是当 LDL <1.81mmol/l（<70mg/dl）和 TG 升高时。然而，由于需要进一步验证和使用可调因子，它并没有在国际上广泛使用。Sampson 方程是为 TG 高达 9mmol/l（800mg/dl）的患者开发的，它基于β定量法，在高 TG、餐后和低 LDL-C 样本上的表现与直接 LDL-C 相似。
方程的选择应考虑甘油三酯的水平。需要在不同人群中对不同的方程进行进一步验证。
