Shi Boqun, Wang Hao-Yu, Yin Dong, Zhu Chenggang, Feng Lei, Wang Hongjian, Jia Lei, Fu Rui, Song Chenxi, Zhou Zhou, Lin Yahui, Song Weihua, Dou Ke-Fei
Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing 100037, China.
Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing 100037, China.
J Cardiovasc Dev Dis. 2022 Oct 7;9(10):342. doi: 10.3390/jcdd9100342.
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.
我们在本研究中的目标是：（1）量化不同公式（弗瑞德沃德公式、桑普森公式以及马丁/霍普金斯公式）计算的低密度脂蛋白胆固醇（LDL-C）水平之间的不一致性，并将其与直接检测的LDL-C（dLDL-C）进行比较；（2）探讨使用这三种不同公式通过计算LDL-C对患者进行错误分类的比例。方法：前瞻性纳入总共30349例经血管造影证实患有冠心病（CAD）的连续患者。一致性定义为在LDL-C公式的每一对比较中，若LDL-C <1.8 mmol/L。估计的LDL-C在以下水平与dLDL-C属于同一类别：<1.4、1.4至1.7、1.8至2.5、2.6至2.9以及≥3.0 mmol/L被认为分类正确。结果：一致性分别为96.3%（桑普森公式与马丁/霍普金斯公式比较）、95.0%（弗瑞德沃德公式与桑普森公式比较）以及91.4%（弗瑞德沃德公式与马丁/霍普金斯公式比较）。在高甘油三酯血症（TG≥1.7 mmol/L）患者中，这一比例降至82.4%。马丁/霍普金斯公式的准确分类率为73.6%，大幅优于桑普森公式（69.5%）和弗瑞德沃德公式（59.3%）。结论：与经过验证的马丁/霍普金斯公式相比，弗瑞德沃德公式计算出的LDL-C水平最低，并低于桑普森公式。在LDL-C分类方面，马丁/霍普金斯公式也显示出更高的准确性。这些公式与直接测量方法之间存在显著差异，这可能导致过度治疗或治疗不足。
