Yang Hyun Suk, Kim Soo-Nyung, Lee Seungho, Hur Mina
Department of Cardiovascular Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Republic of Korea.
Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05029, Republic of Korea.
Metabolites. 2025 Jan 5;15(1):18. doi: 10.3390/metabo15010018.
: 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. 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. 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). The novel SSLE demonstrated superior accuracy and agreement in Korean adults. Further validation studies across different ethnic populations are warranted.
目前用于计算低密度脂蛋白胆固醇（LDLc）的既定公式并未反映出脂质代谢中的性别差异。我们旨在开发一种性别特异性LDLc方程（SSLE），并将其与三个既定公式（Friedewald、Sampson-NIH和ext-Martin-Hopkins）针对韩国成年人的直接LDLc测量值进行验证。本研究纳入了2009 - 2022年韩国国家健康与营养检查调查中的23,757名受试者（51%为男性；中位年龄51岁）。我们通过纳入总胆固醇（TC）、高密度脂蛋白胆固醇（HDLc）、甘油三酯（TG）和性别的多元线性回归开发了SSLE。验证指标包括基于平均绝对百分比误差（MAPE）的Bland-Altman分析以及根据美国国家胆固醇教育计划成人治疗组第三次报告（NCEP ATP-III）指南进行的分类一致性，按性别和脂质亚组进行评估。推导得出的SSLE方程如下：对于TG < 200 mg/dL，LDLc = 0.963 × TC - 0.881 × HDLc - 0.111 × TG + 0.982 × 性别 - 6.958；对于TG ≥ 200 mg/dL，LDLc = 0.884 × TC - 0.646 × HDLc - 0.126 × TG + 3.742 × 性别 - 3.214（男性 = 1，女性 = 0）。SSLE在男性和女性中的MAPE相似（均为4.6%），ext-Martin-Hopkins在男性和女性中的MAPE也相似（分别为5.0%和4.9%），但Sampson-NIH在男性中的MAPE更高（分别为5.4%和4.9%），Friedewald在男性中的MAPE更高（分别为7.6%和5.7%）。在TG ≥ 400 mg/dL组中，MAPE逐渐增加：SSLE为10.2%，ext-Martin-Hopkins为12.0%，Sampson-NIH为12.7%，Friedewald为27.4%。在LDLc < 70 mg/dL组中，MAPE如下：SSLE为8.0%，Sampson-NIH为8.6%，ext-Martin-Hopkins为9.7%，Friedewald为12.8%。在TG 200 - 400 mg/dL时，SSLE显示出非常好的一致性（κ = 0.801），而其他公式显示出良好的一致性（ext-Martin-Hopkins κ = 0.794，Sampson-NIH κ = 0.782，Friedewald κ = 0.696）。新的SSLE在韩国成年人中显示出更高的准确性和一致性。有必要在不同种族人群中进行进一步的验证研究。
