Estimation of LDL cholesterol based on the Friedewald formula and on apo B levels

Objectives: The plasma apolipoprotein B (apo B) concentrations have been considered to be a more accurate representation of atherogenic particles and it has been proposed that the formula LDL-C (mmol/L) = 0.41TC − 0.32TG + 1.70apo B − 0.27 is reliable for the estimation of LDL-C (Clin Chem 1997; 43: 808–15). We undertook the present study to investigate the reliability of this formula in a large number of hyperlipidemic patients. Design and methods: 1) The Friedewald formula (LDL-F) and the apo B-based formula (LDL-B) were compared with the β-quantification reference procedure in 130 individuals with a wide range of total cholesterol (TC) and triglyceride (TG) levels, and 2) the LDL-C levels obtained by the Friedewald formula were compared with those calculated by the apo B-based formula in 1010 individuals attending our outpatient lipid clinic. Results: The LDL-F and the LDL-B formulae for LDL-C estimation were found to be in good agreement with the β-quantification (r = 0.96 and 0.97, respectively). The bias of each method plotted as a function of TG (up to 4.52 mmol/L) was found positive for the LDL-F, whereas the LDL-B was independent of the concentrations of TG. When a large number of individuals were examined, a good correlation between the two equations was found (n = 1010, r = 0.98). The difference between the two methods was not correlated with serum TG levels. However, it was correlated to serum TC, and apo B levels. Conclusions: The LDL-B formula is a more reliable and accurate method than the LDL-F formula, especially at TG levels >2.26 mmol/L, although it underestimates LDL-C concentrations. Furthermore, this equation can be used in hypertriglyceridemic patients (TG >4.52 mmol/L) in whom the Friedewald equation is inaccurate.