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Friedewald-Estimated Versus Directly Measured Low-Density Lipoprotein Cholesterol and Treatment Implications
Open accessAbstract
Objectives The aim of this study was to compare Friedewald-estimated and directly measured low-density lipoprotein cholesterol (LDL-C) values.Background LDL-C is routinely estimated by the Friedewald equation to guide treatment; however, compatibility with direct measurement has received relatively little scrutiny, especially at levels <70 mg/dl now targeted in high-risk patients.Methods We examined 1,340,614 U.S. adults who underwent lipid profiling by vertical spin density gradient ultracentrifugation (Atherotech, Birmingham, Alabama) from 2009 to 2011. Following standard practice, Friedewald LDL-C was not estimated if triglyceride levels were ≥ 400 mg/dl (n = 30,174), yielding 1,310,440 total patients and 191,333 patients with Friedewald LDL-C <70 mg/dl.Results Patients were 59 ± 15 years of age and 52% were women. Lipid distributions closely matched those in the National Health and Nutrition Examination Survey. A greater difference in the Friedewald-estimated versus directly measured LDL-C occurred at lower LDL-C and higher triglyceride levels. If the Friedewald-estimated LDL-C was <70 mg/dl, the median directly measured LDL-C was 9.0 mg/dl higher (5th to 95th percentiles, 1.8 to 15.4 mg/dl) when triglyceride levels were 150 to 199 mg/dl and 18.4 mg/dl higher (5th to 95th percentiles, 6.6 to 36.0 mg/dl) when triglyceride levels were 200 to 399 mg/dl. Of patients with a Friedewald-estimated LDL-C <70 mg/dl, 23% had a directly measured LDL-C ≥ 70 mg/dl (39% if triglyceride levels were concurrently 150 to 199 mg/dl; 59% if triglyceride levels were concurrently 200 to 399 mg/dl).Conclusions The Friedewald equation tends to underestimate LDL-C most when accuracy is most crucial. Especially if triglyceride levels are ≥ 150 mg/dl, Friedewald estimation commonly classifies LDL-C as <70 mg/dl despite directly measured levels ≥ 70 mg/dl, and therefore additional evaluation is warranted in high-risk patients.
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“This may erroneously exclude > 20% of patients for initiation or intensification of lipid-lowering therapy [45].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [45]
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“At very low LDLC concentration ranges < 1.8 mmol/L, in which VLDLC constitutes a relatively larger fraction of the blood cholesterol, VLDLC overestimation at high TG concentration > 2.3 mmol/L introduces a more significant error in the calculation of cLDLC [45].”
From Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM (2020) · cites this paper as [45]
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“This risk is accelerated in the presence of other ASCVD risk factors(18,19).”
From 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk (2016) · cites this paper as [19]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
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“The use of the Martin-Hopkins method provides a more accurate assessment of LDL-C in individuals with hypertriglyceridemia (38,39).”
From 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia (2021) · cites this paper as [38]
Experimental — accuracy not yet measuredIn the citing paper
“For the general population, calculated LDL-C and direct LDL-C show very strong correlations [80-83].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [80]
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“Nonetheless, the committee acknowledges that there can be significant discrepancies in levels of directly measured versus calculated LDL-C within the same sample, especially at lower LDL-C levels (19,20).”
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“Patients with baseline elevation of LDL-C $190 mg/dL not due to secondary modifiable causes are at very high risk of first and recurrent ASCVD events because of their lifetime exposure to markedly elevated LDL-C levels.”
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PCSK9 Inhibitors: Novel Therapeutic Strategies for Lowering LDLCholesterol
Wang, Y., & Liu, Z. (2018) · Mini-Reviews in Medicinal Chemistry · doi:10.2174/1389557518666180423111442 · Cited by 34
Nunez, D. J., Yao, X., Lin, J., Walker, A. C., Zuo, P., Webster, L., Krug‐Gourley, S., Zamek‐Gliszczynski, M. J., Gillmor, D., & JOHNSON, S. L. (2016) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12656 · Cited by 34
“The calculated fasting LDL cholesterol concentration was reduced, but this may have been affected by triglyceride changes, a term in the Friedewald equation [16,17].”
BackgroundIs Lp(a) ready for prime time use in the clinic? A pros-and-cons debate
Kostner, K., Kostner, G. M., & Wierzbicki, A. S. (2018) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2018.04.032 · Cited by 33
Calculation of LDL ‐Cholesterol vs. Direct Homogenous Assay
Rasouli, M., & Mokhtari, H. (2016) · Journal of Clinical Laboratory Analysis · doi:10.1002/jcla.22057 · Cited by 31
Song, Y., Lee, H. S., Baik, S. J., Jeon, S., Han, D., Choi, S., Chun, E. J., Han, H., Park, S. H., Sung, J., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-92625-x · Cited by 34
Habeeb, N. W.-A., Higgins, V., Venner, A. A., Bailey, D., Beriault, D. R., Collier, C. P., & Adeli, K. (2022) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2022.03.019 · Cited by 31
Calculated Low Density Lipoprotein-Cholesterol: Friedewald's Formula versus Other Modified Formulas
Nigam, P. K. (2014) · International Journal of Life Science and Medical Research · doi:10.5963/lsmr0402002 · Cited by 30
“A greater difference in the Friedewald estimated LDLc versus directly measured LDLc occurred at lower LDLc and higher TG levels [7] and this equation gives overestimation of LDLc in sera having low TG and high TC levels [8, 9].”
Measuring the contribution of Lp(a) cholesterol towards LDL-C interpretation
Fatica, E. M., Meeusen, J. W., Vasile, V. C., Jaffe, A. S., & Donato, L. J. (2020) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2020.09.007 · Cited by 31
Thambiah, S. C., & Lai, L. C. (2021) · Practical Laboratory Medicine · doi:10.1016/j.plabm.2021.e00248 · Cited by 35
“0 mmol/L, and is misleading at extremely low LDL concentrations with hyperTG [55].”
BackgroundSampson, M. L., Wolska, A. T., Meeusen, J. W., Donato, L. J., Jaffe, A. S., & Remaley, A. T. (2022) · Frontiers in Genetics · doi:10.3389/fgene.2022.935257 · Cited by 29
Zafrir, B., Saliba, W., & Flugelman, M. Y. (2020) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.57133 · Cited by 33
Luo, Y., & Peng, D. (2023) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/10742484231189597 · Cited by 30
“25 Although Martin/Hopkins and Sampson ’ s equations are considered more accurate than Friedewald ’ s equation, the Martin/ Hopkins method may not be a standardized method in all laboratories and Sampson ’ s equation has not been extensively validated.”
MethodImpact of the pre-illness lipid profile on sepsis mortality
Maile, M. D., Sigakis, M. J. G., Stringer, K. A., Jewell, E. S., & Engoren, M. (2020) · Journal of Critical Care · doi:10.1016/j.jcrc.2020.01.016 · Cited by 28
Sampson, M. L., Wolska, A. T., Cole, J., Zubirán, R., Otvos, J. D., Meeusen, J. W., Donato, L. J., Jaffe, A. S., & Remaley, A. T. (2022) · Biomedicines · doi:10.3390/biomedicines10123156 · Cited by 27
“The M-LDL-C equation was previously assessed for its classification concordance with the BQ reference method by its ratio of true positives over true positives plus false positives [15], which is its positive predictive value.”
BackgroundMethodInfluentialda Silva, P. M., Duarte, J. S., HAFE, P. V., Gil, V. M., de Oliveira, J. N., & de Sousa, G. (2018) · Atherosclerosis Supplements · doi:10.1016/j.atherosclerosissup.2018.04.001 · Cited by 26
Murphy, C., Bennett, K., Fahey, T., Shelley, E., Graham, I., & Kenny, R. A. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008017 · Cited by 25
“LDL-C was estimated based on the Friedewald equation.(17) Total cholesterol and LDL-C were grouped according to targets set in the 2007(12) guidelines and threshold categories for drug intervention in the 2012(3) guidelines.”
MethodGender-Affirming Hormone Treatment and Metabolic Syndrome Among Transgender Veterans
Hashemi, L., Buljubasic, A. M., Budoff, M. J., Copeland, L. A., JACKSON, N. J., Jasuja, G. K., GORNBEIN, J. A., & Reue, K. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.19696 · Cited by 29
Zhuang, C., Wang, Q., Wang, W., Sun, R., Zhang, F., & Yu, J. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.822079 · Cited by 29
Measured versus calculated LDL-cholesterol in subjects with Type 2 Diabetes
Fawwad, A., Sabir, R., Riaz, M., Moin, H., & Basit, A. (2016) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.324.9896 · Cited by 24
Vergneau‐Grosset, C., Polley, T. M., Holt, D. D. C., Vernau, W., & Paul‐Murphy, J. (2016) · Journal of Avian Medicine and Surgery · doi:10.1647/2015-129 · Cited by 24
Validating the NIH LDL-C equation in a specialized lipid cohort: Does it add up?
Higgins, V., Leiter, L. A., Delaney, S. R., & Beriault, D. R. (2021) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2021.10.003 · Cited by 23
Atherosclerotic Cardiovascular Disease Risk and Lipid-Lowering Therapy Requirement in China
Bi, L., Yi, J., Wu, C., Hu, S., Zhang, X., Lu, J., Liu, J., Zhang, H., Yang, Y., Cui, J., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.839571 · Cited by 24
“Second, the concentration of LDL-C in our study was calculated using the Friedewald equation rather than directly measured, which might result in an underestimation of LDL-C levels in the setting of high triglyceride levels (34).”
MethodLin, Q.-Z., Chen, Y., Guo, L., Xiang, Q., Tian, F., Wen, T., & Liu, L. (2019) · Clinica Chimica Acta · doi:10.1016/j.cca.2019.05.010 · Cited by 22
Shin, S., Yang, E. H., Lee, H. C., Moon, S. H., & Ryoo, J. (2022) · BMC Public Health · doi:10.1186/s12889-022-14319-x · Cited by 22
“However, the Friedewald equation is unreliable to calculate serum LDL-C levels in patients with low LDL-C (< 70 mg/dL) [64, 65].”
BackgroundMethodOkpoghono, J., Ukperegbulem, J. K., & Igue, U. B. (2023) · Foods and raw materials · doi:10.21603/2308-4057-2024-2-602 · Cited by 22
“(1) as in [18]: LDL-C = (Total cholesterol – HDL) – Triacylglycerol/5 (1) Lipid peroxidation.”
Are We Moving Towards Concordance on the Principle That Lipid Discordance Matters?
Martin, S. S., & Michos, E. D. (2013) · Circulation · doi:10.1161/circulationaha.113.007207 · Cited by 22
“seem a virtue to use a direct assay, as it avoids the challenges of LDL-C estimation.(6,7) However, not all direct techniques are created equal.”
Self-citationBarakett, V., Ghayad, J. P., Mchantaf, G., & Sleilaty, G. (2021) · Clinica Chimica Acta · doi:10.1016/j.cca.2021.05.008 · Cited by 21
Remnant cholesterol and the risk of aortic valve calcium progression: insights from the MESA study
Li, Z., Hao, Q.-Y., Zeng, Y. H., Guo, J., Li, S., Gao, J., & Yang, P. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-023-02081-2 · Cited by 20
“Recognizing the limitations of the Friedewald equation, particularly its propensity to underestimate LDL-C in the presence of hypertriglyceridemia or when TG levels are ≥ 150 mg/dL [22], we employed the Martin/Hopkins equation.”
MethodSung, K., Kwon, C. H., Lee, M. Y., Kwon, M., Lee, J. H., Jung, M., & Shin, J. (2019) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2019.12.036 · Cited by 20
Antonio‐Villa, N. E., Bello‐Chavolla, O. Y., Vargas‐Vázquez, A., Mehta, R., Aguilar-Salinas, C. A., & for the Metabolic Syndrome Study Group (2020) · Diabetic Medicine · doi:10.1111/dme.14274 · Cited by 18
Langlois, M. R., & Nordestgaard, B. G. (2018) · Current Cardiology Reports · doi:10.1007/s11886-018-1036-1 · Cited by 19
Ramli, A. S., Lakshmanan, S., Haniff, J., Selvarajah, S., Tong, S. F., Bujang, M. A., Abdul-Razak, S., Shafie, A. A., Lee, V. K. M., Rahman, T. H. A., et al. (2014) · BMC Family Practice · doi:10.1186/1471-2296-15-151 · Cited by 20
“LDL-C concentration was derived by calculation using the Friedewald equation [64].”
MethodKwon, Y., Lee, H., Baik, S. J., Chang, H., & Lee, J. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.824574 · Cited by 20
“The limitations of the Friedewald formula are that it is not applicable in non-fasting subjects or those with TG levels of 400 mg/dl or more or those with LDL levels lower than 70 mg/dl (31).”
Gustavsen, K. A., Stanhope, K. L., Lin, A. S., Graham, J. L., Havel, P. J., & Paul‐Murphy, J. (2016) · Journal of Zoo and Wildlife Medicine · doi:10.1638/2015-0192.1 · Cited by 19
Secular Trends in Lipid Profiles in Korean Adults Based on the 2005–2015 KNHANES
Kwon, Y., Lee, J., & Kang, H. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16142555 · Cited by 20
“Although LDL-C levels estimated by the Friedwald equation were correlated with direct measurement, underestimation of the LDL-C level is an important problem to evaluate the high-risk group in the presence of TG ≥ 150 mg/dL [37].”
MethodFu, C., Liu, D., Liu, Q., Wang, X., Ma, X., Pan, H., Feng, S., Sun, Z., Qiao, W., Yang, M., et al. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02140-2 · Cited by 22
“Non-high density lipoprotein cholesterol (non-HDL-c) is essentially comprised of remnant cholesterol and LDL-c, encompassing the total cholesterol content of all atherogenic lipoprotein particles [12].”
BackgroundMartin, S. S., Ditmarsch, M., Simmons, M., Alp, N., Turner, T. A., Davidson, M. H., & Kastelein, J. J. P. (2022) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvac056 · Cited by 20
Self-citationGoel, P. K., Ashfaq, F., Khanna, R., Ramesh, V., & Pandey, C. M. (2016) · Indian Journal of Clinical Biochemistry · doi:10.1007/s12291-016-0592-7 · Cited by 19
“LDL-C was calculated using the Friedewald equation [10]: LDLC = TC - (TG/5) - HDL-C.”
Chung, S. (2017) · Medical Principles and Practice · doi:10.1159/000485977 · Cited by 19
Witt, C. R., Renfroe, L. G., & Lyons, S. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16335 · Cited by 18
Vázquez, N. M., Redondo‐Rodríguez, R., Rioja, J., Jiménez-Núñez, F. G., Arija, S. M., Lisbona-Montañez, J. M., Cano‐García, L., Rojas-Gimenez, M., Garnica, I. U., Valdivielso, P., et al. (2022) · Biomedicines · doi:10.3390/biomedicines10010133 · Cited by 17
“4 mg/dL higher if triglyceride levels are between 200–399) according to some studies [46] and the postprandial hypertriglyceridemia values observed in our study were moderate.”
Update on low-density lipoprotein cholesterol quantification
Chung, S. (2019) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000611 · Cited by 19
“Even when triglycerides levels are under 400 mg/dl, Friedewald’s equation commonly classifies LDL-C as below 70 mg/dl, despite directly measured levels above 70 mg/dl and thus misclassifies CVD risk [9], especially if triglycerides levels are at least 150 mg/dl.”
BackgroundHermans, M. P., Ahn, S. A., & Rousseau, M. F. (2014) · Cardiovascular Diabetology · doi:10.1186/1475-2840-13-56 · Cited by 18
“A disadvantage of this method is the requirement for direct apoB100 measurement, limiting its use unless apoB100 is inferred from routine lipids, as previously described [17-21].”
BackgroundMethodImpaired mitochondria and intracellular calcium transients in the salivary glands of obese rats
Ittichaicharoen, J., Apaijai, N., Tanajak, P., Sa‐nguanmoo, P., Chattipakorn, N., & Chattipakorn, S. C. (2016) · Applied Physiology Nutrition and Metabolism · doi:10.1139/apnm-2016-0545 · Cited by 18
Chen, Y., Lei, K., Liu, Y., Liu, J., Wei, K., Guo, J., & Su, Z. (2025) · Biomolecules · doi:10.3390/biom15070990 · Cited by 20
“In clinical practice, traditional methods such as the Friedewald method [185], ultracen-trifugation method [186], and chemical precipitation method are usually used to monitor and quantify VLDL levels so as to provide strong support for the diagnosis and treatment of MASLD.”
N-3 polyunsaturated fatty acids for cardiovascular risk
Goff, Z. D., & Nissen, S. E. (2022) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000962 · Cited by 17
Azimi, V., Farnsworth, C. W., & Roper, S. M. (2022) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2022.07.005 · Cited by 17
Remnant cholesterol and long-term incidence of death in coronary artery disease patients
Drexel, H., Mader, A., Larcher, B., Festa, A., Vonbank, A., Fraunberger, P., Leiherer, A., & Saely, C. H. (2025) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2024.119048 · Cited by 17
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Elías-López, D., Kobylecki, C. J., Vedel‐Krogh, S., Doi, T., & Nordestgaard, B. G. (2025) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2025.119241 · Cited by 17
Intuitive Modification of the Friedewald Formula for Calculation of LDL-Cholesterol
Hong, J., Gu, H., Lee, J., Lee, W., Chun, S., Han, K. H., & Min, W. (2022) · Annals of Laboratory Medicine · doi:10.3343/alm.2023.43.1.29 · Cited by 16
“This tendency is particularly strong when triglyceride concentrations >150 mg/dL [26].”
BackgroundColesterol remanente, riesgo vascular y prevención de la arteriosclerosis
Pintó, X., Fanlo‐Maresma, M., Esteve, V., Millán, J., Blanco, A., Blasco, M., Díaz-Díaz, J. L., Rodríguez, Á. D., Mangas, A., Pascual, V., et al. (2023) · Clínica e Investigación en Arteriosclerosis · doi:10.1016/j.arteri.2023.02.001 · Cited by 18
Ahmed, I. A., Mikail, M. A., & Ibrahim, M. (2017) · Nutrition Research · doi:10.1016/j.nutres.2017.04.012 · Cited by 16
“The concentration of low-density lipoprotein (LDL) cholesterol was calculated using the formula of Friedewald equation [35, 36].”
MethodCVD Risk Stratification in the PCSK9 Era: Is There a Role for LDL Subfractions?
Kjellmo, C. A., Hovland, A., & Lappegård, K. T. (2018) · Diseases · doi:10.3390/diseases6020045 · Cited by 16
“to calculate LDL cholesterol (LDL-C) [8].”
Cartier, L.-J., St-Cœur, S., Robin, A., Lagacé, M., & Douville, P. (2019) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2019.12.002 · Cited by 17
Nonfasting Lipids for All Patients?
Farukhi, Z. M., & Mora, S. (2020) · Clinical Chemistry · doi:10.1093/clinchem/hvaa195 · Cited by 18
Should apolipoprotein B replace LDL cholesterol as therapeutic targets are lowered?
Meeusen, J. W., Donato, L. J., & Jaffe, A. S. (2016) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000313 · Cited by 17
Omage, K., Azeke, M. A., & Omage, S. O. (2018) · Clinical Phytoscience · doi:10.1186/s40816-018-0060-4 · Cited by 16
“LDL – Cholesterol (LDL) was by the equation of Friedwald [12].”
MethodSample Size and the Precision of the Confidence Interval in Meta-analyses
Liu, X. S. (2015) · Therapeutic Innovation & Regulatory Science · doi:10.1177/2168479015570332 · Cited by 15
“2 mg/dL and the standard deviation of LDL is 38 mg/dl.(8,9) The common effect size is, therefore, y 1⁄4 9:2=38: If the average sample size in a randomized controlled trial is about 45 subjects per group ( n 1⁄4 45), the variance of the standardized effect size from an individual study is”
BackgroundNanda, S. K., Bharathy, M., Dinakaran, A., Ray, L., & Ravichandran, K. (2017) · International Journal of Applied and Basic Medical Research · doi:10.4103/2229-516x.198525 · Cited by 15
“observed that Friedewalds formula underestimated LDL cholesterol especially when TG value is >150 mg/dl.[16] Knopfholz et al.”
BackgroundComparing calculated LDL-C with directly measured LDL-C in healthy and in dyslipidemic children
Garoufi, A., Drakatos, A., Tsentidis, C., Klinaki, E., Paraskakis, I., Marmarinos, A., & Gourgiotis, D. (2016) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2016.05.026 · Cited by 15
“Based on calculated LDL-C level using FF for the assessment of cardiovascular risk according to the NCEP categories, many patientsmay bemisclassifiedmainly due to the presence of hypertriglyceridemia [13,14].”
BackgroundMethodAssessing the dyslipidemias: to fast or not to fast?
Farukhi, Z. M., & Mora, S. (2021) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000615 · Cited by 16
Lipoprotein Assessment in the twenty-first Century
Lucero, D., Wolska, A. T., Aligabi, Z., Turecamo, S. E., & Remaley, A. T. (2022) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.02.009 · Cited by 16
Liu, J., Zhao, L., Zhang, Y., Wang, L., Feng, Q., Cui, J., Zhang, W., Zheng, J., Wang, D., Zhao, F., et al. (2024) · Clinical Cardiology · doi:10.1002/clc.24243 · Cited by 13
Dintshi, M., Kone, N., & Khoza, S. P. (2022) · PLoS ONE · doi:10.1371/journal.pone.0277981 · Cited by 17
“Multiple studies have demonstrated that this formula underestimates LDL-C, resulting in cardiovascular risk misclassification [27,28].”
BackgroundRahman, F., Blumenthal, R. S., Jones, S. R., Martin, S. S., Gluckman, T. J., & Whelton, S. P. (2018) · Current Atherosclerosis Reports · doi:10.1007/s11883-018-0713-2 · Cited by 15
Self-citationGuisantes-Batán, E., Mazuecos, L., Rubio, B., Pereira‐Caro, G., Moreno‐Rojas, J. M., Andrés, A., Gómez‐Alonso, S., & Gallardo, N. (2022) · Food & Function · doi:10.1039/d2fo02199d · Cited by 13
Ferlini, M., Munafò, A. R., Varbella, F., Delnevo, F., Solli, M., Trabattoni, D., Piccaluga, E., Cardile, A., Canova, P. A., Rossini, R., et al. (2023) · International Journal of Cardiology · doi:10.1016/j.ijcard.2023.131659 · Cited by 15
The Role of Statins in Diabetes Treatment
Subedi, B. H., Tota-Maharaj, R., Silverman, M. G., Minder, C. M., Martin, S. S., Ashen, M. D., Blumenthal, R. S., & Blaha, M. J. (2013) · Diabetes Spectrum · doi:10.2337/diaspect.26.3.156 · Cited by 13
Self-citationShin, D., Bohra, C., & Kongpakpaisarn, K. (2018) · Medicine · doi:10.1097/md.0000000000010612 · Cited by 13
“As a result, the Friedewald method can underestimate the LDL-C level when the TG level was high, which resulted in misclassification and under-treatment of highrisk patients.([6]) Given this limitation, Martin et al([5]) suggested a novel method for estimating LDL-C using an adjustable factor for the TG:VLDL-C ratio d…”
MethodReiber, I., Márk, L., Paragh, G., & Toth, P. P. (2020) · Archives of Medical Science · doi:10.5114/aoms.2020.97847 · Cited by 13
Self-citationLi, D.-B., Xu, T., Xie, D., Wang, M.-Y., Sun, S., Wang, M., Zhang, S.-S., Yang, X.-R., Zhang, Z., Wang, S., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/44939 · Cited by 12
“The Friedewald formula calculated the LDL-C level [28].”
Xu, X., Wang, Z., Huang, R., Guo, Y., Xiong, Z., Zhuang, X., & Liao, X. (2023) · Circulation Cardiovascular Imaging · doi:10.1161/circimaging.123.015589 · Cited by 14
Ariel, D., Kim, S. H., Liu, A., Abbasi, F., Lamendola, C. A., Grove, K., Tomasso, V., & Reaven, G. M. (2015) · Journal of clinical lipidology · doi:10.1016/j.jacl.2015.06.009 · Cited by 13
“directly measured LDL-C concentrations referred to above (7).”
InfluentialThe evolution of selective analyses of HDL and LDL cholesterol in clinical and point of care testing
Ahmadraji, T., & Killard, A. J. (2013) · Analytical Methods · doi:10.1039/c3ay40715b · Cited by 13
Methods of Calculating Low-Density Lipoprotein Cholesterol Level
Brown, W. V. (2020) · JAMA Cardiology · doi:10.1001/jamacardio.2020.0042 · Cited by 13
Langlois, M. R., Nordestgaard, B. G., Langsted, A., Chapman, M. J., Aakre, K. M., Baum, H. H. E., Borén, J., Bruckert, É., Catapano, A. L., Cobbaert, C. M., et al. (2021) · Laboratory Service · doi:10.17116/labs20211001145 · Cited by 13
Accuracy of New Equation to Calculate Low-Density Lipoprotein Cholesterol
Martin, S. S., Elshazly, M. B., & Jones, S. R. (2020) · JAMA Cardiology · doi:10.1001/jamacardio.2020.4411 · Cited by 13
Self-citationHashemi, L., Hsiung, J.-T., Arif, Y., Soohoo, M., Jackson, N., Gosmanova, E. O., Budoff, M., Kovesdy, C., Kalantar-Zadeh, K., & Streja, E. (2022) · American Journal of Cardiology · doi:10.1016/j.amjcard.2022.01.034 · Cited by 9
GAUSS-2, RUTHERFORD-2, LAPLACE-2, DESCARTES, and TESLA Part B: PCSK9 inhibitors gain momentum
Hassan, M. S., & Yacoub, M. H. (2014) · Global Cardiology Science and Practice · doi:10.5339/gcsp.2014.49 · Cited by 12
“On the other hand, the Friedewald equation may underestimate LDL-C when the level is very low.(21) In results of these 5 phase III studies, Amgen announced the submission of license application to the US Food and Drug Administration (FDA) seeking approval of evolocumab for treatment of high cholesterol.”
BackgroundPinart, M., Jeran, S., Boeing, H., Stelmach-Mardas, M., Standl, M., Schulz, H., Harris, C. P., Berg, A. V., Herberth, G., Koletzko, S., et al. (2021) · Journal of Nutrition · doi:10.1093/jn/nxab077 · Cited by 12
Fan, G., Zhang, S., Wu, Q., Song, Y., Jia, A., Li, D., Yue, Y., & Wang, Q. (2022) · Clinica Chimica Acta · doi:10.1016/j.cca.2022.08.007 · Cited by 12
Roper, S. M., Cao, J., Tam, E., & Devaraj, S. (2017) · American Journal of Clinical Pathology · doi:10.1093/ajcp/aqx042 · Cited by 11
“Previous reports point out that the negative bias of the Friedewald equation stems from its reliance on a static factor (ie, TG/5) to represent cholesterol from VLDL-C and therefore does not account for interindividual variation in this ratio.(2,13,14) In fact, this shortcoming was acknowledged in the original Friedew…”
BackgroundBriers, P.-J., & Langlois, M. R. (2022) · University of Zagreb University Computing Centre (SRCE) · Cited by 11
Arterial Stiffness and HbA1c: Association Mediated by Insulin Resistance in Hispanic Adults
Martagón, A. J., Fermín‐Martínez, C. A., Antonio‐Villa, N. E., Mehta, R., Almeda‐Valdés, P., Vargas‐Vázquez, A., Muñóz-Hernández, L. L., Gómez‐Velasco, D., Elías-López, D., Galán-Ramírez, G. A., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191711017 · Cited by 11
“The potential confounding variables total cholesterol, triglycerides, and HDL-C were measured using colorimetric assays (Unicel DxC 600 Synchron Clinical System Beckman Coulter), and LDL-C was calculated using Martin’s equation [22].”
MethodAssociation between obesity indicators and cardiometabolic disease in Chinese adults
Wu, J., Zou, L., Liu, Y., Yu, H.-B., Yin, H., Zhong, L., Liu, Y.-F., Fu, W.-N., & Zhang, S.-C. (2023) · PLoS ONE · doi:10.1371/journal.pone.0273235 · Cited by 10
“Although global clinical practice guidelines recommend the use of the Friedewald formula (FF) to calculate LDL-C levels in routine patients [16], the enzymatic method was chosen for this study to measure LDL-C, considering that FF tends to underestimate LDL-C levels in the presence of high TG levels [17].”
MethodRemnant cholesterol, vascular risk, and prevention of atherosclerosis
Pintó, X., Fanlo‐Maresma, M., Esteve-Luque, V., & Millán, J. (2023) · Clínica e Investigación en Arteriosclerosis (English Edition) · doi:10.1016/j.artere.2023.07.005 · Cited by 13
Pallazola, V. A., Sathiyakumar, V., Ogunmoroti, O., Fashanu, O. E., Jones, S. R., Santos, R. D., Toth, P. P., Bittencourt, M. S., Duncan, B. B., Lotufo, P. A., et al. (2019) · Journal of clinical lipidology · doi:10.1016/j.jacl.2019.07.002 · Cited by 11
Self-citationFerrinho, C., Alves, A. C., Bourbon, M., & Duarte, S. (2021) · Revista Portuguesa de Cardiologia (English Edition) · doi:10.1016/j.repce.2021.07.001 · Cited by 13
Cruz, D. E., Ahmed, H. M., Jones, S. R., Elshazly, M. B., & Martin, S. S. (2014) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-014-0382-9 · Cited by 10
Self-citationComparison of LDL-C Reduction Using Different Evolocumab Doses and Intervals
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Ikeyi, A. P., Okagu, I. U., Ezeanyika, L. U. S., & Alumanah, E. O. (2020) · All Life · doi:10.1080/26895293.2020.1788653 · Cited by 10
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“…C reactive protein, procalcitonin, N-terminal pro-brain natriuretic peptide, hemoglobin A1c, and albumin; Notably, low-density lipoprotein levels were obtained as either directly measured values or calculated using the Friedewald formula, standardizing all results to mg/dL for consistency [28,29].”
Gruchot, M., Graeter, T., Oeztuerk, S., Haenle, M. M., Köenig, W., Imhof, A., Boehm, B. O., Mason, R. A., Kratzer, W., Akinli, A. S., et al. (2014) · Lipids in Health and Disease · doi:10.1186/1476-511x-13-18 · Cited by 9
“0 mmol/l [27,28].”
PCSK9 Inhibitors and Their Role in high-risk Patients in Reducing Ldl Cholesterol Levels: Alirocumab
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Metadata
- Authors
- Martin, S. S., Blaha, M. J., Elshazly, M. B., Brinton, E. A., Toth, P. P., McEvoy, J. W., Joshi, P. H., Kulkarni, K. R., Mize, P. D., Kwiterovich, P. O., DeFilippis, A. P., Blumenthal, R. S., & Jones, S. R.
- Affiliations
- Johns Hopkins University (US)
- Foundation for Biomedical Research (US)
- CGH Medical Center (US)
- University of Louisville (US)
- Corresponding author
- Martin, Seth S.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 62
- Issue
- 8
- Pages
- 732-739
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2054299101
- Cited by
- 428
- References
- 23
- Citations by year
- 2026: 21 · 2025: 24 · 2024: 35 · 2023: 59 · 2022: 43 · 2021: 38 · 2020: 32 · 2019: 25 · 2018: 35 · 2017: 22 · 2016: 28 · 2015: 22 · 2014: 30 · 2013: 14
- FWCI
- 30.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Abbott Laboratories
- Merck & Co.
- Amarin Pharmaceuticals
- Health Diagnostics Laboratory
- Roche/Genentech
- Pfizer
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- Friedewald formula, LDL cholesterol estimation, direct LDL-C measurement, triglyceride levels, hypertriglyceridemia, lipidomics, dyslipidemia management, cardiovascular risk stratification
- MeSH terms
- Adult, Aged, Apolipoproteins B, Blood Chemical Analysis, Centrifugation, Density Gradient, Female, Humans, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Triglycerides, Reproducibility of Results, Risk Assessment
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