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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]
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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]
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“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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Cites
Friedewald, W. T., Levy, R. I., & Fredrickson, D. S. (1972) · Clinical Chemistry · doi:10.1093/clinchem/18.6.499 · Cited by 32,423
Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)
Grundy, S. M., Becker, D. M., Clark, L. T., Cooper, R., Denke, M. A., Howard, J. L., Hunninghake, D. B., Illingworth, D. R., Luepker, R. V., McBride, P. E., et al. (2002) · Civil War Book Review · Cited by 12,198
Grundy, S. M., Cleeman, J. I., Merz, C. N. B., Brewer, H. B., Clark, L. T., Hunninghake, D. B., Pasternak, R. C., Smith, S. C., & Stone, N. J. (2004) · Circulation · doi:10.1161/01.cir.0000133317.49796.0e · Cited by 6,902
ESC/EAS Guidelines for the management of dyslipidaemias
Reiner, Ž., Catapano, A. L., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehr158 · Cited by 3,549
Triglycerides and Cardiovascular Disease: A Scientific Statement From the American Heart Association
Miller, M., Stone, N. J., Ballantyne, C., Bittner, V., Criqui, M. H., Ginsberg, H. N., Goldberg, A. C., Howard, W. J., Jacobson, M. S., Kris-Etherton, P. M., et al. (2011) · Circulation · doi:10.1161/cir.0b013e3182160726 · Cited by 1,871
Grundy, S. M., Cleeman, J. I., Bairey Merz, C. N., Brewer, H. B., Clark, L. T., Hunninghake, D. B., Pasternak, R. C., Smith, S. C., & Stone, N. J. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.07.001 · Cited by 1,550
Smith, S. C., Benjamin, E. J., Bonow, R. O., Braun, L. T., Creager, M. A., Franklin, B. A., Gibbons, R. J., Grundy, S. M., Hiratzka, L. F., Jones, D. W., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.10.824 · Cited by 918
Genest, J. J., McPherson, R., Frohlich, J. J., Anderson, T. J., Campbell, N. R. C., Carpentier, A. C., Couture, P., Dufour, R., Fodor, G. J., Francis, G. A., et al. (2009) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(09)70715-9 · Cited by 765
ESC/EAS Guidelines for the management of dyslipidaemias
Catapano, A. L., Reiner, Ž., De Backer, G., Graham, I., Taskinen, M.-R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M. J., Durrington, P., et al. (2011) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.06.028 · Cited by 706
Research works printed but not linked: 1
- Li, 2011, Surveillance of certain health behaviors and conditions among states and selected local areas, MMWR Surveill Summ, 60, 1
Cited by
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Items 201–300 of 428
Hartanto, A., Kasturiratna, K. T. A. S., Hu, M., Diong, S. F., & Lua, V. Y. Q. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111594 · Cited by 9
“Given that the Fridewald formula begins to be unreliable when triglycerides are elevated [62], when calculating LDL cholesterol, 400 mg/dL was used as the upper limit for triglycerides if the Subject ’ s triglyceride level is > 400 mg/dL.”
MethodLee, S.-Y., Hahm, S. K., Park, J., Choi, S.-K., Yoon, J.-Y., Choi, S.-H., & Jeon, K.-S. (2015) · Korean Journal of Family Medicine · doi:10.4082/kjfm.2015.36.4.168 · Cited by 9
Choukem, S. P., Manases, T., Mefo’o, J. P. N., Dimala, C. A., Mboue-Djieka, Y., Sobngwi, E., & Kengne, A. P. (2017) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2017.12.008 · Cited by 9
“AC C EP TE D M AN U SC R IP T values when compared to the ultracentrifugation [10] or to the direct homogeneous assay [11], or to overestimate it [12].”
BackgroundHypertriglyceridemia and Cardiovascular Outcomes
Malhotra, G., Sethi, A., & Arora, R. R. (2014) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000000116 · Cited by 9
Machine learning-based prediction of LDL cholesterol: performance evaluation and validation
Meng, J.-B., An, Z.-J., & Jiang, C.-S. (2025) · PeerJ · doi:10.7717/peerj.19248 · Cited by 8
“7A) ( Barakett-Hamade et al., 2021 ; Martin et al., 2013a ).”
High-protein diet with excess leucine prevents inactivity-induced insulin resistance in women
Mangogna, A., Girolamo, F. G. D., Fiotti, N., Vinci, P., Landolfo, M., Mearelli, F., & Biolo, G. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.10.028 · Cited by 8
Nazli, S. A., Rosman, A., Kasim, N. A. M., Al-Khateeb, A. M., Ul-Saufie, A. Z., Radzi, A. B. M., Ibrahim, K. S., Kassim, S. S., & Nawawi, H. M. (2024) · Scientific Reports · doi:10.1038/s41598-024-53539-6 · Cited by 13
“The level of LDL-c is often measured using calculation; most commonly using Friedewald equation, instead of direct measurement which may give inaccurate results 84,85 .”
MethodSjöblom, L., Hantikainen, E. M., Dahlgren, A., Lagerros, Y. T., & Bonn, S. E. (2025) · Nutrition Journal · doi:10.1186/s12937-024-01069-2 · Cited by 12
“Fasting blood sampling of HbA1c (mmol/mol) [37] and serum lipid levels (mmol/L) [38] including triglycerides (mmol/L) [39], total cholesterol (mmol/L), LDL-cholesterol [39], and HDL-cholesterol (mmol/L) [40], were collected at baseline and after 3-and 6-months.”
Discordance: Can we capitalize on it to better personalize atherosclerosis treatment?
Nasir, K., Martin, S. S., & Virani, S. S. (2013) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2013.04.018 · Cited by 8
“Limitations of Traditional Cholesterol Measurement? In part, discordance between lipids and atherosclerosis may be explained by limitations of the most commonly used lipid parameter, Friedewald equation-estimated LDL-C, can underestimate ‘actual’ LDL-C in a considerable number of patients [10].”
BackgroundSelf-citationLarsson, A., Hagström, E., Nilsson, L. E., & Svensson, M. K. E. (2018) · Upsala Journal of Medical Sciences · doi:10.1080/03009734.2018.1465496 · Cited by 8
“compared Friedewaldestimated LDL-C and LDL-C with density gradient ultracentrifugation for LDL-C determination (6).”
MethodSzoeke, C. E. I., Goodwill, A. M., Gorelik, A., Dennerstein, L., Caeyenberghs, K., Simpson, S., Hill, E., & Campbell, S. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-180815 · Cited by 8
Donato, L. J., & Meeusen, J. W. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-815499-1.00028-4 · Cited by 8
Hypertriglyceridemia with acute pancreatitis in a 14-year-old girl with diabetic ketoacidosis
Park, H., Kim, M.-S., Kim, J., Lee, S.-M., Cho, S. Y., Yoo, E.-G., & Jin, D. (2021) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2040250.125 · Cited by 8
Ferrinho, C., Alves, A. C., Bourbon, M., & Duarte, S. (2021) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2020.11.011 · Cited by 9
Jo, S.-Y., Kwon, Y., & Cho, A. (2022) · Korean Journal of Family Medicine · doi:10.4082/kjfm.21.0102 · Cited by 8
Hypolipidaemic effect of crude extract from Carpobrotus rossii (pigface) in healthy rats
Pirie, A. D., Davies, N. W., Ahuja, K., Adams, M. J., Shing, C. M., Narkowicz, C., Jacobson, G. A., & GERAGHTY, D. P. (2014) · Food and Chemical Toxicology · doi:10.1016/j.fct.2014.01.034 · Cited by 8
Trombeta, J. C. D. S., Prestes, J., Nascimento, D. D. C., Tibana, R. A., Pereira, G. B., Lima, T. D. R., Fraga, G. A., Vieira, R. C., & Voltarelli, F. A. (2017) · Archives of Endocrinology and Metabolism · doi:10.1590/2359-3997000000270 · Cited by 8
“Charles, MO, USA) and by an automated analyzer (Human GmbH, Germany), while low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) were estimated by the Friedewald equation (17).”
MethodAlaminos-Castillo, M. A., Ho‐Plagaro, A., García‐Serrano, S., Santiago‐Fernández, C., Rodríguez‐Pacheco, F., Garrido‐Sánchez, L., Rodriguez, C., Valdés, S., Gonzalo, M., Moreno‐Ruiz, F. J., et al. (2019) · International Journal of Clinical Practice · doi:10.1111/ijcp.13315 · Cited by 8
Evinacumab for Homozygous Familial Hypercholesterolemia
Luo, F., Das, A., & Fang, Z. (2021) · New England Journal of Medicine · doi:10.1056/nejmc2033612 · Cited by 8
Prediction of low-density lipoprotein cholesterol levels using machine learning methods
Kim, Y., Lee, W. K., & Lee, W. (2024) · Laboratory Medicine · doi:10.1093/labmed/lmad114 · Cited by 7
Cardiovascular disease lipids and lipoproteins biomarker standardization
Lyle, A. N., Danilenko, U., Sugahara, O., & Vesper, H. W. (2025) · Critical Reviews in Clinical Laboratory Sciences · doi:10.1080/10408363.2025.2462817 · Cited by 7
“The equation was derived using lipids data from healthy individuals and provides reliable estimates in individuals with normal TG values; however, the equation is prone to underestimation of LDL-C in patients with high TG and when the actual LDL-C concentration is low [26].”
Hamazaki, K., Nishi, D., Yonemoto, N., Noguchi, H., Kim, Y., & Matsuoka, Y. (2014) · European Psychiatry · doi:10.1016/j.eurpsy.2014.05.002 · Cited by 7
“It is known that the Friedewald equation tends to be inaccurate in patients with low LDL-C and higher TG [19] and this might have contributed to the loss of statistical power for LDL-C.”
Ma, Z., Zhang, Y. P., Chen, Z., Liu, D., Gu, S., & Zuo, H. (2023) · Neurological Research · doi:10.1080/01616412.2023.2176630 · Cited by 7
Quispe, R., Al-Hijji, M. A., Swiger, K. J., Martin, S. S., Elshazly, M. B., Blaha, M. J., Joshi, P. H., Blumenthal, R. S., Sniderman, A. D., Toth, P. P., et al. (2015) · Journal of clinical lipidology · doi:10.1016/j.jacl.2015.05.005 · Cited by 7
Self-citationNaser, A., Isgandarov, K., Güvenç, T. S., Güvenç, R. Ç., & Şahin, M. (2022) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20210641 · Cited by 7
LDL Cholesterol—How Low Can We Go?
Tobert, J. A. (2022) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2022.01.005 · Cited by 8
Heidemann, B. E., Koopal, C., van Lennep, J. E. R., Stroes, E. S. G., Riksen, N. P., Mulder, M. T., van der Zee, L. C. V. V. –., Blackhurst, D., Visseren, F. L. J., & Marais, A. D. (2022) · Clinica Chimica Acta · doi:10.1016/j.cca.2022.11.035 · Cited by 7
Improving lipid control following myocardial infarction
Ankam, J. V., Feldman, D. I., Blaha, M. J., & Martin, S. S. (2014) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000093 · Cited by 7
“Furthermore, it should be noted that studies likely overestimate LDL-C control, given that the Friedewald equation underestimates LDL-C at low levels [32,33].”
BackgroundSelf-citationHerencia, J. A. C., Rueda, M. S., Bru, A. P., Escribano, F. M., García, I. P., Ródenas, L. M. A., Bernardo, D. C., Divisón, J. A., & Gil-Guillén, V. F. (2018) · Clínica e Investigación en Arteriosclerosis (English Edition) · doi:10.1016/j.artere.2017.10.003 · Cited by 7
Lipoprotein remnants: to be or not to be
Pirillo, A., & Catapano, A. L. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab511 · Cited by 7
“The determination of RC levels as total cholesterol minus LDLcholesterol (LDL-C) minus HDL-cholesterol (HDL-C) concentrations has, however, limitations related to the evaluation of LDL-C and TG levels.(7) High plasma TG levels, or very low levels of LDL-C, make the Friedewald equation unreliable in estimating LDL-C, t…”
BackgroundSheng, J., Ma, C., Wu, X., & Li, X.-X. (2025) · PLoS ONE · doi:10.1371/journal.pone.0316934 · Cited by 6
Orejón, I. M. S., Ricra, M. Á. B., & Huallpa, J. A. C. (2017) · Anales de la Facultad de Medicina · doi:10.15381/anales.v78i1.13020 · Cited by 6
“Todo ello hace que el método de determinación directa se constituya como una razonable alternativa al méto - do de referencia, además de presentar la ventaja de su automatización completa, lo que ocasiona una disminución aprecia-ble de los errores en la determinación del LDLc (6,29) .”
BackgroundValidation of low-density lipoprotein cholesterol equations in pediatric population
Zararsız, G. E., Bolat, S., Cephe, A., Koçhan, N., Yerlitaş, S. İ., Doğan, H. O., & Zararsız, G. (2023) · PeerJ · doi:10.7717/peerj.14544 · Cited by 6
“Apart from that, it overestimates LDL-C levels when triglycerides (TG) are very low and underestimates LDL-C levels when TG levels are between 150 and 399 mg/dL ( Martin et al., 2013a ) or higher than 400 mg/dL.”
Wang, I., Rahman, M. H., Hou, S., & Lin, H. (2023) · Journal of Lipid and Atherosclerosis · doi:10.12997/jla.2023.12.3.252 · Cited by 6
A new formula for estimation of low-density lipoprotein cholesterol in an ethnic Chinese population
Hu, C.-Y., Lee, C.-L., Sheu, W. H., Wang, J., Lee, I., Song, Y.-M., Fu, C., Ling, J.-T., Li, Y., & Lin, S.-Y. (2015) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2014-1029 · Cited by 6
“This finding was also supported by several previous studies [26, 35, 36], but some studies with relatively small sample sizes had different results [16, 17, 34, 37].”
BackgroundResultAl‐Daghri, N. M., Aljohani, N. J., Al-Attas, O. S., Al‐Saleh, Y., Wani, K., Alnaami, A. M., Alfawaz, H., Al-Ajlan, A., Kumar, S., Chrousos, G. P., et al. (2014) · Journal of clinical lipidology · doi:10.1016/j.jacl.2014.11.001 · Cited by 6
Devaraj, S., Cao, J., & Roper, S. M. (2017) · Archives of Pathology & Laboratory Medicine · doi:10.5858/arpa.2016-0309-ed · Cited by 6
Shi, B., Wang, H., Yin, D., Zhu, C., Feng, L., Wang, H., Jia, L., Fu, R., Song, C., Zhou, Z., et al. (2022) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd9100342 · Cited by 7
“On the other hand, it tends to significantly underestimate LDL-C values in patients with hypertriglyceridemia and low LDL-C, a population mainly beyond the Friedewald derivation sample [11,15].”
BackgroundVelilla, T. A., Guijarro, C., Ruíz, R. C., Piñero, M. R., Marcos, J. F. V., Pérez, A., López, M. A. B., López, A. M., Donaire, J. A. G., Obaya, J. C., et al. (2023) · Clínica e Investigación en Arteriosclerosis · doi:10.1016/j.arteri.2022.10.002 · Cited by 15
Chung, S. (2023) · Journal of Clinical Laboratory Analysis · doi:10.1002/jcla.24963 · Cited by 5
Luo, F., Lin, Y., Zhang, X., Li, Y., Su, L., Zhou, S., Xu, R., Gao, Q., Chen, R., Guo, Z., et al. (2023) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwad354 · Cited by 8
Saiedullah, M., Chowdhury, N., Khan, M. A., Hayat, S., Begum, S., & Rahman, M. R. (2013) · Journal of Scientific Research · doi:10.3329/jsr.v6i1.14864 · Cited by 6
Is it time to abandon fasting for routine lipid testing?
Farukhi, Z. M., & Mora, S. (2017) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.84a.16135 · Cited by 6
Herencia, J. A. C., Rueda, M. S., Bru, A. P., Escribano, F. M., García, I. P., Ródenas, L. M. A., Bernardo, D. C., Divisón, J. A., & Gil-Guillén, V. F. (2018) · Clínica e Investigación en Arteriosclerosis · doi:10.1016/j.arteri.2017.10.003 · Cited by 8
Brito, F. A., Pedrosa, W., Maluf, C. B., dos Reis, R. C. P., Fedeli, L., de Castilhos, C. D., Barreto, S. M., & Vidigal, P. G. (2018) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2018.04.007 · Cited by 6
Clinical Correlates of Aortic Stiffness and Wave Amplitude in Black Men and Women in the Community
Tsao, C. W., Washington, F., Musani, S. K., Cooper, L. L., Tripathi, A., Hamburg, N. M., Benjamin, E. J., Vasan, R. S., Mitchell, G. F., & Fox, E. R. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.117.008431 · Cited by 6
“Lowdensity lipoprotein (LDL) was calculated using the Friedewald equation.(17,18) Cigarette smoking was considered present if the participant smoked ≥1 cigarette daily in the past 12 months.”
MethodIntermittent hypoxia, energy expenditure, and visceral adipocyte recovery
Umeda, A., Miyagawa, K., Mochida-Saito, A., Takeda, H., Takeda, K., Okada, Y., & Gozal, D. (2019) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2019.103332 · Cited by 7
DeWaters, A. L., Mejía, D., Thomas, J. A. L., Elwood, B., & Bowen, M. E. (2020) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2020.04.002 · Cited by 6
Asarcıklı, L. D., Kış, M., Güvenç, T. S., Tosun, V., Açar, B., Demir, F. A., Naser, A., Zoghi, M., & CVSCORE‐TR investigators (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14090 · Cited by 6
Indirect calculation of LDL using thirteen equations in Pakistani population
Khan, M., Ain, Q., Nawaz, A., Khan, M. I., & Sadiq, F. (2022) · Clinica Chimica Acta · doi:10.1016/j.cca.2022.09.010 · Cited by 6
Ittichaicharoen, J., Apaijai, N., Tanajak, P., Sa‐nguanmoo, P., Chattipakorn, N., & Chattipakorn, S. C. (2017) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2017.10.015 · Cited by 6
Khera, A. V., Everett, B. M., Caulfield, M. P., Hantash, F. M., Wohlgemuth, J. G., Ridker, P. M., & Mora, S. (2014) · Circulation · doi:10.1161/circulationaha.114.010927 · Cited by 7
Biochemistry laboratories should routinely report non-HDL-cholesterol
Preiss, D., & Neely, D. (2015) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/0004563215594818 · Cited by 6
“3mmol/L.(7,8) It assumes that the cholesterol content of VLDL is fixed, an overly simplistic assumption which fails to take account of the variable composition of other atherogenic apolipoprotein B-containing lipoproteins like VLDL and chylomicron remnants, introducing an unpredictable error which is greatest in the c…”
BackgroundConcordance between LDL-C estimated by various formulas and directly measured LDL-C
David-Pardo, D. G., Ruiz, Á. J., Múñoz, Ó., Peña, Á. A. G., García, D. X. S., & Arcila, J. (2024) · Journal of clinical lipidology · doi:10.1016/j.jacl.2024.08.009 · Cited by 5
Ismaiil, L. A., Joumaa, W. H., & Moustafa, M. E. (2019) · Journal of Taibah University for Science · doi:10.1080/16583655.2019.1649881 · Cited by 5
Langlois, M. R., & Briers, P.-J. (2021) · Biochemia Medica · doi:10.11613/bm.2022.010704 · Cited by 11
“This may be explained by a lesser accuracy of LDL-F using the fixed VLDLC term at a low LDLC concentration range, in which VLDLC represents a relatively larger fraction of the total serum cholesterol (6,10,12,24).”
BackgroundBorg, S. Á., Bork, C. S., Nielsen, M. R. S., Schmidt, E. B., Kollslíð, R., Lundbye‐Christensen, S., & Joensen, A. M. (2022) · Atherosclerosis Plus · doi:10.1016/j.athplu.2022.03.004 · Cited by 5
“According to local practice, LDL-C values that were calculated, despite triglyceride levels exceeding 4 mmol/ L, were excluded as the Friedewald equation is not valid for such values [16,18].”
MethodVelilla, T. A., Guijarro, C., Ruíz, R. C., Piñero, M. R., Marcos, J. F. V., Pérez, A., López, A. M. B., López, A. M., Donaire, J. A. G., Obaya, J. C., et al. (2023) · Advances in Laboratory Medicine / Avances en Medicina de Laboratorio · doi:10.1515/almed-2023-0047 · Cited by 5
“Friedewald ’ s is the most frequently used formula [34].”
Cemin, R., Casablanca, S., Ermacora, D., & Daves, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134422 · Cited by 5
Rodríguez-Domínguez, J., Piedra-Aguilera, Á., Martínez-Bujidos, M., Malumbres, S., Morales‐Indiano, C., & Fernández‐Prendes, C. (2024) · Annals of Laboratory Medicine · doi:10.3343/alm.2023.0387 · Cited by 5
Mănescu, I. B., Demian, L., & Dobreanu, M. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14091000 · Cited by 5
“Most notably, the traditional Friedewald equation is less accurate at low LDL-C levels, especially when TGs are elevated [1,2,4–6 ,8].”
BackgroundAn update on trials of novel lipid-lowering drugs
Wierzbicki, A. S., Reynolds, T., & Viljoen, A. (2018) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000518 · Cited by 5
Manita, D., Yoshida, H., Koyama, I., Nakamura, M., & Hirowatari, Y. (2020) · The Journal of Applied Laboratory Medicine · doi:10.1093/jalm/jfaa144 · Cited by 5
Dataset dependency of low-density lipoprotein-cholesterol estimation by machine learning
Hidekazu, I., Nagasawa, H., Yamamoto, Y., Doi, H., Saito, M., Ishihara, Y., Fujita, T., Ishida, M., Kato, Y., Kikuchi, R., et al. (2023) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/00045632231180408 · Cited by 6
Opinion paper: Is the Friedewald equation obsolete?
Jialal, I., & Winter, W. E. (2020) · Clinica Chimica Acta · doi:10.1016/j.cca.2020.12.032 · Cited by 5
Sánchez‐Bacaicoa, C., Galán, J., Guijarro, C., Rico‐Martín, S., Monréal, M., García, J. F. C., Aguilar‐Cortés, E., Muñoz-Torrero, J. F. S., & for FRENA Investigators (2021) · European Journal of Clinical Investigation · doi:10.1111/eci.13732 · Cited by 5
Bringing Back Targets to “IMPROVE” Atherosclerotic Cardiovascular Disease Outcomes
Michos, E. D., Martin, S. S., & Blumenthal, R. S. (2015) · Circulation · doi:10.1161/circulationaha.115.018511 · Cited by 5
“Especially when triglyceride levels are ≥150 mg/dL, Friedewald estimation commonly classifies LDL-C <70 despite direct LDL-C ≥70 mg/dL; therefore, these patients may warrant additional evaluation.(11) A novel method for estimating LDL-C by using an adjustable factor for the triglyceride/very-low-density lipoprotein ch…”
MethodSelf-citationAdvances in Lipid Testing: A Practical Step Forward
Stone, N. J. (2016) · Clinical Chemistry · doi:10.1373/clinchem.2016.258996 · Cited by 5
“Martin et al. (13 ) in a sample of 1 million patients noted that the Friedewald equation tended to underestimate LDL-C when triglyceride concentrations were 150 mg/dL ( 1.7 mmol/L).”
BackgroundInfluentialKataoka, Y., Nicholls, S. J., Kitahara, S., Katasako-Yabumoto, A., Hosoda, H., Funabashi, S., Mitsui, K., Murai, K., Iwai, T., Sawada, K., et al. (2026) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2026.120684 · Cited by 4
Watanabe, D. K., Kitayama, S., Williams, D. P., & Thayer, J. F. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100555 · Cited by 5
“However, in MIDUS and MIDJA the Friedewald equation (Friedewald et al., 1972) was used to compute LDL-C, which has been shown to be inaccurate in computing LDL-C and is problematic for the detection of very low LDL-C (Martin et al., 2013; Schectman & Sasse 1993).”
InfluentialNew joint consensus initiative on quantifying atherogenic lipoproteins
Stock, J. K. (2018) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2018.08.037 · Cited by 4
Labordiagnostik von Fettstoffwechselstörungen
März, W., Scharnagl, H., Kleber, M. E., Silbernagel, G., Nauck, M., Müller‐Wieland, D., & von Eckardstein, A. (2023) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-1516-2511 · Cited by 5
Demirci, F., Emeç, M., Doruk, Ö. G., Örmen, M., Akan, P., & Özcanhan, M. H. (2023) · Turkish Journal of Biochemistry · doi:10.1515/tjb-2023-0154 · Cited by 4
“In particular, for patients with low LDL levels (LDL 70 mg/dL), the Martin-Hopkins equation (MH-E) equation (LDL=TC − HDL − TG/ novel factor) has been considered the most successful [5, 6].”
BackgroundTraditional and Novel Markers: Target of Treatment vs Marker of Risk
Mancini, G. B. J., Poirier, P., & Esau, D. (2024) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2024.04.003 · Cited by 4
Fatigued with Friedewald: why isn't everyone onboard yet with the new LDL-C equations?
Narasimhan, M., Cao, J., Meeusen, J. W., Remaley, A. T., Martin, S. S., & Muthukumar, A. (2025) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2025.1534460 · Cited by 4
Self-citationBrookhart, M. A., Todd, J., Li, X., Reams, B. D., Pate, V., & Kshirsagar, A. V. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.07.013 · Cited by 4
“Previous research has found reasonably good comparability between various lipid measures collected in routine care and their corresponding population levels in NHANES [6,7].”
ResultMontero, D., Dutheil, F., Walther, G., Pérez‐Martin, A., Soto-Esclapez, L., Vinet, A., & Roche, E. (2021) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.01.025 · Cited by 4
Prevalence and clinical risk prediction of hypertriglyceridaemia in a community cohort
Tan, H., Hure, A. J., Peel, R., Hancock, S. J., & Attia, J. (2021) · Internal Medicine Journal · doi:10.1111/imj.15626 · Cited by 4
Zhang, Y., Minxiang, W., & Mao, C. (2024) · Medicine · doi:10.1097/md.0000000000036805 · Cited by 4
Gomes, D., Paiva, M. S., Freitas, P., Albuquerque, F., Lima, M. R., Santos, R. R., Presume, J., Trabulo, M., Aguíar, C., Ferreira, J., et al. (2024) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20230242 · Cited by 4
Milinković, N., Sarić, M., Jovičić, S. Ž., Mirković, D., Ležaić, V., & Ignjatović, S. (2019) · Journal of Medical Biochemistry · doi:10.2478/jomb-2019-0032 · Cited by 4
Saiedullah, M., Chowdhury, N., & Khan, M. A. H. (2015) · Journal of Enam Medical College · doi:10.3329/jemc.v5i1.21491 · Cited by 4
Sha, M., Siddique, A. H., Saiedullah, M., & Khan, M. A. H. (2015) · Journal of Enam Medical College · doi:10.3329/jemc.v5i2.23376 · Cited by 4
Use of friedewald equation for dyslipidemia in metabolic syndrome
Kaur, J. (2014) · International Journal of Medicine · doi:10.14419/ijm.v2i1.2370 · Cited by 4
Utility of Advanced Lipoprotein Testing in Clinical Practice
Feingold, K. R., & Grünfeld, C. (2016) · Europe PMC (PubMed Central) · Cited by 4
Jialal, I. (2014) · American Journal of Clinical Pathology · doi:10.1309/ajcped9x7rnmyaeq · Cited by 4
Vargas‐Vázquez, A., Bello‐Chavolla, O. Y., Antonio‐Villa, N. E., Mehta, R., Aguilar-Salinas, C. A., & Cruz‐Bautista, I. (2021) · Research Square · doi:10.21203/rs.3.rs-249674/v2 · Cited by 4
Lipid Profiling in Obesity: The Limitations of the Friedewald Equation
Zheng, H. (2024) · The American Journal of Medicine · doi:10.1016/j.amjmed.2024.09.011 · Cited by 4
Lipid management in type 2 diabetes and non-HDL-cholesterol: target all atherogenic lipoproteins
Brandts, J., Verket, M., Zambon, A., Marx, N., Müller-Wieland, D., & Federici, M. (2026) · Cardiovascular Diabetology · doi:10.1186/s12933-026-03166-4 · Cited by 3
“Furthermore, the LDL-C estimation methods, including Friedewald formula, may not be reliable in patients with TG ≥ 400 mg/dL (4.5 mmol/L), or with TG ≥ 150 mg/dL (1.69 mmol/L) and LDL-C 70 mg/dL (1.8 mmol/L) [22, 23].”
InfluentialKnowlton, K. U., Návar, A. M., Anderson, J. L., Brown, A. S., Muhlestein, J. B., Kleeman, K., Sarwat, S., Abbas, C. A., Ramirez, M. A., Grines, C. L., et al. (2026) · Journal of the American Heart Association · doi:10.1161/jaha.125.043655 · Cited by 3
“46 Not all participants in the inclisiran + usual care arm received 3 doses of inclisiran, which may affect observed LDL-C lowering.”
Chacko, S. R., Sharma, S. S., Ahmadian, S., Saini, J., Fell, V. M., Peersen, A. F., Atkinson, E. J., Gruber, L., Gompel, J. J. V., Simha, V., et al. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf693 · Cited by 3
The Effect of Triglyceride Concentration on Attainment of Lipid Targets in Patients with Diabetes
Cartier, L.-J., Collins, C., Lagacé, M., & Douville, P. (2017) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2016.12.006 · Cited by 3
Zhang, J. Z., Heinsberg, L. W., Krishnan, M., Hawley, N. L., Major, T. J., Carlson, J. C., Hindmarsh, J. H., Watson, H., Qasim, M. H., Stamp, L. K., et al. (2022) · Genetic Epidemiology · doi:10.1002/gepi.22508 · Cited by 3
Velilla, T. A., Guijarro, C., Ruíz, R. C., Piñero, M. R., Marcos, J. F. V., Pérez, A., López, M. A. B., López, A. M., Donaire, J. A. G., Obaya, J. C., et al. (2023) · Advances in Laboratory Medicine / Avances en Medicina de Laboratorio · doi:10.1515/almed-2023-0010 · Cited by 4
Reiber, I., Márk, L., Együd, F., Mező, I., & Császár, A. (2023) · Cardiologia Hungarica · doi:10.26430/chungarica.2023.53.6.633 · Cited by 4
Liu, Y., Sequeira, I. R., Ko, J., Shamaitijiang, X., Skudder‐Hill, L., & Petrov, M. S. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.70077 · Cited by 3
“21,22 In contrast, analysis of LDL subfractions offers more precise measurements and has been shown to improve CVD risk assessment by identifying residual risks that traditional LDL cholesterol levels alone may overlook.”
Rodríguez-Vigil, E., Rodríguez-Chacón, M., Trabanco, C., & Irizarry-Ramos, J. (2014) · PubMed · Cited by 3
Friedewald-Estimated Versus Directly Measured LDL-Cholesterol: KNHANES 2009-2010
Jang, S., & Lee, J.-S. (2015) · Journal of the Korea Academia-Industrial cooperation Society · doi:10.5762/kais.2015.16.8.5492 · Cited by 3
Pallazola, V. A., Quispe, R., Elshazly, M. B., Vakil, R. M., Sathiyakumar, V., Jones, S. R., & Martin, S. S. (2018) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-018-0590-9 · Cited by 3
“…[54] TC-HDL-C-(TG/6.58) No 115 Serbia Determined mean of VLDL-C/TG ratio from observed values Yes [55, 56] De Cordova (2013) [57] 0.75 × (TC − HDL-C) No 10,664 Brazil Least squares linear regression Yes [43, 47] Martin (2013) [58••] TC − (HDL-C − TG/adjustable factor) Adjustable factor 180…”
BackgroundInfluentialSelf-citationEvolocumab Effects on Lipoproteins, Measured by High-Performance Liquid Chromatography
Masuda, D., Kiyosue, A., Hirayama, A., Shimauchi, J., López, J. A. G., Miyawaki, K., & Yamashita, S. (2020) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.54353 · Cited by 3
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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