Accuracy of low-density lipoprotein cholesterol estimation at very low levels
Abstract Background As the approach to low-density lipoprotein cholesterol (LDL-C) lowering becomes increasingly intensive, accurate assessment of LDL-C at very low levels warrants closer attention in individualized clinical efficacy and safety evaluation. We aimed to assess the accuracy of LDL-C es...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12916-017-0852-2 |
| _version_ | 1818684510892457984 |
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| author | Renato Quispe Aditya Hendrani Mohamed B. Elshazly Erin D. Michos John W. McEvoy Michael J. Blaha Maciej Banach Krishnaji R. Kulkarni Peter P. Toth Josef Coresh Roger S. Blumenthal Steven R. Jones Seth S. Martin |
| author_facet | Renato Quispe Aditya Hendrani Mohamed B. Elshazly Erin D. Michos John W. McEvoy Michael J. Blaha Maciej Banach Krishnaji R. Kulkarni Peter P. Toth Josef Coresh Roger S. Blumenthal Steven R. Jones Seth S. Martin |
| author_sort | Renato Quispe |
| collection | DOAJ |
| description | Abstract Background As the approach to low-density lipoprotein cholesterol (LDL-C) lowering becomes increasingly intensive, accurate assessment of LDL-C at very low levels warrants closer attention in individualized clinical efficacy and safety evaluation. We aimed to assess the accuracy of LDL-C estimation at very low levels by the Friedewald equation, the de facto clinical standard, and compare its accuracy with a novel, big data-derived LDL-C estimate. Methods In 191,333 individuals with Friedewald LDL-C < 70 mg/dL, we compared the accuracy of Friedewald and novel LDL-C values in relation to direct measurements by Vertical Auto Profile ultracentrifugation. We examined differences (estimate minus ultracentrifugation) and classification according to levels initiating additional safety precautions per clinical practice guidelines. Results Friedewald values were less than ultracentrifugation measurement, with a median difference (25th to 75th percentile) of –2.4 (–7.4 to 0.6) at 50–69 mg/dL, –7.0 (–16.2 to –1.2) at 25–39 mg/dL, and –29.0 (–37.4 to –19.6) at < 15 mg/dL. The respective values by novel estimation were –0.1 (–1.5 to 1.3), –1.1 (–2.5 to 0.3), and –2.7 (–4.9 to 0.0) mg/dL. Among those with Friedewald LDL–C < 15, 15 to < 25, and 25 to < 40 mg/dL, the classification was discordantly low in 94.9%, 82.6%, and 59.9% of individuals as compared with 48.3%, 42.4%, and 22.4% by novel estimation. Conclusions Estimation of even lower LDL-C values (by Friedewald and novel methods) is even more inaccurate. More often than not, a Friedewald value < 40 mg/dL is underestimated, which translates into unnecessary safety alarms that could be reduced in half by estimation using our novel method. |
| first_indexed | 2024-12-17T10:51:47Z |
| format | Article |
| id | doaj.art-d51d36f3c2a144acb132f0d25c34c342 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-17T10:51:47Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-d51d36f3c2a144acb132f0d25c34c3422022-12-21T21:51:58ZengBMCBMC Medicine1741-70152017-04-0115111110.1186/s12916-017-0852-2Accuracy of low-density lipoprotein cholesterol estimation at very low levelsRenato Quispe0Aditya Hendrani1Mohamed B. Elshazly2Erin D. Michos3John W. McEvoy4Michael J. Blaha5Maciej Banach6Krishnaji R. Kulkarni7Peter P. Toth8Josef Coresh9Roger S. Blumenthal10Steven R. Jones11Seth S. Martin12Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineDepartment of Medicine, Medstar Good Samaritan/Union Memorial HospitalDepartment of Cardiovascular Medicine, Cleveland ClinicCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineDepartment of Hypertension, Chair of Nephrology and Hypertension, Medical University of LodzAtherotech Diagnostics LaboratoryCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineWelch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineCiccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineAbstract Background As the approach to low-density lipoprotein cholesterol (LDL-C) lowering becomes increasingly intensive, accurate assessment of LDL-C at very low levels warrants closer attention in individualized clinical efficacy and safety evaluation. We aimed to assess the accuracy of LDL-C estimation at very low levels by the Friedewald equation, the de facto clinical standard, and compare its accuracy with a novel, big data-derived LDL-C estimate. Methods In 191,333 individuals with Friedewald LDL-C < 70 mg/dL, we compared the accuracy of Friedewald and novel LDL-C values in relation to direct measurements by Vertical Auto Profile ultracentrifugation. We examined differences (estimate minus ultracentrifugation) and classification according to levels initiating additional safety precautions per clinical practice guidelines. Results Friedewald values were less than ultracentrifugation measurement, with a median difference (25th to 75th percentile) of –2.4 (–7.4 to 0.6) at 50–69 mg/dL, –7.0 (–16.2 to –1.2) at 25–39 mg/dL, and –29.0 (–37.4 to –19.6) at < 15 mg/dL. The respective values by novel estimation were –0.1 (–1.5 to 1.3), –1.1 (–2.5 to 0.3), and –2.7 (–4.9 to 0.0) mg/dL. Among those with Friedewald LDL–C < 15, 15 to < 25, and 25 to < 40 mg/dL, the classification was discordantly low in 94.9%, 82.6%, and 59.9% of individuals as compared with 48.3%, 42.4%, and 22.4% by novel estimation. Conclusions Estimation of even lower LDL-C values (by Friedewald and novel methods) is even more inaccurate. More often than not, a Friedewald value < 40 mg/dL is underestimated, which translates into unnecessary safety alarms that could be reduced in half by estimation using our novel method.http://link.springer.com/article/10.1186/s12916-017-0852-2Low-density lipoprotein cholesterolVery lowAccuracyFriedewald estimationNovel methodClinical decision making |
| spellingShingle | Renato Quispe Aditya Hendrani Mohamed B. Elshazly Erin D. Michos John W. McEvoy Michael J. Blaha Maciej Banach Krishnaji R. Kulkarni Peter P. Toth Josef Coresh Roger S. Blumenthal Steven R. Jones Seth S. Martin Accuracy of low-density lipoprotein cholesterol estimation at very low levels BMC Medicine Low-density lipoprotein cholesterol Very low Accuracy Friedewald estimation Novel method Clinical decision making |
| title | Accuracy of low-density lipoprotein cholesterol estimation at very low levels |
| title_full | Accuracy of low-density lipoprotein cholesterol estimation at very low levels |
| title_fullStr | Accuracy of low-density lipoprotein cholesterol estimation at very low levels |
| title_full_unstemmed | Accuracy of low-density lipoprotein cholesterol estimation at very low levels |
| title_short | Accuracy of low-density lipoprotein cholesterol estimation at very low levels |
| title_sort | accuracy of low density lipoprotein cholesterol estimation at very low levels |
| topic | Low-density lipoprotein cholesterol Very low Accuracy Friedewald estimation Novel method Clinical decision making |
| url | http://link.springer.com/article/10.1186/s12916-017-0852-2 |
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