Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2014

Open Access 01-12-2014 | Research article

Comparison of various formulae for estimating low-density lipoprotein cholesterol by a combination of ages and genders in Taiwanese adults

Authors: Chung-Huang Tsai, Hsin-Hung Wu, Shao-Jen Weng

Published in: BMC Cardiovascular Disorders | Issue 1/2014

Login to get access

Abstract

Background

The accuracy and precision of the Friedewald formula for estimating low-density lipoprotein cholesterol (LDL-C) is questionable. Although other formulae have been developed, only a few studies compare them. Thus, we compared the efficiencies of various formulae, based on the age and gender of adults, to determine which ones yield more accurate estimations in terms of mean squared error, and which formulae underestimated and overestimated LDL-C performance.

Methods

This study compares various formulae in terms of mean squared error (MSE), as well as underestimation and overestimation of LDL-C concentrations, using subjects of various ages and both genders. Six groups were examined in this study based on age and gender: males 20–44 years old, 45–64, and 65 and above, and females in the same three age ranges.

Results

The results show that the Friedewald formula has relatively low accuracy, and while its performance among older (aged 45 and above) women with triglyceride concentrations ≤ 400 mg/dL is better than that with other groups, it is still more inaccurate than the other formulae. In terms of prediction errors and mean squared errors, Tsai’s formula (TF) and a calibrated TF provide the most accurate results with regard to the LDL-C concentration. Moreover, based on a cross-validation of age and gender, these two formulae provide highly accurate results for the LDL-C concentrations of all the studied groups, except for women aged 20–44 years.

Conclusions

Based on the experimental results, this study provides a set of benchmarks for the formulae used in LDL-C tests when considering the factors of age and gender. Therefore, it is a valuable method for providing formula benchmarking.
Appendix
Available only for authorised users
Literature
1.
go back to reference National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002, 106: 3143-3421. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002, 106: 3143-3421.
2.
go back to reference Teramoto T, Sasaki J, Ueshima H, Egusa G, Kinoshita M, Shimamoto K, Daida H, Biro S, Hirobe K, Funahashi T, Yokote K, Yokode M: Executive summary of Japan Atherosclerosis Society (JAS) guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese. J Atheroscler Thromb. 2007, 14: 45-50. 10.5551/jat.14.45.CrossRefPubMed Teramoto T, Sasaki J, Ueshima H, Egusa G, Kinoshita M, Shimamoto K, Daida H, Biro S, Hirobe K, Funahashi T, Yokote K, Yokode M: Executive summary of Japan Atherosclerosis Society (JAS) guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases for Japanese. J Atheroscler Thromb. 2007, 14: 45-50. 10.5551/jat.14.45.CrossRefPubMed
3.
go back to reference Friedewald WT, Levy RI, Fredrickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972, 18: 499-502.PubMed Friedewald WT, Levy RI, Fredrickson DS: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972, 18: 499-502.PubMed
4.
go back to reference DeLong DM, DeLong ER, Wood PD, Lippel K, Rifkind BM: A comparison of methods for the estimation of plasma low- and very-low-density lipoprotein cholesterol. The Lipid Research Clinics Prevalence Study. JAMA. 1986, 256: 2372-2377. 10.1001/jama.1986.03380170088024.CrossRefPubMed DeLong DM, DeLong ER, Wood PD, Lippel K, Rifkind BM: A comparison of methods for the estimation of plasma low- and very-low-density lipoprotein cholesterol. The Lipid Research Clinics Prevalence Study. JAMA. 1986, 256: 2372-2377. 10.1001/jama.1986.03380170088024.CrossRefPubMed
5.
go back to reference Teerakanchana T, Puavilai W, Suriyaprom K, Tungtrongchitr R: Comparative study of LDL cholesterol levels in Thai patients by the direct method and using the Friedewald formula. Southeast Asian J Trop Med Public Health. 2007, 38: 519-527.PubMed Teerakanchana T, Puavilai W, Suriyaprom K, Tungtrongchitr R: Comparative study of LDL cholesterol levels in Thai patients by the direct method and using the Friedewald formula. Southeast Asian J Trop Med Public Health. 2007, 38: 519-527.PubMed
6.
go back to reference Balal M, Paydas S, Inal T, Demir E, Kurt C, Sertdemir Y: Validation of the Friedewald formula for the determination of low-density lipoprotein cholesterol in renal transplant recipients. Ren Fail. 2010, 32: 455-458. 10.3109/08860221003658266.CrossRefPubMed Balal M, Paydas S, Inal T, Demir E, Kurt C, Sertdemir Y: Validation of the Friedewald formula for the determination of low-density lipoprotein cholesterol in renal transplant recipients. Ren Fail. 2010, 32: 455-458. 10.3109/08860221003658266.CrossRefPubMed
7.
go back to reference Tsai C-H, Su J-L, Wu M-H, Huang C-J, Lin J-L: Estimating low-Density lipoprotein cholesterol by a new formula instead of the Friedewald formula in Adult Taiwanese. Taiwan J Fam Med. 2013, 23: 1-14. Tsai C-H, Su J-L, Wu M-H, Huang C-J, Lin J-L: Estimating low-Density lipoprotein cholesterol by a new formula instead of the Friedewald formula in Adult Taiwanese. Taiwan J Fam Med. 2013, 23: 1-14.
8.
go back to reference Tsai C-H, Lin H-Y, Wang H-F, Wang J, Gau-De L, Jiunn-Lung L: Comparison of the efficiencies of various formulae for estimating low-density lipoprotein cholesterol in Adult Taiwanese. Nutr Sci J. 2012, 37 (4): 119-127. Tsai C-H, Lin H-Y, Wang H-F, Wang J, Gau-De L, Jiunn-Lung L: Comparison of the efficiencies of various formulae for estimating low-density lipoprotein cholesterol in Adult Taiwanese. Nutr Sci J. 2012, 37 (4): 119-127.
9.
go back to reference Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation. 1998, 97: 1837-1847. 10.1161/01.CIR.97.18.1837.CrossRefPubMed Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB: Prediction of coronary heart disease using risk factor categories. Circulation. 1998, 97: 1837-1847. 10.1161/01.CIR.97.18.1837.CrossRefPubMed
10.
go back to reference Sharrett AR, Ballantyne CM, Coady SA, Heiss G, Sorlie PD, Catellier D, Patsch W: Coronary heart disease prediction from lipoprotein cholesterol concentrations, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2001, 104: 1108-1113. 10.1161/hc3501.095214.CrossRefPubMed Sharrett AR, Ballantyne CM, Coady SA, Heiss G, Sorlie PD, Catellier D, Patsch W: Coronary heart disease prediction from lipoprotein cholesterol concentrations, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2001, 104: 1108-1113. 10.1161/hc3501.095214.CrossRefPubMed
11.
go back to reference Okamura T, Kokubo Y, Watanabe M, Higashiyama A, Miyamoto Y, Yoshimasa Y, Okayama A: Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort study: the Suita study. Atherosclerosis. 2009, 203: 587-592. 10.1016/j.atherosclerosis.2008.07.020.CrossRefPubMed Okamura T, Kokubo Y, Watanabe M, Higashiyama A, Miyamoto Y, Yoshimasa Y, Okayama A: Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort study: the Suita study. Atherosclerosis. 2009, 203: 587-592. 10.1016/j.atherosclerosis.2008.07.020.CrossRefPubMed
12.
go back to reference Maruyama K, Hirobe K, Noda H, Iso H, Dohi S, Terai T, Fujioka S, Goto K, Horie S, Nakano S: Associations between blood lipid profiles and risk of myocardial infarction among Japanese male workers: 3M study. J Atheroscler Thromb. 2009, 16: 714-721.CrossRefPubMed Maruyama K, Hirobe K, Noda H, Iso H, Dohi S, Terai T, Fujioka S, Goto K, Horie S, Nakano S: Associations between blood lipid profiles and risk of myocardial infarction among Japanese male workers: 3M study. J Atheroscler Thromb. 2009, 16: 714-721.CrossRefPubMed
13.
go back to reference Mora S, Rifai N, Buring JE, Ridker PM: Comparison of LDL cholesterol concentrations by Friedewald’s calculation and direct measurement in relation to cardiovascular events in 27,331 women. Clin Chem. 2009, 55: 888-894. 10.1373/clinchem.2008.117929.CrossRefPubMedPubMedCentral Mora S, Rifai N, Buring JE, Ridker PM: Comparison of LDL cholesterol concentrations by Friedewald’s calculation and direct measurement in relation to cardiovascular events in 27,331 women. Clin Chem. 2009, 55: 888-894. 10.1373/clinchem.2008.117929.CrossRefPubMedPubMedCentral
14.
go back to reference Faas FH, Earleywine A, Smith G, Simmons DL: How should low-density lipoprotein cholesterol concentration be determined?. J Fam Pract. 2002, 51: 972-975.PubMed Faas FH, Earleywine A, Smith G, Simmons DL: How should low-density lipoprotein cholesterol concentration be determined?. J Fam Pract. 2002, 51: 972-975.PubMed
15.
go back to reference Tighe DA, Ockene IS, Reed G, Nicolosi R: Calculated low-density lipoprotein cholesterol levels frequently underestimate directly measured low-density lipoprotein cholesterol determinations in patients with serum triglyceride levels < or = 4.52 mmol/l: an analysis comparing the LipiDirect magnetic LDL assay with the Friedewald calculation. Clin Chim Acta. 2006, 365: 236-242. 10.1016/j.cca.2005.08.026.CrossRefPubMed Tighe DA, Ockene IS, Reed G, Nicolosi R: Calculated low-density lipoprotein cholesterol levels frequently underestimate directly measured low-density lipoprotein cholesterol determinations in patients with serum triglyceride levels < or = 4.52 mmol/l: an analysis comparing the LipiDirect magnetic LDL assay with the Friedewald calculation. Clin Chim Acta. 2006, 365: 236-242. 10.1016/j.cca.2005.08.026.CrossRefPubMed
16.
go back to reference Can M, Acikgoz S, Mungan G, Ugurbas E, Ankarali H, Sumbuloglu V, Demirtas S, Karaca L: Is direct method of low-density lipoprotein cholesterol measurement appropriate for targeting lipid-lowering therapy?. Int J Cardiol. 2010, 142: 105-107. 10.1016/j.ijcard.2008.11.141.CrossRefPubMed Can M, Acikgoz S, Mungan G, Ugurbas E, Ankarali H, Sumbuloglu V, Demirtas S, Karaca L: Is direct method of low-density lipoprotein cholesterol measurement appropriate for targeting lipid-lowering therapy?. Int J Cardiol. 2010, 142: 105-107. 10.1016/j.ijcard.2008.11.141.CrossRefPubMed
17.
go back to reference Cordova CM, Schneider CR, Juttel ID, Cordova MM: Comparison of LDL cholesterol direct measurement with the estimate using the Friedewald’s formula in a sample of 10,664 patients. Arq Bras Cardiol. 2004, 83 (6): 482-487. 76–81CrossRefPubMed Cordova CM, Schneider CR, Juttel ID, Cordova MM: Comparison of LDL cholesterol direct measurement with the estimate using the Friedewald’s formula in a sample of 10,664 patients. Arq Bras Cardiol. 2004, 83 (6): 482-487. 76–81CrossRefPubMed
18.
go back to reference Jun KR, Park HI, Chun S, Park H, Min WK: Effects of total cholesterol and triglyceride on the percentage difference between the low-density lipoprotein cholesterol concentration measured directly and calculated using the Friedewald formula. CCLM / FESCC. 2008, 46: 371-375. Jun KR, Park HI, Chun S, Park H, Min WK: Effects of total cholesterol and triglyceride on the percentage difference between the low-density lipoprotein cholesterol concentration measured directly and calculated using the Friedewald formula. CCLM / FESCC. 2008, 46: 371-375.
19.
go back to reference Eblen-Zajjur A, Eblen-Zajjur M: Estimation of low-density lipoprotein-cholesterol concentration: regression analysis versus Friedewald’s formula. Rev Med Chil. 2001, 129: 1263-1270.CrossRefPubMed Eblen-Zajjur A, Eblen-Zajjur M: Estimation of low-density lipoprotein-cholesterol concentration: regression analysis versus Friedewald’s formula. Rev Med Chil. 2001, 129: 1263-1270.CrossRefPubMed
20.
go back to reference Tremblay AJ, Morrissette H, Gagne JM, Bergeron J, Gagne C, Couture P: Validation of the Friedewald formula for the determination of low-density lipoprotein cholesterol compared with beta-quantification in a large population. Clin Biochem. 2004, 37: 785-790. 10.1016/j.clinbiochem.2004.03.008.CrossRefPubMed Tremblay AJ, Morrissette H, Gagne JM, Bergeron J, Gagne C, Couture P: Validation of the Friedewald formula for the determination of low-density lipoprotein cholesterol compared with beta-quantification in a large population. Clin Biochem. 2004, 37: 785-790. 10.1016/j.clinbiochem.2004.03.008.CrossRefPubMed
21.
go back to reference Marniemi J, Maki J, Maatela J, Jarvisalo J, Impivaara O: Poor applicability of the Friedewald formula in the assessment of serum LDL cholesterol for clinical purposes. Clin Biochem. 1995, 28: 285-289. 10.1016/0009-9120(94)00095-D.CrossRefPubMed Marniemi J, Maki J, Maatela J, Jarvisalo J, Impivaara O: Poor applicability of the Friedewald formula in the assessment of serum LDL cholesterol for clinical purposes. Clin Biochem. 1995, 28: 285-289. 10.1016/0009-9120(94)00095-D.CrossRefPubMed
22.
go back to reference Davidson M, Liu SX, Barter P, Brinton EA, Cannon CP, Gotto AM, Leary ET, Shah S, Stepanavage M, Mitchel Y, Dansky HM: Measurement of LDL-C after treatment with the CETP inhibitor anacetrapib. Journal of LIPID Research. 2013, 54: 467-472. 10.1194/jlr.M032615.CrossRefPubMedPubMedCentral Davidson M, Liu SX, Barter P, Brinton EA, Cannon CP, Gotto AM, Leary ET, Shah S, Stepanavage M, Mitchel Y, Dansky HM: Measurement of LDL-C after treatment with the CETP inhibitor anacetrapib. Journal of LIPID Research. 2013, 54: 467-472. 10.1194/jlr.M032615.CrossRefPubMedPubMedCentral
23.
go back to reference Fredrickson DS, Levy RI, Lees RS: Fat transport in lipoproteins–an integrated approach to mechanisms and disorders. N Engl J Med. 1967, 276: 34-44. 10.1056/NEJM196701052760107.CrossRefPubMed Fredrickson DS, Levy RI, Lees RS: Fat transport in lipoproteins–an integrated approach to mechanisms and disorders. N Engl J Med. 1967, 276: 34-44. 10.1056/NEJM196701052760107.CrossRefPubMed
24.
go back to reference Hatch FT: Practical methods for plasma lipoprotein analysis. Adv Lipid Res. 1968, 6: 1-68.PubMed Hatch FT: Practical methods for plasma lipoprotein analysis. Adv Lipid Res. 1968, 6: 1-68.PubMed
25.
go back to reference McNamara JR, Cohn JS, Wilson PW, Schaefer EJ: Calculated values for low-density lipoprotein cholesterol in the assessment of lipid abnormalities and coronary disease risk. Clin Chem. 1990, 36: 36-42.PubMed McNamara JR, Cohn JS, Wilson PW, Schaefer EJ: Calculated values for low-density lipoprotein cholesterol in the assessment of lipid abnormalities and coronary disease risk. Clin Chem. 1990, 36: 36-42.PubMed
26.
go back to reference Lai HS, Liu WJ, Chen CY: Study on the accuracy of using the Friedewald formula in predicting serum low-density lipoprotein level in Taiwan. Tw Fam Med Res. 2004, 2: 10-19. Lai HS, Liu WJ, Chen CY: Study on the accuracy of using the Friedewald formula in predicting serum low-density lipoprotein level in Taiwan. Tw Fam Med Res. 2004, 2: 10-19.
27.
go back to reference Cohn JS, McNamara JR, Cohn SD, Ordovas JM, Schaefer EJ: Postprandial plasma lipoprotein changes in human subjects of different ages. J Lipid Res. 1988, 29: 469-479.PubMed Cohn JS, McNamara JR, Cohn SD, Ordovas JM, Schaefer EJ: Postprandial plasma lipoprotein changes in human subjects of different ages. J Lipid Res. 1988, 29: 469-479.PubMed
28.
go back to reference Weintraub MS, Zechner R, Brown A, Eisenberg S, Breslow JL: Dietary polyunsaturated fats of the W-6 and W-3 series reduce postprandial lipoprotein levels. Chronic and acute effects of fat saturation on postprandial lipoprotein metabolism. J Clin Invest. 1988, 82: 1884-1893. 10.1172/JCI113806.CrossRefPubMedPubMedCentral Weintraub MS, Zechner R, Brown A, Eisenberg S, Breslow JL: Dietary polyunsaturated fats of the W-6 and W-3 series reduce postprandial lipoprotein levels. Chronic and acute effects of fat saturation on postprandial lipoprotein metabolism. J Clin Invest. 1988, 82: 1884-1893. 10.1172/JCI113806.CrossRefPubMedPubMedCentral
Metadata
Title
Comparison of various formulae for estimating low-density lipoprotein cholesterol by a combination of ages and genders in Taiwanese adults
Authors
Chung-Huang Tsai
Hsin-Hung Wu
Shao-Jen Weng
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2014
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-14-113

Other articles of this Issue 1/2014

BMC Cardiovascular Disorders 1/2014 Go to the issue