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Canadian Journal of Cardiology

Calculated LDL-C: Time to Move On?

Published:October 27, 2022DOI:https://doi.org/10.1016/j.cjca.2022.10.023
      Despite its shortcomings, the Friedewald equation is still being used today in most clinical laboratories to calculate low-density lipoprotein-cholesterol (LDL-C). Updated equations have been proposed to circumvent some of the problems of LDL-C calculation. A recent article by White-Al Habeeb et al.
      • White-Al Habeeb N.M.A.
      • Higgins V.
      • Venner A.A.
      • et al.
      Canadian Society of Clinical Chemists Working Group on Reference Interval Harmonization
      Canadian Society of Clinical Chemists harmonized clinical laboratory lipid reporting recommendations on the basis of the 2021 Canadian Cardiovascular Society Lipid Guidelines.
      in this journal recommended implementation of the new National Institutes of Health (NIH) equation
      • Samson M.
      • Ling C.
      • Sun Q.
      • et al.
      A new equation for calculation of low-density lipoprotein cholesterol in patients with normolipidemia and/or hypertriglyceridemia.
      rather than the Friedewald calculation. The authors stated that the new NIH equation “allows for calculation of LDL-C up to triglyceride 9.04 mmol/L.”
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      References

        • White-Al Habeeb N.M.A.
        • Higgins V.
        • Venner A.A.
        • et al.
        • Canadian Society of Clinical Chemists Working Group on Reference Interval Harmonization
        Canadian Society of Clinical Chemists harmonized clinical laboratory lipid reporting recommendations on the basis of the 2021 Canadian Cardiovascular Society Lipid Guidelines.
        Can J Cardiol. 2022; 38: 1180-1188
        • Samson M.
        • Ling C.
        • Sun Q.
        • et al.
        A new equation for calculation of low-density lipoprotein cholesterol in patients with normolipidemia and/or hypertriglyceridemia.
        JAMA Cardiol. 2020; 5: 540-548
        • Packard C.
        Remnants, LDL, and the quantification of lipoprotein-associated risk in atherosclerotic cardiovascular disease.
        Curr Atheroscler Rep. 2022; 24: 133-142
        • Cartier L.-J.
        • St-Cœur S.
        • Robin A.
        • et al.
        Impact of the Martin/Hopkins modified equation for estimating LDL-C on lipid target attainment in a high-risk patient population.
        Clin Biochem. 2020; 76: 35-37

      Linked Article

      • Canadian Society of Clinical Chemists Harmonized Clinical Laboratory Lipid Reporting Recommendations on the Basis of the 2021 Canadian Cardiovascular Society Lipid Guidelines
        Canadian Journal of CardiologyVol. 38Issue 8
        • Preview
          There is limited guidance on laboratory reporting and interpretation of lipids and lipoproteins used in cardiovascular risk stratification. This contributes to inconsistencies in lipid reporting across clinical laboratories. Recently, the Canadian Cardiovascular Society (CCS) published the 2021 CCS guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. A subcommittee of the Working Group on Reference Interval Harmonization of the Canadian Society of Clinical Chemists has developed harmonized lipid reporting recommendations that are aligned with the 2021 CCS guidelines, to improve the standardization of lipid assessment and clinical decision-making.
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      • Letter to the Editor - Response to Calculated LDL-C: Time to move on?
        Canadian Journal of Cardiology
        • Preview
          We recommended laboratories implement the NIH equation, to replace the Friedewald equation, for calculating LDL-C in all patients (1). In response, Cartier et al. argue that since LDL-C is an inferior marker to non-HDL-C and apoB for atherogenicity when TG >1.50 mmol/L, LDL-C calculation should be omitted when not pertinent. We agree that non-HDL-C and apoB are superior when TG is elevated, however, it is still important to clinically report accurate LDL-C values, when possible.
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        • PDF