Canadian Journal of Cardiology

Comparison of three methods for LDLC calculation for cardiovascular disease risk categorization in three distinct patient populations

Published:December 28, 2022DOI:



      Limitations of Friedewald equation for LDLC (F-LDLC) calculation led to the Martin-Hopkins (M-LDLC) and Sampson-NIH (S-LDLC) equations. We studied these newer calculations of LDLC for correlation, and discordance for stratification into the Canadian Cardiovascular Society (CCS) 2021 Dyslipidemia Guidelines’ cardiovascular disease (CVD) risk categories.


      We performed analyses on lipid profiles from three populations: Hospital Biochemistry Laboratory (population 1); Lipid Clinic patients without select monogenic dyslipidemias (population 2A); Lipid Clinic patients with familial hypercholesterolemia (FH) (population 2B).


      There is very strong correlation among the three calculated LDLC. In populations 1 and 2A, M-LDLC and S-LDLC are progressively higher than F-LDLC as triglyceride (TG) levels increase from normal to about 5 mmol/L. In population 2B, M-LDLC is higher than F-LDLC, however, S-LDLC is progressively lower than F-LDLC. Using the CCS 2021 guidelines’ 4 CVD risk categories, 7.0% (population 2A) to 7.2% (population 1) of cases for M-LDLC vs F-LDLC, and 3.9% (population 2A) to 4.4% (population 1) of cases for S-LDLC vs F-LDLC, were reclassified to an adjacent CVD risk category, mostly from a lower to a higher risk category.


      Switching from F-LDLC to S-LDLC or M-LDLC can reclassify up to ∼ 4.4 or 7.2% of patients to another CCS CVD risk category, respectively. The difference between F-LDLC and M-LDLC or S-LDLC is greater with higher TG, and with lower LDLC. We recommend that clinical laboratories switch to reporting results from either M-LDLC or S-LDLC, but S-LDLC should not be used in FH patients, pending further studies.
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