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Commonly used cholesterol calculation underestimates heart disease danger for many
Date:3/26/2013

their findings, many people especially those with high triglyceride levels may have a false sense of assurance that their LDL cholesterol targets have been met.

For the study, the researchers obtained detailed lipid profiles of more than 1.3 million American adults almost one out of every 180 adults in the United States analyzed from 2009 to 2011. The LDL cholesterol and other blood lipid components in those samples had been directly measured with a technique known as ultracentrifugation. The researchers then evaluated those samples using the Friedewald equation that is used routinely in doctors' offices worldwide. When they compared the results, the differences came to light.

The lipid profiles were from a laboratory in Birmingham, Alabama, that provides a detailed analysis of samples sent in by doctors across the country. Except for the age of people on whom the samples were based (59 years on average) and the gender (52 percent of the samples were from women), the patients were not identifiable to the researchers. The researchers collaborated with the lab to develop the database they would need for the study.

The Friedewald equation was introduced into clinical practice by William Friedewald, M.D., to work around the significant time and expense of ultracentrifugation specifically to measure LDL cholesterol among about 400 people in families with genetic cholesterol abnormalities. The equation calculates LDL cholesterol with the following formula: total cholesterol minus HDL cholesterol minus triglycerides divided by five. The result is expressed in milligrams per deciliter.

"The database that we used was almost 3,000 times larger than the sample used to devise the Friedewald equation," Martin says.

As an alternative to Friedewald, Martin and his colleagues suggest that a more accurate way to assess risk for patients is to look at non-HDL, which is acquired by subtracting HDL from total cholesterol.

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Contact: Ellen Beth Levitt
eblevitt@jhmi.edu
410-955-5307
Johns Hopkins Medicine
Source:Eurekalert

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