TY  - BOOK
AU  - Hendrani, Aditya
TI  - Accuracy of low-density lipoprotein cholesterol estimation at very low levels
SN  - 1741-7015
PY  - 2017///
KW  - *Cholesterol, LDL/bl [Blood]
KW  - Databases, Factual/st [Standards]
KW  - Female
KW  - Hematologic Tests/st [Standards]
KW  - Humans
KW  - Male
KW  - Nutrition Surveys/mt [Methods]
KW  - Triglycerides/bl [Blood]
KW  - Ultracentrifugation/st [Standards]
KW  - MedStar Good Samaritan Hospital
KW  - MedStar Union Memorial Hospital
KW  - Medicine
KW  - Journal Article
N1  - Available online through MWHC library: 2003 - present
N2  - 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; 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; 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
UR  - https://dx.doi.org/10.1186/s12916-017-0852-2
ER  -