The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults
<b>Background/Objectives</b>: The currently established equations for calculating low-density lipoprotein cholesterol (LDLc) do not reflect the sex-specific differences in lipid metabolism. We aimed to develop a sex-specific LDLc equation (SSLE) and validate it with three established equ...
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| author | Hyun Suk Yang Soo-Nyung Kim Seungho Lee Mina Hur |
| author_facet | Hyun Suk Yang Soo-Nyung Kim Seungho Lee Mina Hur |
| author_sort | Hyun Suk Yang |
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| description | <b>Background/Objectives</b>: The currently established equations for calculating low-density lipoprotein cholesterol (LDLc) do not reflect the sex-specific differences in lipid metabolism. We aimed to develop a sex-specific LDLc equation (SSLE) and validate it with three established equations (Friedewald, Sampson-NIH, and ext-Martin–Hopkins) against direct LDLc measurement in Korean adults. <b>Methods:</b> This study included 23,757 subjects (51% male; median age, 51 years) from the 2009–2022 Korean National Health and Nutrition Examination Survey. We developed the SSLE through multiple linear regression incorporating total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), triglycerides (TG), and sex. The validation metrics included Bland–Altman analysis for mean absolute percentage error (MAPE) and agreement of the categorization based on the NCEP ATP-III guidelines, assessed by sex and lipid subgroups. <b>Results:</b> The derived SSLE equation was as follows: for TG < 200 mg/dL, LDLc = 0.963 × TC − 0.881 × HDLc − 0.111 × TG + 0.982 × Sex − 6.958; for TG ≥ 200 mg/dL, LDLc = 0.884 × TC − 0.646 × HDLc − 0.126 × TG + 3.742 × Sex − 3.214 (male = 1, female = 0). The MAPE was similar between males and females for the SSLE (4.6% for both) and ext-Martin–Hopkins (5.0% vs. 4.9%) but higher in males for the Sampson-NIH (5.4% vs. 4.9%) and Friedewald (7.6% vs. 5.7%). In the TG ≥ 400 mg/dL group, the MAPE increased progressively: SSLE (10.2%), ext-Martin–Hopkins (12.0%), Sampson-NIH (12.7%), and Friedewald (27.4%). In the LDLc < 70 mg/dL group, the MAPE was as follows: SSLE (8.0%), Sampson-NIH (8.6%), ext-Martin–Hopkins (9.7%), and Friedewald (12.8%). At TG 200–400 mg/dL, the SSLE revealed very good agreement (κ = 0.801) versus good agreement for other equations (ext-Martin–Hopkins κ = 0.794, Sampson-NIH κ = 0.782, Friedewald κ = 0.696). <b>Conclusions:</b> The novel SSLE demonstrated superior accuracy and agreement in Korean adults. Further validation studies across different ethnic populations are warranted. |
| format | Article |
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| institution | Kabale University |
| issn | 2218-1989 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-60b9504c40cf41aaaef4685048f85ae02025-01-24T13:41:11ZengMDPI AGMetabolites2218-19892025-01-011511810.3390/metabo15010018The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean AdultsHyun Suk Yang0Soo-Nyung Kim1Seungho Lee2Mina Hur3Department of Cardiovascular Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Republic of KoreaDepartment of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05029, Republic of KoreaDepartment of Preventive Medicine, College of Medicine, Dong-A University, Busan 49201, Republic of KoreaDepartment of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea<b>Background/Objectives</b>: The currently established equations for calculating low-density lipoprotein cholesterol (LDLc) do not reflect the sex-specific differences in lipid metabolism. We aimed to develop a sex-specific LDLc equation (SSLE) and validate it with three established equations (Friedewald, Sampson-NIH, and ext-Martin–Hopkins) against direct LDLc measurement in Korean adults. <b>Methods:</b> This study included 23,757 subjects (51% male; median age, 51 years) from the 2009–2022 Korean National Health and Nutrition Examination Survey. We developed the SSLE through multiple linear regression incorporating total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), triglycerides (TG), and sex. The validation metrics included Bland–Altman analysis for mean absolute percentage error (MAPE) and agreement of the categorization based on the NCEP ATP-III guidelines, assessed by sex and lipid subgroups. <b>Results:</b> The derived SSLE equation was as follows: for TG < 200 mg/dL, LDLc = 0.963 × TC − 0.881 × HDLc − 0.111 × TG + 0.982 × Sex − 6.958; for TG ≥ 200 mg/dL, LDLc = 0.884 × TC − 0.646 × HDLc − 0.126 × TG + 3.742 × Sex − 3.214 (male = 1, female = 0). The MAPE was similar between males and females for the SSLE (4.6% for both) and ext-Martin–Hopkins (5.0% vs. 4.9%) but higher in males for the Sampson-NIH (5.4% vs. 4.9%) and Friedewald (7.6% vs. 5.7%). In the TG ≥ 400 mg/dL group, the MAPE increased progressively: SSLE (10.2%), ext-Martin–Hopkins (12.0%), Sampson-NIH (12.7%), and Friedewald (27.4%). In the LDLc < 70 mg/dL group, the MAPE was as follows: SSLE (8.0%), Sampson-NIH (8.6%), ext-Martin–Hopkins (9.7%), and Friedewald (12.8%). At TG 200–400 mg/dL, the SSLE revealed very good agreement (κ = 0.801) versus good agreement for other equations (ext-Martin–Hopkins κ = 0.794, Sampson-NIH κ = 0.782, Friedewald κ = 0.696). <b>Conclusions:</b> The novel SSLE demonstrated superior accuracy and agreement in Korean adults. Further validation studies across different ethnic populations are warranted.https://www.mdpi.com/2218-1989/15/1/18low-density lipoprotein cholesterolequationssex specificFriedewaldSampson-NIHMartin–Hopkins |
| spellingShingle | Hyun Suk Yang Soo-Nyung Kim Seungho Lee Mina Hur The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults Metabolites low-density lipoprotein cholesterol equations sex specific Friedewald Sampson-NIH Martin–Hopkins |
| title | The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults |
| title_full | The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults |
| title_fullStr | The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults |
| title_full_unstemmed | The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults |
| title_short | The Validation of a Novel, Sex-Specific LDL-Cholesterol Equation and the Friedewald, Sampson-NIH, and Extended-Martin–Hopkins Equations Against Direct Measurement in Korean Adults |
| title_sort | validation of a novel sex specific ldl cholesterol equation and the friedewald sampson nih and extended martin hopkins equations against direct measurement in korean adults |
| topic | low-density lipoprotein cholesterol equations sex specific Friedewald Sampson-NIH Martin–Hopkins |
| url | https://www.mdpi.com/2218-1989/15/1/18 |
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