Triglycerides and small dense LDL: the twin Achilles heels of the Friedewald formula
AD Sniderman, D Blank, R Zakarian, J Bergeron… - Clinical …, 2003 - Elsevier
AD Sniderman, D Blank, R Zakarian, J Bergeron, J Frohlich
Clinical biochemistry, 2003•ElsevierThe calculation of LDL cholesterol (LDL-C) by the Friedewald formula is the cornerstone of
the conventional method to estimate the risk of vascular disease and to assess the
adequacy of statin therapy. To be sure, there are a number of well-known and well-accepted
limitations to this approach. The two most prominent are that samples must be obtained after
a 12 to 14 h fast and that LDL-C cannot be calculated if plasma triglyceride is 4.52 mmol/L
(400 mg/dL). However, there is no concern for triglyceride values below this level …
the conventional method to estimate the risk of vascular disease and to assess the
adequacy of statin therapy. To be sure, there are a number of well-known and well-accepted
limitations to this approach. The two most prominent are that samples must be obtained after
a 12 to 14 h fast and that LDL-C cannot be calculated if plasma triglyceride is 4.52 mmol/L
(400 mg/dL). However, there is no concern for triglyceride values below this level …
The calculation of LDL cholesterol (LDL-C) by the Friedewald formula is the cornerstone of the conventional method to estimate the risk of vascular disease and to assess the adequacy of statin therapy. To be sure, there are a number of well-known and well-accepted limitations to this approach. The two most prominent are that samples must be obtained after a 12 to 14 h fast and that LDL-C cannot be calculated if plasma triglyceride is 4.52 mmol/L (400 mg/dL). However, there is no concern for triglyceride values below this level. Unfortunately, as we will show, this faith is misplaced.
The problems with triglyceride and LDL-C calculated by the Friedewald formula go much deeper. This, in fact, had been noted previously, but lost sight of over time. Moreover, there are additional limitations not previously suspected, most importantly those associated with LDL-C at or below ATPIII target levels.
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