Assessing the clinical implications of low-density lipoprotein cholesterol equations using Nigerian data.

Background: Newer equations, which are more accurate than the Friedewald formula (FF), have been published for the calculation of low-density lipoprotein (LDL) cholesterol. The impact of their adoption on decision-making has not been examined in Nigerian laboratories. Objective: This study examined the clinical implications of differences in estimating LDL cholesterol by the FF, Martin-Hopkins (MH), and Sampson-National Institutes of Health (NIH) equations. Methods: Between 01 January 2019 and 31 December 2023, lipid profile data, and the associated gender, were retrieved from the laboratory information system of Synlab Nigeria for persons aged 18-75 years. Differences in LDL cholesterol estimates from the three equations, and agreement with category assignments that determine clinical decisions, were examined. Results: Lipid profile data from 19 126 records were retrieved. This included data from 8234 (43.1%) women. The difference between FF estimates of LDL cholesterol and the other two equations was less than 10% for over 96% of the data. This difference increased with triglyceride levels. There was at least substantial agreement in the clinical category assignment of the equations, (ĸ > 0.715, Conclusion: Using the FF formula may significantly impact primary prevention of atherosclerotic cardiovascular disease. Switching to the MH or Sampson-NIH equation is advisable. What this study adds: This study provides a basis for Nigerian laboratories to switch from the Friedewald formula to one of the newer equations for the calculation of LDL cholesterol.