Introduction
Low-density lipoprotein cholesterol (LDL-C), a known risk factor for cardiovascular disease, is commonly estimated using the Friedewald equation. Although the Sampson-NIH equation has been recommended by the Canadian Society of Clinical Chemists for its improved accuracy, particularly in cases of high triglyceride and low LDL-C concentration, its adoption across Canada has been limited.
Objective
Assess the impact of implementation of the Sampson-NIH equation for the calculation of LDL-C in a large community population in Ontario, including reporting frequency, reclassification and agreement with non-HDL-C.
Methods
Results for total cholesterol, HDL-C, non-HDL cholesterol and triglycerides were obtained from Dynacare and LifeLabs community samples (n = 474,911). LDL-C was calculated using Friedewald and Sampson-NIH equations, followed by regression and clinical impact analysis.
Results
Samples with triglycerides ≤ 4.52 mmol/L, showed excellent comparison between Friedewald and Sampson-NIH calculated results (R2 = 0.995, y = 1.00x + 0.08, both cohorts). Samples with triglycerides 4.53–9.04 mmol/L, showed worsening agreement between the two equations (R2 = 0.994, y = 0.81x + 0.79, both cohorts). The comparison results were similar when analyzed across ages (pediatric and adults) and fasting status. Implementation of the Sampson-NIH equation allowed reporting of an additional 1.49% patients (n = 7055). Minor reclassification was observed based on pediatric and adult LDL-C decision thresholds. The Sampson-NIH calculated LDL-C showed better agreement with non-HDL-C than Friedewald calculated LDL-C (86.0 % vs 84.2 %).
Conclusion
There is excellent agreement between Sampson-NIH equation and Friedewald equations, resulting in reclassification of only a small proportion of patients. This study demonstrated the impact of the Sampson-NIH equation for LDL-C in a large pediatric and adult Canadian community population.
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