Choosing the right equation for calculating indirect LDL-Cholesterol (LDL-C) in adult Pakistani population: Evaluation of seven equations using big data analytics

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. Low density lipoprotein cholesterol (LDL-C) contributes to the atherogenic process. However, direct LDL-C (d-LDL) has rarely been estimated by the gold standard method because it is cumbersome and expensive. We aim to evaluate calculated low density lipoprotein (LDL-c) by various equations with reference to directly measured LDL-C in the Pakistani adult population as a cost-effective alternative. We retrospectively evaluated the validity of seven equations for estimating calculated LDL-C by computing correlation coefficients (r) and Bland Altman plots to assess agreement (mean %) for (d-LDL) and calculated (LDL-c) on all seven equations. Statistical analysis was performed in Stata Statistical Software: Release 17, College Station, TX: StataCorp LLC. We analyzed 247082 direct assays of lipid profiles of adults aged ≥18 years. The mean LDL-C levels computed on Friedewald, de Cordova, Chen, Hattori, Vujovic, Teerakanchana, Sampson equations were 106.8 ± 31.4, 103.7 ± 25.0, 108.6 ± 28.2, 100.1 ± 29.5, 115.2 ± 31.2, 113.1 ± 28.3 and 110.3 ± 30.6 respectively. Friedewald and Hattori equations correlated strongly with direct LDL-C (r = 0.937) for each followed by Sampson (r = 0.935) and Vujovic (r = 0.931). However, the median bias was least for the Friedwald equation (−1.6) compared to the other equations. In contrast to the global literature advocating for the use of newer equations, although the conventional and widely utilized Friedewald equation remains the best alternative for calculated LDL-C estimation in adult Pakistani population.