Friedewald Equation For Calculation Of Ldl Cholesterol
The Friedewald equation is used to calculate VLDL-c and LDL-c levels in a lipoprotein estimation test. In this method, total cholesterol, triglycerides and HDL-c are directly estimated using reagents. The formula published by Friedewald WT et al in 19721 was validated by Warnick GR and colleagues in 1990.2
VLDL-c = Triglycerides/5
LDL-c = Total cholesterol
Limitation of Friedewald equation
This method of indirect LDL-c estimation becomes unreliable when the triglyceride levels are high. In that case direct LDL-c measurements have to be resorted to. Friedewald equation was introduced to reduce the time and cost needed for ultracentrifugation in case of direct LDL-c measurement in 1972. Now a days, many laboratories are switching to direct LDL-c measurements in all situations to avoid errors and give better reliability to LDL-c values.
Friedewald equation is not very accurate for estimation of VLDL-c. Friedewald and colleagues had pointed this out in their original publication in 1972 itself. But at that time VLDL-c levels were low compared to LDL-c and the inaccuracy was tolerable.LDL-c values are also not very accurate at the low levels which are currently targeted in those with coronary artery disease. At low levels, Friedewald equation underestimates LDL-c values. This is more important now as hypertriglyceridemia is increasingly common because of obesity, insulin resistance, and diabetes mellitus . 3
References
What Is A Healthy Cholesterol Level
This table is a general guide for ideal cholesterol and triglyceride levels for healthy adults in the UK. If you have a condition such as heart disease or diabetes, your target levels may be lower your doctor will be able to tell you your individual targets.
| Above 6 is considered high risk the lower this figure is the better | Above 6 is considered high risk the lower this figure is the better |
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What Ldl Levels Mean
When you have your cholesterol checked, you usually receive a consultation to help explain what the measures mean. As mentioned, high LDL levels are a red flag, as are those of triglycerides when the latter are also higher than normal, it can be a sign that atherosclerosis has already developed.
LDL levels are broken down into five specific categories, defined as optimal and near optimal, often considered healthy ranges, as well as borderline high, high, and very high. The results are expressed as milligrams per deciliter .
| Healthy LDL Ranges |
|---|
| 190 mg/dL and higher |
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High Ldl Cholesterol Diagnosis
A blood test can check your LDL, HDL, and total cholesterol levels. It also measures triglycerides, a type of fat that stores extra energy from your diet. High triglyceride levels can make you more likely to have heart problems.
Experts recommend testing every 4 to 6 years. Youâll probably need it more often if you have heart disease or diabetes, or if high cholesterol runs in your family.
Lower numbers are better when it comes to LDL cholesterol test results. The general guidelines for adults in the United States are:
- Less than 100 milligrams per deciliter : Optimal
- 100-129 mg/dL: Near or above optimal
- 130-159 mg/dL: Borderline high
- 160-189 mg/dL: High
- 190 mg/dL and above: Very high
If you have a condition like heart disease or diabetes, your doctor might recommend an LDL target of 70 mg/dL or below.
Question 3 Why Does Quest No Longer Rely On The Friedewald Equation
Although the Friedewald equation it is still widely used and generally produces reliable results, it may underestimate LDL-C at the low LDL-C levels that modern treatment guidelines call for and therapies can achieve .3 PCSK-9 inhibitors can drive LDL-C levels even lower . Such low LDL-C concentrations are below the concentrations considered when the Friedewald equation was developed.2
This limitation relates to the fact that the Friedewald equation uses a fixed ratio of triglyceride to VLDL-C it does not allow for heterogeneity in the ratio of triglycerides to VLDL-C. This becomes a problem especially at lower LDL-C and higher triglyceride concentrations, when the Friedewald calculation tends to underestimate LDL-C. In a 2013 study, Martin and colleagues compared the results of direct LDL-C and calculated LDL-C using the Friedewald equation in more than 1.3 million U.S. adults.4 Friedewald-estimated LDL-C tended to be lower than directly measured LDL-C, especially in patients with calculated LDL-C levels below 100 mg/dL. At triglyceride levels 150 mg/dL, calculated LDL-C was often below < 70 mg/dL in patients with directly measured LDL-C in the 71-80 mg/dL range. These findings suggest that the tendency of the Friedewald equation to underestimate LDL-C at higher triglyceride and lower LDL-C levels could result in high-risk patients being undertreated.
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Are Test Results Accurate
While no test is always accurate, measurements of blood cholesterol are an effective tool for estimating your risk of cardiovascular disease. Various factors can affect the accuracy of a cholesterol test:
- Direct vs calculated testing: While calculated LDL cholesterol levels are sufficient in most cases, direct testing provides more accurate results in patients with elevated triglyceride levels. Patients who may have elevated triglyceride levels include those diagnosed with type II diabetes or obesity, patients with a history of considerable alcohol intake, and patients taking medication to increase triglycerides.
- Fasting: In most cases, a lipid profile requires fasting. Eating within 8-12 hours before a lipid panel may increase the level of triglycerides in your bloodstream. Because this increased level of triglycerides could affect the accuracy of calculated LDL cholesterol values, your doctor may request that you refrain from eating prior to your blood draw.
Cholesterol Hdl Ldl Triglycerides Ratio Calculator
Cholesterol, HDL, LDL, triglycerides ratio calculator explains you what your TC, HDL, LDL and triglyceride levels mean and whether you are under any risk for heart and cardiovascular diseases. The calculator shows you interpretation of your cholesterol levels and the TC/HDL, LDL/HDL and triglyceride/HDL ratios. Elevated total cholesterol is not necessarily an alarm and doesn’t always present the whole truth about the condition of the body, while elevated triglycerides in the blood increase the risk of cardiovascular diseases, including risk of coronary artery disease , risk of heart attack and stroke, more than elevated total cholesterol.Do you have results in mmol/l? How to convert mmol/l to mg/dl?For total, HDL, and LDL cholesterol multiply mmol/l by 38.67, for example 4.5 x 38.67 = 174 For triglycerides multiply mmol/l by 88.57, for example 1.4 x 88,57 = 124 How to use calculator? Select your gender, enter your total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides numbers. Press the button “Interpretation of the results, calculate the ratios”. That?s all!
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How Is It Made
Your liver, other organs, and other cells in your body produce about 80 percent of the cholesterol in your blood.
The other 20 percent of the cholesterol in your body is affected by the foods you eat. Foods high in trans and saturated fats can contribute to unhealthy cholesterol levels.
As you take in more of these fats, your liver compensates by reducing its own production of cholesterol and removing excess cholesterol. However, not everyone makes and removes cholesterol with the same efficiency.
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How To Lower Ldl
For many individuals, reducing LDL-C may lower the risk of heart disease.
If LDL-C is high, most doctors will probably suggest lifestyle changes.
Quitting smoking will be helpful, and so may eating whole grain, oatmeal, olive oil, beans, fruit, and vegetables.
Most doctors will recommend eating less saturated fat, found primarily in meat and dairy products.
Trans fats should be avoided. These fats are found in fried foods and many commercial products, such as cookies, crackers, and snack cakes.
However, keep in mind that food products labeled trans-fat-free may still contain some trans fat. In the US, if a food is labeled trans-fat-free if it contains less than 0.5 grams of trans fat in a serving.
Soluble fiber may help lower LDL-C. It is found in oats and oat bran, fruits, beans, lentils, and vegetables.
Some studies show that low-carbohydrate diets may positively affect LDL particle size and number .
Weight loss in overweight or obese people is usually recommended.
If lifestyle changes dont help, your doctor may suggest medications that lower cholesterol. So-called statins are the most commonly used drugs for lowering cholesterol.
Studies have shown that statins improve prognosis among patients with established cardiovascular disease.
Their role for treatment of raised LDL-C in healthy people is less clear .
The decision to give statins in primary prevention is usually based on other risk factors as well as the LDL-C value itself .
What Should You Eat
Until science figures out the answer, what should you eat?
Donât view the study as a green light to load up on butter, steak, and cheese. Be smart about the saturated fats in your diet.
âCountless studies show that if you replace saturated fat with polyunsaturated fat, you do get a reduction in heart disease risk,â says Alice Lichtenstein, professor of nutrition science and policy at Tufts University in Boston. Polyunsaturated fats, often called omega-3 and omega-6 fatty acids, come from vegetable oils — soybean, corn, and canola — and fatty fish like salmon, mackerel, herring, and trout. They are also found in most nuts, especially walnuts, pine nuts, pecans, and brazil nuts.
The best way to prevent heart disease may be to eat more whole, unprocessed foods. So eat fish, beans, fruits, vegetables, brown rice, nuts, seeds, vegetable oils and olive oils, and even some animal products like yogurt and high-quality meat and cheese. The Mediterranean diet, which draws about 45% of calories from fat — including small amounts of saturated fat — is a good choice.
And remember: Diet isnât the only reason people get or donât get heart disease. Your genes and lifestyle habits also play a part.
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How Is Cholesterol Measured
The primary way to measure your cholesterol levels is with a blood test from your arm, usually done in a laboratory. This test is frequently performed in adults, it takes only a few minutes, and its relatively painless.
Your doctor may ask you to fast if you are having a complete lipid profile that includes your LDL. If you are only having a total cholesterol test, you do not need to fast. If you are not sure if you should fast, call your doctor or the lab.
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What Treatments Are Recommended For High Ldl
Maintaining a healthy lifestyle is an important part of heart health and in treating high LDL-C. This may mean you will need to change your lifestyle, specifically by adopting a diet low in saturated fat and trans unsaturated fats , avoiding smoking, controlling high blood pressure and diabetes, achieving and maintaining desirable body weight, and getting regular exercise. You may be referred to a dietician for advice in making dietary changes.
Your healthcare practitioner will talk to you about risks and benefits of lipid-lowering therapy, based on your history, health risks, the results of your lipid panel, and possibly your calculated risk for CVD. Statins are generally recommended as a first choice for lowering LDL-C. You may be prescribed one of these. Your LDL-C will be checked at regular intervals to make sure that the drug is working. If your LDL-C is above target levels, your healthcare practitioner may increase the amount of drug, change drugs, or possibly add a second drug.
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Concordance In Guideline Classification By Friedewald Vs Novel Estimates Of Ldl
Our final analysis assessed the changes that clinicians would expect to see in patient LDL-C values if the novel method were to be implemented in routine practice rather than the Friedewald. Overall, 19 541 patients would have been grouped in the same NCEP category, 330 patients would have been categorized in a lower NCEP category, and 3184 patients would have been categorized in a higher NCEP category . The largest changes would be seen in patients with LDL-CF< 100 mg/dL, for which > 20% of patients were grouped in a higher NCEP category by LDL-CN compared to LDL-CF.
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Measure Your Ldl And Other Blood Lipids
Everyone age 20 and older should have their cholesterol checked at least every five years through a blood test. The guidelines recommend you have a complete “lipoprotein profile” that measures total cholesterol, LDL cholesterol, high-density lipoprotein , and triglycerides, another type of fat in the blood stream. The test should be performed after fasting.
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What Should I Do If My Ldl Cholesterol Is High
If your LDL is found to be high, you and your doctor will need to come up with a plan to manage this condition. You’ll get instructions about dietary changes you need to make and will be encouraged to adopt a healthier, more active lifestyle this is typically the first step in taking on high cholesterol.
Make sure your levels are being regularly monitored, and keep track of your progress. If changing lifestyle habits isn’t enough on its own, you and your doctor can consider pharmaceutical approaches.
What Happens If High Cholesterol Goes Untreated
High blood levels of LDL cholesterol and triglycerides have been linked to the development of CVDs, along with other factors such as hypertension and diabetes mellitus. The risk of damage to the vascular walls and the formation of deposits and blockages increases when there is more bad and less good cholesterol in our blood. The good news is that the reduction in total cholesterol by 1% leads to a 2% reduction in the risk of developing cardiovascular disease.
Increased cholesterol levels may be caused by a familial predisposition as well, as is the case in about 3% of people. Usually, blood cholesterol is high from an early age and is unaffected by the diet. In these cases, specialists recommend taking lipid-lowering agents such as statins from a younger age. These drugs are prescribed and taken under medical supervision.
However, it is a myth that lipid-lowering medication can be stopped as soon as your results are within the cholesterol and triglycerides normal range. The levels may be lowered, but if you stop taking the drug, the cholesterol, and especially LDL, will rise again. You should consult your doctor about any change in your treatment.
In about20% of the population, high LDL cholesterol levels are associated with another underlying condition such as:
- obesity
- increased adrenal function
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What To Do If Your Ldl Level Is 131
- Eat fiber-rich foods such as veggies, fruit, whole grains, and legumes, for a total of 30-40g fiber/ day.
- Limit sources of refined carbs and added sugars such as soda, chips, candy, baked goods, sweetened yogurt, and ice cream.
- Avoid trans fats and reduce your saturated fat intake to < 10% total calories.
- Eat small, fatty fish such as salmon, sardines, and trout, at least twice a week.
- Move your body every day. Aim to get 30-60 minutes of physical activity 5x/week.
- Incorporate plant sterols and stanols daily in the form of food or a supplement.
- Lose weight if you are overweight or obese.
- Quit smoking.
- If you have diabetes, achieve and maintain good blood sugar control .
Question 7 My Patients Ldl Cholesterol Concentration Could Not Be Calculated Because The Triglycerides Were Too High What Options Do I Have For Getting An Ldl Cholesterol Concentration
If the LDL concentration could not be calculated because the triglyceride level was too high, direct LDL-C testing may be useful. Direct LDL measurement provides a reliable result even when triglyceride levels are up to 1,000 mg/dL. It can be ordered as a stand-alone test, as a reflex if the patients triglyceridelevel is likely to exceed 400 mg/dL, or as part of one of several panels. The table below lists tests and panels that include direct LDL-C measurement or reflex to direct LDL-C measurement when the triglyceride level is above 400 mg/dL:
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Question 4 How Does The Martin
The Martin-Hopkins calculation provides greater customization to a patients specific triglyceride level by using a more personalized factor to calculate VLDL-C from triglycerides.4 This adjustable factor, which can range from 3.1 to 11.9, was derived from an analysis of triglyceride-to-VLDL-C ratios in more than 1.3 million people.4 The factor is lowest for patients with very low levels of triglyceride and high levels of non-HDL-cholesterol , and highest for those with very high levels of triglyceride and low levels of non-HDL-cholesterol.
How It Is Done
The health professional taking a sample of your blood will:
- Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
- Clean the needle site with alcohol.
- Put the needle into the vein. More than one needle stick may be needed.
- Attach a tube to the needle to fill it with blood.
- Remove the band from your arm when enough blood is collected.
- Put a gauze pad or cotton ball over the needle site as the needle is removed.
- Put pressure on the site and then put on a bandage.
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