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High Cholesterol Message Board

High Cholesterol Board Index

AFAIK the direct calculation of LDL is accurate without regard to elevated triglyceride levels. The author of the Friedewald formula has also stated that a calculated LDL is only accurate when both the total cholesterol and LDL levels are within the normal range. If you are taking a statin and using a calculated LDL your LDL will be reported as lower then it actually is. If you look on the Atherotech VAP site they have Friedewald's comments there.

Low-Density Lipoprotein Cholesterol (Direct)

"For the direct determination of LDL cholesterol in nonfasting patients or in patients whose fasting triglycerides are >400 mg/dL, where the estimation of LDL by calculation may not be possible or may lead to inaccuracies. LDL cholesterol measurement, in conjunction with other lipid measurements, has been shown to be useful in assessing the risk of coronary heart disease (CHD). The National Cholesterol Education Program (NCEP)1 has stated that LDL cholesterol should be the "key index" in determination of CHD risk. Laboratory estimation of LDL cholesterol is most commonly determined by the use of formulas, such as the Friedewald formula.2 Use of this formula is limited to fasting samples with triglycerides <400 mg/dL. Triglyceride values between 250-400 mg/dL may also be associated with errors in LDL cholesterol estimation by calculation which, in turn, can lead to misclassification of the patient in regard to the NCEP guidelines."

"The NCEP ATP III recommends that LDL be directly measured as a new feature of the guidelines. LDL is not directly measured in today’s routine lipid panels. Rather, it is calculated using the Freidewald equation: [LDL] = [total cholesterol] – [HDL] – [triglycerides/5]. Thus, calculated LDL is falsely low in patients with elevated triglycerides, and it does not correlate well in patients with diabetes, coronary disease, or other atherosclerotic diseases."

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