Novel method enhances accuracy of LDL estimates

Seth S. Martin

LAS VEGAS — A novel method using non-HDL and triglyceride values estimated LDL better than the Friedewald method in patients who reduced their LDL with PCSK9 inhibition, according to data presented at the National Lipid Association Scientific Sessions.

Seth S. Martin, MD, MHS, assistant professor of medicine and co-director of the Advanced Lipid Disorders Center at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, a member of the Cardiology Today Editorial Board and a Cardiology Today’s Next Gen Innovator, won a Young Investigator Award for this research.

Martin and colleagues from the TIMI study group assessed the accuracy of the Friedewald method and the Martin/Hopkins method with gold standard beta-quantification (ultracentrifugation) in 56,624 observations of 12,742 patients (mean age, 63 years; 23% women) with atherosclerotic CVD who achieved low LDL in the FOURIER trial. Patients included in this analysis had a Friedewald LDL estimate of less than 40 mg/dL.

As Cardiology Today previously reported, the FOURIER trial found that reduction of LDL to a median of 30 mg/dL with the PCSK9 inhibitor evolocumab (Repatha, Amgen) in patients with atherosclerotic CVD was associated with reduced risk for CV events.

The Martin/Hopkins method correlated better with beta-quantification and was less likely to underestimate LDL compared with the Friedewald method. The novel method was also more evenly distributed around the regression line vs. the Friedewald method.

The majority of Martin/Hopkins LDL values were within 10 mg/dL (97.4%) and 5 mg/dL (77.1%) compared with Friedewald estimation (86.7% vs. 59.9%, respectively; P < .001). The advantages of the Martin/Hopkins LDL method were even more apparent in the group with triglycerides 150 mg/dL or more, where the Friedewald method was particularly prone to underestimation. As underestimation could lead to undertreatment, the investigators highlighted the importance of this analysis in best translating the FOURIER trial results.

“These data suggest [Martin/Hopkins] estimation should be the preferred method to estimate LDL-C levels in such intensively treated patients,” Martin and colleagues wrote. – by Darlene Dobkowski

Reference:

Martin SS, et al. Martin/Hopkins estimation, Friedewald and beta-quantification of LDL-C in patients in FOURIER. Presented at: National Lipid Association Scientific Sessions; April 26-29, 2018; Las Vegas.

Disclosure: Martin reports he has served on scientific advisory boards for Amgen, Quest Diagnostics and Sanofi/Regeneron, and that he is a co-inventor on a pending patent filed by Johns Hopkins University for the novel method of LDL estimation.