Clinical value of LDL-C determination in non-fasting blood samples

doi:10.3969/j.issn.1673-8640.2022.011.010

Abstract

Abstract:

Objective To analyze the consistency of 4 calculated low-density lipoprotein cholesterol（LDL-C） levels（Friedewald formula，Martine formula，Sampson formula and Vujovic formula） with the direct determination of LDL-C（D-LDL-C） in non-fasting serum，and to evaluate the clinical value of LDL-C determination in non-fasting serum lipids. Methods Totally，110 cardiovascular disease（CVD） patients were enrolled，and the changes of fasting and postprandial 2 h serum lipids were compared. In addition，291 patients with CVD and/or diabetes mellitus（DM） and 259 healthy subjects were enrolled. Non-fasting serum lipids（fasting time <4 h） were determined，which included total cholesterol（TC），triglyceride（TG），LDL-C，high-density lipoprotein cholesterol（HDL-C） and small and dense low-density lipoprotein cholesterol（sd-LDL-C），and non-high-density lipoprotein cholesterol（non-HDL-C） was calculated. Spearman correlation analysis was used for D-LDL-C with calculated LDL-C levels，and the consistency was evaluated by different LDL-C cut-off points. Results For CVD patients，the levels of TC，HDL-C，LDL-C and non-HDL-C were lower after 2 h of routine meal（P<0.05），and there was no statistical significance in sd-LDL-C and TG levels whether postprandial or fasting condition（P>0.05）. For males，postprandial TG was increased as 0.11 mmol/L on average（P<0.05），and LDL-C was decreased as 0.13 mmol/L（P<0.05）. For females，the levels of TC，LDL-C and non-HDL-C were decreased as 0.22，0.14 and 0.19 mmol/L，respectively（P<0.05），and the change of TG level was not obvious（P>0.05）. Spearman correlation analysis showed that the calculated LDL-C levels of Friedewald formula，Martine formula，Sampson formula and Vujovic formula were positively correlated with D-LDL-C（r=0.922，0.953，0.949 and 0.944，P<0.05）. When TG≤2.26 mmol/L，the mean absolute deviation（MAD） between calculated LDL-C by Friedewald formula and D-LDL-C was minimum，and when TG>2.26 mmol/L，the deviation showed calculated LDL-C by Martine formula was minimum. For atherosclerotic cardiovascular disease（ASCVD） low-risk cases，different LDL-C cut-off points（2.6，3.4 and 4.9 mmol/L） were selected and concerned. When non-fasting serum TG>2.3 mmol/L，the consistency rates of calculated LDL-C of Martine formula，Sampson formula and Vujovic formula with D-LDL-C for evaluating ASCVD risk were 83.8%，83.8% and 82.5%，respectively，which were better than that of Friedewald formula（72.5%）. For ASCVD high-risk cases，when TG<2.3 mmol/L，the clinical assessment results of 4 calculated LDL-C levels showed good consistency with D-LDL-C（≥95%）. When 2.3<TG<5.6 mmol/L，the calculated LDL-C level of Martine formula showed the highest consistency with D-LDL-C（88.8%）. When TG>5.6 mmol/L，all the calculated LDL-C levels had no consistency with D-LDL-C. Conclusions Compared with fasting serum lipids，the levels of non-fasting serum lipids are usually increased in TG level and decreased in TC and LDL-C levels，but there was difference for males and females between fasting and postprandial changes. Using non-fasting calculated LDL-C of Martine formula may do help for the precise estimation of LDL-C level by clinicians，especially when TG>4.52 mmol/L. Non-fasting condition for lipid determination is convenient and acceptable for hypertriglyceridemia and CVD and DM patients，which should choose fasting blood sampling for serum lipid determination.

Key words: Low-density lipoprotein cholesterol, Non-fasting lipid, Friedewald formula, Martine formula, Sampson formula, Vujovic formula, Cardiovascular disease

CLC Number:

R446.1

SHEN Ying, XU Xiaoping, ZHANG Lele, DU Yongping, MENG Chao. Clinical value of LDL-C determination in non-fasting blood samples[J]. Laboratory Medicine, 2022, 37(11): 1049-1056.

Figures/Tables 5

References 19

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项目	例数	TC/ （mmol/L）	TG/ （mmol/L）	HDL-C/（mmol/L）	LDL-C/（mmol/L）	sd-LDL-C/（mmol/L）	non-HDL-C/（mmol/L）
空腹	110	4.15±1.36	1.86±1.55	1.05±0.26	2.32±1.06	0.74±0.41	3.10±1.37
男性	77	3.92±1.29	1.69±1.32	0.99±0.21	2.22±1.09	0.69±0.40	2.93±1.32
女性	33	4.69±1.40	2.27±1.95	1.18±0.32	2.55±0.96	0.85±0.41	3.52±1.42
餐后2 h	110	4.05±1.30^**	1.95±1.39	1.02±0.24^**	2.19±1.04^**	0.73±0.40	3.03±1.31^*
男性	77	3.87±1.26	1.80±1.30^#	0.96±0.19^#	2.09±1.06^#	0.68±0.38	2.90±1.30
女性	33	4.47±1.31^△	2.32±1.55	1.14±0.30	2.41±0.99^△	0.84±0.44	3.33±1.31^△

项目	例数	TC/ （mmol/L）	TG/ （mmol/L）	HDL-C/（mmol/L）	LDL-C/（mmol/L）	sd-LDL-C/（mmol/L）	non-HDL-C/（mmol/L）
空腹	110	4.15±1.36	1.86±1.55	1.05±0.26	2.32±1.06	0.74±0.41	3.10±1.37
男性	77	3.92±1.29	1.69±1.32	0.99±0.21	2.22±1.09	0.69±0.40	2.93±1.32
女性	33	4.69±1.40	2.27±1.95	1.18±0.32	2.55±0.96	0.85±0.41	3.52±1.42
餐后2 h	110	4.05±1.30^**	1.95±1.39	1.02±0.24^**	2.19±1.04^**	0.73±0.40	3.03±1.31^*
男性	77	3.87±1.26	1.80±1.30^#	0.96±0.19^#	2.09±1.06^#	0.68±0.38	2.90±1.30
女性	33	4.47±1.31^△	2.32±1.55	1.14±0.30	2.41±0.99^△	0.84±0.44	3.33±1.31^△

组别	例数	TG/（mmol/L）	TC/（mmol/L）	HDL-C/（mmol/L）
TG≤2.26 mmo/L组	343	1.30（0.96~1.38）	4.23（3.39~5.06）	1.15（0.96~1.38）
TG 2.27~4.51 mmol/L组	146	3.06（2.66~3.48）	5.09（4.17~5.84）	0.99（0.86~1.14）
TG≥4.52 mmol/L组	61	7.26（5.79~9.50）	6.06（4.81~6.73）	0.86（0.72~0.99）
合计	550	1.78（1.13~2.98）	4.51（3.75~5.49）	1.06（0.89~1.30）
组别	D-LDL-C/（mmol/L）	non-HDL-C/（mmol/L）	sd-LDL-C/（mmol/L）	sd-LDL-C百分比/%
TG≤2.26 mmo/L组	2.43（1.76~3.18）	3.00（2.31~3.75）	0.67（0.43~0.94）	28.2（20.6~35.8）
TG 2.27~4.51 mmol/L组	2.89（2.21~3.58）	3.98（3.25~4.75）	1.22（1.01~1.57）	45.3（37.3~53.7）
TG>4.52 mmol/L组	2.54（1.86~3.25）	5.15（4.10~5.65）	1.43（1.13~1.86）	55.3（45.5~78.3）
合计	2.54（1.90~3.32）	3.43（2.67~4.46）	0.85（0.54~1.30）	33.7（23.7~44.7）

组别	例数	TG/（mmol/L）	TC/（mmol/L）	HDL-C/（mmol/L）
TG≤2.26 mmo/L组	343	1.30（0.96~1.38）	4.23（3.39~5.06）	1.15（0.96~1.38）
TG 2.27~4.51 mmol/L组	146	3.06（2.66~3.48）	5.09（4.17~5.84）	0.99（0.86~1.14）
TG≥4.52 mmol/L组	61	7.26（5.79~9.50）	6.06（4.81~6.73）	0.86（0.72~0.99）
合计	550	1.78（1.13~2.98）	4.51（3.75~5.49）	1.06（0.89~1.30）
组别	D-LDL-C/（mmol/L）	non-HDL-C/（mmol/L）	sd-LDL-C/（mmol/L）	sd-LDL-C百分比/%
TG≤2.26 mmo/L组	2.43（1.76~3.18）	3.00（2.31~3.75）	0.67（0.43~0.94）	28.2（20.6~35.8）
TG 2.27~4.51 mmol/L组	2.89（2.21~3.58）	3.98（3.25~4.75）	1.22（1.01~1.57）	45.3（37.3~53.7）
TG>4.52 mmol/L组	2.54（1.86~3.25）	5.15（4.10~5.65）	1.43（1.13~1.86）	55.3（45.5~78.3）
合计	2.54（1.90~3.32）	3.43（2.67~4.46）	0.85（0.54~1.30）	33.7（23.7~44.7）

组别	D-LDL-C	Friedewald公式^①	Martine公式	Sampson公式	Vujovic公式
TG<4.52 mmol/L组
LDL-C/（mmol/L）	2.69±1.08	2.57±1.11	2.71±1.08	2.67±1.12	2.80±1.13
绝对偏差/（mmol/L）		-0.12±0.30	0.02±0.22	-0.03±0.25	0.10±0.24
相对偏差/%		4.46	0.74	1.12	3.72
TG≤2.26 mmol/L组
LDL-C/（mmol/L）	2.57±1.09	2.56±1.14	2.60±1.12	2.62±1.18	2.73±1.17
绝对偏差/（mmol/L）		-0.01±0.21	0.03±0.17	0.04±0.19	0.15±0.19
相对偏差/%		0.39	1.17	1.56	5.84
TG 2.27~4.51 mmol/L组
LDL-C/（mmol/L）	2.98±0.99	2.59±1.03	2.97±0.93	2.79±0.96	2.97±1.02
绝对偏差/（mmol/L）		-0.39±0.32	-0.01±0.31	-0.19±0.30	-0.01±0.31
相对偏差/%		13.09	0.34	6.38	0.34
TG≥4.52 mmol/L组
LDL-C/（mmol/L）	2.52±0.90	1.81±0.90	2.49±1.06	2.05±0.77	2.38±1.18
绝对偏差/（mmol/L）		-1.00±0.73	-0.03±0.78	-0.48±0.63	-0.24±0.86
相对偏差/%		39.68	1.19	19.05	9.52