Liong Boy Kurniawan, Windarwati Windarwati, Budi Mulyono


LDL-C is important to evaluate the risk of cardiovascular disease. LDL-C can be measured directly or by using the Friedewald equation. Type 2 Diabetes Mellitus (DM) patients have tighter LDL-C target compared with normal population. This research is aimed to analyze the difference of LDL-C level measured by direct test and Friedewald equation in DM and non-DM. This research was a cross-sectional study using LDL-C data of 208 patients who were tested in Laboratory of Clinical Pathology, Hasanuddin University Hospital from a period of August 2015 to January 2016. LDL-C and other lipid were measured using ABX Pentra 400 meanwhile Friedewald LDL-C was calculated with equation LDLC= Total Cholesterol-HDL-C-(1/5 Triglycerides). Type 2 DM patients were diagnosed by ADA 2015 criteria or who had previous DM history. Friedewald LDL-C estimates lower than direct method (139.07+50.60 mg/dL vs 155.33+51.74 mg/dL, p=0.000). Delta of direct LDL-C and Friedewald equation measurement is higher in DM than non-DM patients (11.97+11.52% vs 8.49+11.27%, p=0.030) Fridewald LDL-C estimates LDL-C lower than direct method and the difference is wider in DM than non-DM. It is suggested to measure LDL-C directly in DM type 2 to reach the actual LDL-C target.


Direct LDL-C, Friedewald, diabetes mellitus

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Nigam PK. Calculated low-density lipoprotein-cholesterol: Friedewald’s formula versus other modified formulas. International Journal of Life Science and Medical Research. 2014; 4(2): 25-31.

Cole T, Ferguson C, Gibson D, Nowatzke W. Optimization of quantification methods for high throughput applications. Clin Chem. 2001; 47: 712-721.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of preparative ultracentrifuge. Clin Chem. 1972; 18: 499-502.

Haffner SM. Management of dyslipidemia in adults with diabetes. Diabetes Care. 1998; 21: 160-178.

American Diabetes Association. Cardiovascular disease and risk management. Diabetes Care 2016; 39(1): S60-S71.

Sudha K, Ashok PK, Anupama H, Aradhana M, Kiran KAM. Effect of serum triglycerides on LDL estimation by Friedewald formula and direct assay: A laboratory based study. International Journal of Biomedical Research. 2015; 6(3): 189-191.

Ilanchezhian T, Vanaja R, Rajagopalan B. Comparative study of the estimation of LDL cholesterol by the direct method and Friedewald equation in secondary hyperlipidemia. International Journal of Pharmaceutical Science and Research. 2016; 7(11): 4632-4636.

Martin SS, Blaha MJ, Elshazly MB, Brinton EA, Toth PP, et al. Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. Journal of the American College of Cardiology. 2013; 62(8): 732-739.

Garoufi A, Drakatos A, Tsentidis C, Klinaki E, Paraskakis I, et al. Comparing calculated LDL-C with directly measured LDL-C in healthy and dyslipidemic children. Clinical Biochemistry. 2017; 50: 15-22.

Sudha K, Ashok P, Kiran KAM, Aradhana M, Anupama H. Validation of the Friedewald formula in type II diabetes mellitus: An Indian perspective study. International Journal of Biomedical and Advance Research. 2015; 6(2): 103-106.

Fawwad A, Sabir R, Riaz M, Moin H, Basit A. Measured versus calculated LDL-cholesterol in subjects with type 2 diabetes. Pak J Med Sci. 2016; 32(4): 955-959.

Viera PL, Araujo GN, Telo GH, Smidt LFS, Jost MF, et al. Low-density lipoprotein values estimated by Friedewald equation are affected by diabetes control. International Journal of Cardiovascular Sciences. 2016; 29(5): 348-354.

Knopfholz J, Disserol CCD, Pierin AJ, Schirr FL, Streisky L, et al. Validation of the Friedewald formula in patients with metabolic syndrome. Cholesterol. 2014; 2014: Article ID 261878, 5 pages.

LaRosa JC. Living with imprecision. Journal of the American College of Cardiology. 2013; 62(8): 740-741.

Wadhwa N, Krishnaswamy R. Comparison of LDL-cholesterol estimate using various formulae with directly measured LDL-cholesterol in Indian population. Journal of Clinical and Diagnostic Research. 2016; 10(12): BC11-BC13.

Martin SS, Blaha MJ, Elshazly MB, Toth PP, Kwiterovich PO, et al. Comparison of a Novel method vs. the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA. 2013; 310(19): 2061-2068.

Choi H, Shim JS, Lee MH, Yoon YM, Choi DP, Kim HC. Comparison of formulas for calculating low-density lipoprotein cholesterol in general population and high-risk patients with cardiovascular disease. Korean Circulation Journal. 2016; 46(5): 688-698.



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