CC BY-NC-ND 4.0 · J Lab Physicians 2015; 7(01): 011-016
DOI: 10.4103/0974-2727.154780
Original Article

A Leap above Friedewald Formula for Calculation of Low-Density Lipoprotein-Cholesterol

Reema Kapoor
Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
Montosh Chakraborty
Department of Biochemistry, Hindu Rao Medical College, New Delhi, India
Navpreet Singh
Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
› Author Affiliations
Source of Support: Nil.


Purpose: The purpose was to compare the different calculated methods of low-density lipoprotein cholesterol (LDL-C) estimation and to determine which of them correlate best with the direct method.

Materials and Methods: The records of 480 samples for lipid profile were analyzed. Apart from the direct method, LDL-C was calculated by Friedewald low-density lipoprotein cholesterol method (F-LDL-C), modified Friedewald low-density lipoprotein cholesterol method (MF-LDL-C), and Anandaraja low-density lipoprotein cholesterol method (A-LDL-C). Paired t-test and Pearson correlation were evaluated between the different methods. Degree of agreement between the calculated methods and direct method was detected by Bland-Altman graphical plots.

Results: A strong correlation was found between all calculated LDL-C methods and direct low-density lipoprotein cholesterol method (D-LDL-C) assay, that is, F-LDL-C versus D-LDL-C = 0.94; A-LDL-C versus D-LDL-C = 0.93 and MF-LDL-C versus D-LDL-C = 0.95. No statistically significant difference was found between D-LDL-C and MF-LDL-C. Bland-Altman plot for MF-LDL-C showed minimal negative bias.

Conclusions: The study pointed out that MF-LDL-C correlated maximally with D-LDL-C estimation at all levels of triglycerides and MF-LDL-C can be used in place of D-LDL-C when the direct method cannot be afforded.

Publication History

Article published online:
19 April 2020

© 2015.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India


  • 1 World Health Organization. Global Atlas on CVD Prevention and Control. Geneva: WHO; 2011.
  • 2 Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.
  • 3 Bachorik PS, Ross JW. National Cholesterol Education Program recommendations for measurement of low-density lipoprotein cholesterol: Executive summary. The National Cholesterol Education Program Working Group on Lipoprotein Measurement. Clin Chem 1995;41:1414-20.
  • 4 Nauck M, Warnick GR, Rifai N. Methods for measurement of LDL-cholesterol: A critical assessment of direct measurement by homogeneous assays versus calculation. Clin Chem 2002;48:236-54.
  • 5 Kamal AH, Hossain M, Chowdhury S, Mahmud NU. A comparison of calculated with direct measurement of low density lipoprotein cholesterol level. Journal of Chittagong Medical College Teacher's Association 2009;20:19-23.
  • 6 Boshtam M, Ramezani MA, Naderi G, Sarrafzadegan N. Is Friedewald formula a good estimation for low density lipoprotein level in Iranian population? J Res Med Sci 2012;17:519-22.
  • 7 Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
  • 8 Rifai N, Warnick GR. Measurement of lipids, lipoproteins and apolipoproteins. In: Burtis CA, Ashwood ER, Bruns DE editors. Teitz Textbook of Clinical Chemistry and Molecular Diagnosis. 4th ed. St. Louis, Missouri: Elseviers Saunders; 2006. p. 938-52.
  • 9 Anandaraja S, Narang R, Godeswar R, Laksmy R, Talwar KK. Low-density lipoprotein cholesterol estimation by a new formula in Indian population. Int J Cardiol 2005;102:117-20.
  • 10 Gasko R. Low-density lipoprotein cholesterol estimation by the Anandaraja's formula - Confirmation. Lipids Health Dis 2006;5:18.
  • 11 Gupta S, Verma M, Singh K. Does LDL-C estimation using Anandaraja's formula give a better agreement with direct LDL-C estimation than the Friedewald's formula? Indian J Clin Biochem 2012;27:127-33.
  • 12 Puavilai W, Laoragpongse D. Is calculated LDL-C by using the new modified Friedewald equation better than the standard Friedewald equation? J Med Assoc Thai 2004;87:589-93.
  • 13 Allain CC, Poon LS, Chan CS, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem 1974;20:470-5.
  • 14 Bucolo G, David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem 1973;19:476-82.
  • 15 Warnick GR, Benderson J, Albers JJ. Dextran sulfate-Mg2+precipitation procedure for quantitation of high-density-lipoprotein cholesterol. Clin Chem 1982;28:1379-88.
  • 16 Harris N, Galpchian V, Thomas J, Iannotti E, Law T, Rifai N. Three generations of high-density lipoprotein cholesterol assays compared with ultracentrifugation/dextran sulfate-Mg2+method. Clin Chem 1997;43:816-23.
  • 17 Talwalkar PG, Sreenivas CG, Gulati A, Baxi H. Journey in guidelines for lipid management: From adult treatment panel (ATP)-I to ATP-III and what to expect in ATP-IV. Indian J Endocrinol Metab 2013;17:628-35.
  • 18 Sahu S, Chawla R, Uppal B. Comparison of two methods of estimation of low density lipoprotein cholesterol, the direct versus Friedewald estimation. Indian J Clin Biochem 2005;20:54-61.
  • 19 Vujovic A, Kotur-Stevuljevic J, Spasic S, Bujisic N, Martinovic J, Vujovic M, et al. Evaluation of different formulas for LDL-C calculation. Lipids Health Dis 2010;9:27.
  • 20 Kamezaki F, Sonoda S, Nakata S, Otsuji Y. A direct measurement for LDL-cholesterol increases hypercholesterolemia prevalence: Comparison with Friedewald calculation. J UOEH 2010;32:211-20.