Martin, Seth SGiugliano, Robert PMurphy, Sabina AWasserman, Scott MStein, Evan ACeška, RichardLopez-Miranda, JoseGeorgiev, BorislavLorenzatti, Alberto JTikkanen, Matti JSever, Peter SKeech, Anthony CPedersen, Terje RSabatine, Marc S2023-01-252023-01-252018-04-28Martin SS, Giugliano RP, Murphy SA, Wasserman SM, Stein EA, Ceška R, et al. Comparison of Low-Density Lipoprotein Cholesterol Assessment by Martin/Hopkins Estimation, Friedewald Estimation, and Preparative Ultracentrifugation: Insights From the FOURIER Trial. JAMA Cardiol. 2018 Aug 1;3(8):749-753http://hdl.handle.net/10668/12588Recent studies have shown that Friedewald underestimates low-density lipoprotein cholesterol (LDL-C) at lower levels, which could result in undertreatment of high-risk patients. A novel method (Martin/Hopkins) using a patient-specific conversion factor provides more accurate LDL-C levels. However, this method has not been tested in proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor-treated patients. To investigate accuracy of 2 different methods for estimating LDL-C levels (Martin/Hopkins and Friedewald) compared with gold standard preparative ultracentrifugation (PUC) in patients with low LDL-C levels in the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk (FOURIER) trial. The FOURIER trial was a randomized clinical trial of evolocumab vs placebo added to statin therapy in 27 564 patients with stable atherosclerotic cardiovascular disease. The patients' LDL-C levels were assessed at baseline, 4 weeks, 12 weeks, 24 weeks, and every 24 weeks thereafter, and measured directly by PUC when the level was less than 40 mg/dL per the Friedewald method (calculated as non-HDL-C level - triglycerides/5). In the Martin/Hopkins method, patient-specific ratios of triglycerides to very low-density lipoprotein cholesterol (VLDL-C) ratios were determined and used to estimate VLDL-C, which was subtracted from the non-HDL-C level to obtain the LDL-C level. Low-density lipoprotein cholesterol calculated by the Friedewald and Martin/Hopkins methods, with PUC as the reference method. For this analysis, the mean (SD) age was 62.7 (9.0) years; 2885 of the 12 742 patients were women (22.6%). A total of 56 624 observations from 12 742 patients had Friedewald, Martin/Hopkins, and PUC LDL-C measurements. The median difference from PUC LDL-C levels for Martin/Hopkins LDL-C levels was -2 mg/dL (interquartile range [IQR], -4 to 1 mg/dL) and for Friedewald LDL-C levels was -4 mg/dL (IQR, -8 to -1 mg/dL; P  In patients achieving low LDL-C with PCSK9 inhibition, the Martin/Hopkins method for LDL-C estimation more closely approximates gold standard PUC than Friedewald estimation does. The Martin/Hopkins method may prevent undertreatment because of LDL-C underestimation by the Friedewald method.enRandomized controlled trials as topicRisk assessmentStatistics as topicTriglyceridesUltracentrifugationAgedAntibodies, monoclonalAntibodies, monoclonal, humanizedAnticholesteremic agentsAtherosclerosisCholesterol, HDLCholesterol, LDLCholesterol, VLDLFemaleHumansHyperlipidemiasMaleMiddle agedresearch article29898218open accessAnticolesterolemiantesAnticuerpos monoclonalesAnticuerpos monoclonales humanizadosAterosclerosisHDL-colesterolHiperlipidemiasLDL-colesterolVLDL-colesterol10.1001/jamacardio.2018.15332380-6591PMC6143070https://jamanetwork.com/journals/jamacardiology/articlepdf/2684503/jamacardiology_martin_2018_br_180006.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143070/pdf