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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Volume 45, Issue 10 (Oct 2007)


Calculated low-density lipoprotein cholesterol remains a viable and important test for screening and targeting therapy

Ntei Abudu / Stanley S. Levinson
  • 2Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, KY, USA and Laboratory Service, VAMC, Louisville, KY, USA
  • Other articles by this author:
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Background: Most clinical laboratories use calculated (C) low-density lipoprotein cholesterol (LDL-C) for measurement. Some studies have questioned the linearity of CLDL-C in the clinically useful low range. Moreover, it is generally believed that calculation leads to poor precision such that variation in CLDL-C is greater than the 4% guideline since the calculation is dependent on three primary variables. Actually, the degree of variability of a calculated value will be small if the variability of each primary value is small as compared to its contribution to the calculated value. When LDL-C is low, high-density lipoprotein cholesterol (HDL-C), that has poorer precision, becomes more important in defining the precision of CLDL-C. New homogeneous (direct) HDL-C (dHDL) methods show better precision than the older heterogeneous methods. We hypothesized that a direct homogeneous HDL-C method would substantially improve the low range precision of LDL-C as compared to older heterogeneous HDL-C methods.

Methods: We compared CLDL-C to a standardized electrophoretic method that shows very high precision. We also compared the precision of CLDL-C calculated using a homogeneous dHDL and a heterogeneous indirect method.

Results: We found good linearity for CLDL-C down to 500 mg/L (×0.002586). The main source of CLDL-C variation was HDL-C. Precision was within guidelines when the dHDL method was used. Using our automated methods for lipoprotein lipids, assuming our reference method is accurate, the formula that calculated CLDL-C (mg/dL) using triglyceride (mg/dL) (×0.001129) ×0.2 suggested by some gave more accurate results than the formula using triglyceride (mg/dL) ×0.16 suggested by others.

Conclusions: Given the potential for CLDL-C to meet the precision guidelines, until direct LDL-C methods can be refined, CLDL-C should continue to be the primary test used for assessing LDL-C clinically. Standardized testing for CLDL-C for manufacturers should be available so that the formula used for each instrument can provide well-defined accuracy.

Clin Chem Lab Med 2007;45:1319–25.

Keywords: calculated low-density lipoprotein cholesterol; heterogeneous high-density lipoprotein cholesterol; linearity; precision

About the article

Corresponding author: Stanley S. Levinson, Laboratory Service, VAMC, 800 Zorn Avenue, Louisville, KY 40206-1466, USA Phone: +1-502-287-5565/5572, Fax: +1-502-287-6265,

Received: 2007-04-03

Accepted: 2007-06-15

Published in Print: 2007-10-01

Citation Information: Clinical Chemical Laboratory Medicine, ISSN (Online) 14374331, ISSN (Print) 14346621, DOI: https://doi.org/10.1515/CCLM.2007.291.

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