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April 30, 2026Scientific AfricanOpen Access

Agreement and bias between direct LDL-C measurement and estimation equations in routine clinical lipid samples at Sebbi Hospital, Uganda

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Key result

Martin/Hopkins and direct LDL-C outperform Friedewald with up to ~86% agreement at elevated triglycerides.

  • n=1,289

Why the study?

Do newer LDL-C estimation equations (Martin/Hopkins, Sampson) or direct measurement reduce misclassification compared to the Friedewald formula across different triglyceride strata?

Population

1,289 routine clinical lipid profiles from patients at Sebbi Hospital, Uganda (2022–2025)

Comparison

Directly measured LDL-C, Friedewald formula, and… vs Sampson formula and cross-comparisons between…

Design

Cross-sectional

Authors

BJBwambale JonaniMalaria ConsortiumMCMusiime CissyMalaria ConsortiumGNGloria NakibuukaAfrican Bible University

Discussion

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Implication

The Friedewald formula demonstrates poor agreement and high misclassification rates at moderately elevated triglyceride levels, supporting the use of Martin/Hopkins, Sampson, or direct LDL-C measurement to guide lipid-lowering therapy.

Key Points

  • The aim is to compare the accuracy of LDL-C measurement equations against direct assays in a clinical setting in Uganda.
  • Retrospective comparison of LDL-C methods using 1,289 lipid profiles from Sebbi Hospital (2022-2025).
  • Direct measurements by Mindray BS-230 analyzer against Friedewald, Martin/Hopkins, and Sampson equations.
  • Assessment of agreement, correlation, RMSE, MAD, and misclassification rates across triglyceride levels.
  • For triglycerides <150 mg/dL, agreement with the Sampson equation was 84.13 – 85.03% (k=0.696 – 0.706).
  • In the 150–399 mg/dL range, Friedwald showed 67.75% agreement, compared to 86.07% for direct measurements and 82.12% for Martin/Hopkins.
  • At ≥400 mg/dL TG, directly measured LDL-C showed nominally high agreement (78.79), but all methods had poor weighted kappa.

Study Design

Type

Observational (n=1,289)

Multicenter

No

Structured PICO

Do newer LDL-C estimation equations (Martin/Hopkins, Sampson) or direct measurement reduce misclassification compared to the Friedewald formula across different triglyceride strata?

P
Population
1,289 routine clinical lipid profiles from 2022-2025 analyzed retrospectively at a single hospital in Uganda to compare direct LDL-C measurement with estimation equations.
E
Exposure
Directly measured LDL-C (Mindray BS-230 analyzer), Friedewald formula, and Martin/Hopkins formula
C
Comparator
Sampson formula (used as a reference for agreement) and cross-comparisons between methods
O
Outcome
Agreement, correlation, root mean square error (RMSE), mean absolute difference (MAD), and misclassification at ESC/EAS treatment thresholds across triglyceride stratasurrogate

The Friedewald formula demonstrates poor agreement and high misclassification rates at moderately elevated triglyceride levels, supporting the use of Martin/Hopkins, Sampson, or direct LDL-C measurement to guide lipid-lowering therapy.

Limitations

  • Small sample size in the severe hypertriglyceridemia stratum
  • small sample size in the severe hypertriglyceridemia stratum

Cite This Study

Jonani et al. (2026) conducted an observational in Cardiovascular risk assessment (lipid profiling) (n=1,289). Directly measured LDL-C vs. Friedewald, Martin/Hopkins, and Sampson formula-calculated LDL-C was evaluated on Agreement and misclassification at ESC/EAS treatment thresholds across triglyceride strata. Directly measured LDL-C and Martin/Hopkins equation showed higher agreement (86.07% and 82.12%) than the Friedewald formula (67.75%) for LDL-C estimation at moderately elevated triglycerides.

synapsesocial.com/papers/69f2f0e31e5f7920c6386d4chttps://doi.org/10.1016/j.sciaf.2026.e03373
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