Key result
Novel sex-specific LDL-C equation improves accuracy over established formulas with a ~5% error rate.
Why the study?
Currently established equations for calculating LDLc do not reflect sex-specific differences in lipid metabolism.
Does a novel sex-specific LDL-cholesterol equation improve accuracy and agreement with direct measurement compared to established equations in Korean adults?
Cohort (n=23,757)
Does a novel sex-specific LDL-cholesterol equation improve accuracy and agreement with direct measurement compared to established equations in Korean adults?
A novel sex-specific LDL-cholesterol equation provides superior accuracy and categorical agreement compared to established equations in Korean adults, effectively addressing sex-based biases.
Answers are grounded in this paper and cite their sources.
May refine LDL-C estimation in Korean adults; supports equation refinement but leaves external validation and clinical adoption open.
Background/Objectives: The currently established equations for calculating low-density lipoprotein cholesterol (LDLc) do not reflect the sex-specific differences in lipid metabolism. We aimed to develop a sex-specific LDLc equation (SSLE) and validate it with three established equations (Friedewald, Sampson-NIH, and ext-Martin–Hopkins) against direct LDLc measurement in Korean adults. Methods: This study included 23,757 subjects (51% male; median age, 51 years) from the 2009–2022 Korean National Health and Nutrition Examination Survey. We developed the SSLE through multiple linear regression incorporating total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), triglycerides (TG), and sex. The validation metrics included Bland–Altman analysis for mean absolute percentage error (MAPE) and agreement of the categorization based on the NCEP ATP-III guidelines, assessed by sex and lipid subgroups. Results: The derived SSLE equation was as follows: for TG < 200 mg/dL, LDLc = 0.963 × TC − 0.881 × HDLc − 0.111 × TG + 0.982 × Sex − 6.958; for TG ≥ 200 mg/dL, LDLc = 0.884 × TC − 0.646 × HDLc − 0.126 × TG + 3.742 × Sex − 3.214 (male = 1, female = 0). The MAPE was similar between males and females for the SSLE (4.6% for both) and ext-Martin–Hopkins (5.0% vs. 4.9%) but higher in males for the Sampson-NIH (5.4% vs. 4.9%) and Friedewald (7.6% vs. 5.7%). In the TG ≥ 400 mg/dL group, the MAPE increased progressively: SSLE (10.2%), ext-Martin–Hopkins (12.0%), Sampson-NIH (12.7%), and Friedewald (27.4%). In the LDLc < 70 mg/dL group, the MAPE was as follows: SSLE (8.0%), Sampson-NIH (8.6%), ext-Martin–Hopkins (9.7%), and Friedewald (12.8%). At TG 200–400 mg/dL, the SSLE revealed very good agreement (κ = 0.801) versus good agreement for other equations (ext-Martin–Hopkins κ = 0.794, Sampson-NIH κ = 0.782, Friedewald κ = 0.696). Conclusions: The novel SSLE demonstrated superior accuracy and agreement in Korean adults. Further validation studies across different ethnic populations are warranted.
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Yang et al. (2025) conducted a cohort in Cardiovascular risk assessment (LDL-cholesterol estimation) (n=23,757). Sex-specific LDL-cholesterol equation (SSLE) vs. Friedewald, Sampson-NIH, and ext-Martin-Hopkins equations was evaluated on Mean absolute percentage error (MAPE) against direct LDLc measurement. The novel sex-specific LDL-cholesterol equation demonstrated superior accuracy with a mean absolute percentage error of 4.59% compared to established equations in Korean adults.
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