Table 1. Open in new tab Summary of...

Table 1.

Summary of high-quality studies comparing various equations for LDL-C calculation since 2020.

First author and Publication year	Sample size	Location	LDL-C equations evaluated	LDL-C reference method	Baseline population	Summary of findings
Samuel C. et al. (8) 2023	5 051 467	USA	23 total equations including: Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Chen Puavilai	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	Martin–Hopkins was most accurate, followed by the Sampson-NIH, Chen, and Puavilai equations. In addition to the highest overall accuracy, the Martin–Hopkins equation was the top performing equation when stratifying by age, sex, fasting status, and triglyceride levels, as well as in patients with atherosclerotic cardiovascular disease, hypertension, diabetes, kidney disease, inflammation, and thyroid dysfunction.
Sun C. et al. (9) 2023	26 094	Canada	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance among LDL-C equations	Hyperlipidemia: Hospital biochemistry lab Lipid clinic (No FH) Lipid clinic (FH)	Both the Martin–Hopkins and the Sampson-NIH equations reclassified patients with ↑ TG and ↓ LDL-C compared to Friedewald. However, the Sampson-NIH equation underestimated LDL-C in patients with FH.
Martin S.S. et al. (10) 2023	364	Netherlands and Denmark	Martin–Hopkins Sampson-NIH Friedewald	Preparative ultracentrifugation (beta quantification)	Dyslipidemia patients on CETP inhibition in a multicenter randomized controlled trial	Martin–Hopkins was the most accurate, followed by the Sampson-NIH and Friedewald equations. Held true in patients with ↑ TG and ↓ LDL-C.
Steyn N. et al. (11) 2023	64 765	South Africa	Extended Martin–Hopkins Sampson-NIH	Direct chemical assay	Adults with hypertriglyceridemia across 3 hospital sites	The Extended Martin–Hopkins equation correlated better with direct LDL-C than the Sampson-NIH equation on both platforms with TG levels up to 800 mg/dL (9.04 mmol/L).
Ertürk Zararsız G. et al. (12) 2022	3908	Turkey	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assays (Roche, Beckman, Siemens)	Pediatric population (age <18 years) undergoing lipid testing	Martin–Hopkins and Extended Martin–Hopkins had the highest concordance coefficient in both overall and all sublevels of LDL-C, non-HDL-C, and TG.
Naser A. et al. (13) 2022	402	Brazil	Martin–Hopkins Sampson-NIH	Direct chemical assay	Patients with diabetes mellitus	Martin–Hopkins and Sampson-NIH equations showed similar accuracy for calculating LDL-C. (Martin–Hopkins 96.3% and Sampson-NIH 96.0% when compared to direct measurement). However, this study is limited by a relatively small sample size.
Azimi V. et al. (14) 2022	934	USA	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Adult outpatients and inpatients from a variety of specialties	Martin–Hopkins equation ↓ LDL-C treatment group miscategorization rates leading to ↓ underestimation of risk compared to the Sampson-NIH equation; however, neither was sufficiently accurate to report LDL-C in patients with ↑ TG ≥400 mg/dL (≥4.52 mmol/L).
Song Y. et al. (15) 2022	177 111	South Korea	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Asymptomatic adults who underwent lipid testing	Martin–Hopkins outperformed the Sampson-NIH equation with the lowest mean absolute differences across the full spectrum of TG levels, even up to TG values of 500–600 mg/dL (5.64–6.78 mmol/L).
Sajja A. et al. (16) 2022	146 106	Western USA	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance between LDL-C equations	Adults with clinical ASCVD and at least 1 lipid panel with a TG level of <400 mg/dL	The Martin–Hopkins equation consistently estimated higher LDL-C values than the Friedewald and Sampson-NIH equations. Discordance rates were clinically meaningful [>10 mg/dL (0.26 mmol/L)], and highest at low LDL-C [<70 mg/dL (<1.81 mmol/L)] and TG levels ≥150 mg/dL (≥1.69 mmol/L).
Steyn N. et al. (17) 2022	64 763	South Africa	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Hattori Anandaraja	Direct chemical assay	Pediatric patients and adult patients with uncontrolled diabetes mellitus	In the pediatric cohort, the Sampson-NIH equation correlated best with the direct LDL-C assays, however, tended to underestimate LDL-C levels (more so than the Martin–Hopkins method). In adults with diabetes, the Martin–Hopkins equation correlated the best. In hypertriglyceridemia the Extended Martin–Hopkins equation correlated best with the direct LDL-C assays.
Rossouw H. et al. (18) 2021	9995	South Africa	11 total equations including: Martin–Hopkins Sampson-NIH Friedewald and more	Direct chemical assays (Abbott and Roche)	Adult lipid samples analyzed by the Abbott and Roche analyzers	On the Abbott platform there was no difference between the Martin–Hopkins and Sampson-NIH methods; however, with the Roche assay, the Martin–Hopkins method outperformed the Sampson-NIH. The authors suggested the replacement of the Friedewald equation with Martin–Hopkins equation in clinical practice to improve the quality of LDL-C across analyzers, whereas caution was advised regarding the Sampson-NIH equation.
Sajja A. et al. (7) 2021	111 939	USA	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	The extended Martin–Hopkins equation showed greater LDL-C accuracy compared with the Friedewald and Sampson-NIH equations in patients with TG levels of 400 to 799 mg/dL (4.52–9.02 mmol/L).

First author and Publication year	Sample size	Location	LDL-C equations evaluated	LDL-C reference method	Baseline population	Summary of findings
Samuel C. et al. (8) 2023	5 051 467	USA	23 total equations including: Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Chen Puavilai	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	Martin–Hopkins was most accurate, followed by the Sampson-NIH, Chen, and Puavilai equations. In addition to the highest overall accuracy, the Martin–Hopkins equation was the top performing equation when stratifying by age, sex, fasting status, and triglyceride levels, as well as in patients with atherosclerotic cardiovascular disease, hypertension, diabetes, kidney disease, inflammation, and thyroid dysfunction.
Sun C. et al. (9) 2023	26 094	Canada	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance among LDL-C equations	Hyperlipidemia: Hospital biochemistry lab Lipid clinic (No FH) Lipid clinic (FH)	Both the Martin–Hopkins and the Sampson-NIH equations reclassified patients with ↑ TG and ↓ LDL-C compared to Friedewald. However, the Sampson-NIH equation underestimated LDL-C in patients with FH.
Martin S.S. et al. (10) 2023	364	Netherlands and Denmark	Martin–Hopkins Sampson-NIH Friedewald	Preparative ultracentrifugation (beta quantification)	Dyslipidemia patients on CETP inhibition in a multicenter randomized controlled trial	Martin–Hopkins was the most accurate, followed by the Sampson-NIH and Friedewald equations. Held true in patients with ↑ TG and ↓ LDL-C.
Steyn N. et al. (11) 2023	64 765	South Africa	Extended Martin–Hopkins Sampson-NIH	Direct chemical assay	Adults with hypertriglyceridemia across 3 hospital sites	The Extended Martin–Hopkins equation correlated better with direct LDL-C than the Sampson-NIH equation on both platforms with TG levels up to 800 mg/dL (9.04 mmol/L).
Ertürk Zararsız G. et al. (12) 2022	3908	Turkey	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assays (Roche, Beckman, Siemens)	Pediatric population (age <18 years) undergoing lipid testing	Martin–Hopkins and Extended Martin–Hopkins had the highest concordance coefficient in both overall and all sublevels of LDL-C, non-HDL-C, and TG.
Naser A. et al. (13) 2022	402	Brazil	Martin–Hopkins Sampson-NIH	Direct chemical assay	Patients with diabetes mellitus	Martin–Hopkins and Sampson-NIH equations showed similar accuracy for calculating LDL-C. (Martin–Hopkins 96.3% and Sampson-NIH 96.0% when compared to direct measurement). However, this study is limited by a relatively small sample size.
Azimi V. et al. (14) 2022	934	USA	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Adult outpatients and inpatients from a variety of specialties	Martin–Hopkins equation ↓ LDL-C treatment group miscategorization rates leading to ↓ underestimation of risk compared to the Sampson-NIH equation; however, neither was sufficiently accurate to report LDL-C in patients with ↑ TG ≥400 mg/dL (≥4.52 mmol/L).
Song Y. et al. (15) 2022	177 111	South Korea	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Asymptomatic adults who underwent lipid testing	Martin–Hopkins outperformed the Sampson-NIH equation with the lowest mean absolute differences across the full spectrum of TG levels, even up to TG values of 500–600 mg/dL (5.64–6.78 mmol/L).
Sajja A. et al. (16) 2022	146 106	Western USA	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance between LDL-C equations	Adults with clinical ASCVD and at least 1 lipid panel with a TG level of <400 mg/dL	The Martin–Hopkins equation consistently estimated higher LDL-C values than the Friedewald and Sampson-NIH equations. Discordance rates were clinically meaningful [>10 mg/dL (0.26 mmol/L)], and highest at low LDL-C [<70 mg/dL (<1.81 mmol/L)] and TG levels ≥150 mg/dL (≥1.69 mmol/L).
Steyn N. et al. (17) 2022	64 763	South Africa	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Hattori Anandaraja	Direct chemical assay	Pediatric patients and adult patients with uncontrolled diabetes mellitus	In the pediatric cohort, the Sampson-NIH equation correlated best with the direct LDL-C assays, however, tended to underestimate LDL-C levels (more so than the Martin–Hopkins method). In adults with diabetes, the Martin–Hopkins equation correlated the best. In hypertriglyceridemia the Extended Martin–Hopkins equation correlated best with the direct LDL-C assays.
Rossouw H. et al. (18) 2021	9995	South Africa	11 total equations including: Martin–Hopkins Sampson-NIH Friedewald and more	Direct chemical assays (Abbott and Roche)	Adult lipid samples analyzed by the Abbott and Roche analyzers	On the Abbott platform there was no difference between the Martin–Hopkins and Sampson-NIH methods; however, with the Roche assay, the Martin–Hopkins method outperformed the Sampson-NIH. The authors suggested the replacement of the Friedewald equation with Martin–Hopkins equation in clinical practice to improve the quality of LDL-C across analyzers, whereas caution was advised regarding the Sampson-NIH equation.
Sajja A. et al. (7) 2021	111 939	USA	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	The extended Martin–Hopkins equation showed greater LDL-C accuracy compared with the Friedewald and Sampson-NIH equations in patients with TG levels of 400 to 799 mg/dL (4.52–9.02 mmol/L).

FH, familial hypercholesterolemia; CETP, cholesteryl ester transfer protein.

Table 1.

Open in new tab

Summary of high-quality studies comparing various equations for LDL-C calculation since 2020.

First author and Publication year	Sample size	Location	LDL-C equations evaluated	LDL-C reference method	Baseline population	Summary of findings
Samuel C. et al. (8) 2023	5 051 467	USA	23 total equations including: Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Chen Puavilai	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	Martin–Hopkins was most accurate, followed by the Sampson-NIH, Chen, and Puavilai equations. In addition to the highest overall accuracy, the Martin–Hopkins equation was the top performing equation when stratifying by age, sex, fasting status, and triglyceride levels, as well as in patients with atherosclerotic cardiovascular disease, hypertension, diabetes, kidney disease, inflammation, and thyroid dysfunction.
Sun C. et al. (9) 2023	26 094	Canada	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance among LDL-C equations	Hyperlipidemia: Hospital biochemistry lab Lipid clinic (No FH) Lipid clinic (FH)	Both the Martin–Hopkins and the Sampson-NIH equations reclassified patients with ↑ TG and ↓ LDL-C compared to Friedewald. However, the Sampson-NIH equation underestimated LDL-C in patients with FH.
Martin S.S. et al. (10) 2023	364	Netherlands and Denmark	Martin–Hopkins Sampson-NIH Friedewald	Preparative ultracentrifugation (beta quantification)	Dyslipidemia patients on CETP inhibition in a multicenter randomized controlled trial	Martin–Hopkins was the most accurate, followed by the Sampson-NIH and Friedewald equations. Held true in patients with ↑ TG and ↓ LDL-C.
Steyn N. et al. (11) 2023	64 765	South Africa	Extended Martin–Hopkins Sampson-NIH	Direct chemical assay	Adults with hypertriglyceridemia across 3 hospital sites	The Extended Martin–Hopkins equation correlated better with direct LDL-C than the Sampson-NIH equation on both platforms with TG levels up to 800 mg/dL (9.04 mmol/L).
Ertürk Zararsız G. et al. (12) 2022	3908	Turkey	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assays (Roche, Beckman, Siemens)	Pediatric population (age <18 years) undergoing lipid testing	Martin–Hopkins and Extended Martin–Hopkins had the highest concordance coefficient in both overall and all sublevels of LDL-C, non-HDL-C, and TG.
Naser A. et al. (13) 2022	402	Brazil	Martin–Hopkins Sampson-NIH	Direct chemical assay	Patients with diabetes mellitus	Martin–Hopkins and Sampson-NIH equations showed similar accuracy for calculating LDL-C. (Martin–Hopkins 96.3% and Sampson-NIH 96.0% when compared to direct measurement). However, this study is limited by a relatively small sample size.
Azimi V. et al. (14) 2022	934	USA	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Adult outpatients and inpatients from a variety of specialties	Martin–Hopkins equation ↓ LDL-C treatment group miscategorization rates leading to ↓ underestimation of risk compared to the Sampson-NIH equation; however, neither was sufficiently accurate to report LDL-C in patients with ↑ TG ≥400 mg/dL (≥4.52 mmol/L).
Song Y. et al. (15) 2022	177 111	South Korea	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Asymptomatic adults who underwent lipid testing	Martin–Hopkins outperformed the Sampson-NIH equation with the lowest mean absolute differences across the full spectrum of TG levels, even up to TG values of 500–600 mg/dL (5.64–6.78 mmol/L).
Sajja A. et al. (16) 2022	146 106	Western USA	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance between LDL-C equations	Adults with clinical ASCVD and at least 1 lipid panel with a TG level of <400 mg/dL	The Martin–Hopkins equation consistently estimated higher LDL-C values than the Friedewald and Sampson-NIH equations. Discordance rates were clinically meaningful [>10 mg/dL (0.26 mmol/L)], and highest at low LDL-C [<70 mg/dL (<1.81 mmol/L)] and TG levels ≥150 mg/dL (≥1.69 mmol/L).
Steyn N. et al. (17) 2022	64 763	South Africa	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Hattori Anandaraja	Direct chemical assay	Pediatric patients and adult patients with uncontrolled diabetes mellitus	In the pediatric cohort, the Sampson-NIH equation correlated best with the direct LDL-C assays, however, tended to underestimate LDL-C levels (more so than the Martin–Hopkins method). In adults with diabetes, the Martin–Hopkins equation correlated the best. In hypertriglyceridemia the Extended Martin–Hopkins equation correlated best with the direct LDL-C assays.
Rossouw H. et al. (18) 2021	9995	South Africa	11 total equations including: Martin–Hopkins Sampson-NIH Friedewald and more	Direct chemical assays (Abbott and Roche)	Adult lipid samples analyzed by the Abbott and Roche analyzers	On the Abbott platform there was no difference between the Martin–Hopkins and Sampson-NIH methods; however, with the Roche assay, the Martin–Hopkins method outperformed the Sampson-NIH. The authors suggested the replacement of the Friedewald equation with Martin–Hopkins equation in clinical practice to improve the quality of LDL-C across analyzers, whereas caution was advised regarding the Sampson-NIH equation.
Sajja A. et al. (7) 2021	111 939	USA	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	The extended Martin–Hopkins equation showed greater LDL-C accuracy compared with the Friedewald and Sampson-NIH equations in patients with TG levels of 400 to 799 mg/dL (4.52–9.02 mmol/L).

First author and Publication year	Sample size	Location	LDL-C equations evaluated	LDL-C reference method	Baseline population	Summary of findings
Samuel C. et al. (8) 2023	5 051 467	USA	23 total equations including: Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Chen Puavilai	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	Martin–Hopkins was most accurate, followed by the Sampson-NIH, Chen, and Puavilai equations. In addition to the highest overall accuracy, the Martin–Hopkins equation was the top performing equation when stratifying by age, sex, fasting status, and triglyceride levels, as well as in patients with atherosclerotic cardiovascular disease, hypertension, diabetes, kidney disease, inflammation, and thyroid dysfunction.
Sun C. et al. (9) 2023	26 094	Canada	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance among LDL-C equations	Hyperlipidemia: Hospital biochemistry lab Lipid clinic (No FH) Lipid clinic (FH)	Both the Martin–Hopkins and the Sampson-NIH equations reclassified patients with ↑ TG and ↓ LDL-C compared to Friedewald. However, the Sampson-NIH equation underestimated LDL-C in patients with FH.
Martin S.S. et al. (10) 2023	364	Netherlands and Denmark	Martin–Hopkins Sampson-NIH Friedewald	Preparative ultracentrifugation (beta quantification)	Dyslipidemia patients on CETP inhibition in a multicenter randomized controlled trial	Martin–Hopkins was the most accurate, followed by the Sampson-NIH and Friedewald equations. Held true in patients with ↑ TG and ↓ LDL-C.
Steyn N. et al. (11) 2023	64 765	South Africa	Extended Martin–Hopkins Sampson-NIH	Direct chemical assay	Adults with hypertriglyceridemia across 3 hospital sites	The Extended Martin–Hopkins equation correlated better with direct LDL-C than the Sampson-NIH equation on both platforms with TG levels up to 800 mg/dL (9.04 mmol/L).
Ertürk Zararsız G. et al. (12) 2022	3908	Turkey	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assays (Roche, Beckman, Siemens)	Pediatric population (age <18 years) undergoing lipid testing	Martin–Hopkins and Extended Martin–Hopkins had the highest concordance coefficient in both overall and all sublevels of LDL-C, non-HDL-C, and TG.
Naser A. et al. (13) 2022	402	Brazil	Martin–Hopkins Sampson-NIH	Direct chemical assay	Patients with diabetes mellitus	Martin–Hopkins and Sampson-NIH equations showed similar accuracy for calculating LDL-C. (Martin–Hopkins 96.3% and Sampson-NIH 96.0% when compared to direct measurement). However, this study is limited by a relatively small sample size.
Azimi V. et al. (14) 2022	934	USA	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Adult outpatients and inpatients from a variety of specialties	Martin–Hopkins equation ↓ LDL-C treatment group miscategorization rates leading to ↓ underestimation of risk compared to the Sampson-NIH equation; however, neither was sufficiently accurate to report LDL-C in patients with ↑ TG ≥400 mg/dL (≥4.52 mmol/L).
Song Y. et al. (15) 2022	177 111	South Korea	Martin–Hopkins Sampson-NIH Friedewald	Direct chemical assay	Asymptomatic adults who underwent lipid testing	Martin–Hopkins outperformed the Sampson-NIH equation with the lowest mean absolute differences across the full spectrum of TG levels, even up to TG values of 500–600 mg/dL (5.64–6.78 mmol/L).
Sajja A. et al. (16) 2022	146 106	Western USA	Martin–Hopkins Sampson-NIH Friedewald	Not applicable: study assessed discordance between LDL-C equations	Adults with clinical ASCVD and at least 1 lipid panel with a TG level of <400 mg/dL	The Martin–Hopkins equation consistently estimated higher LDL-C values than the Friedewald and Sampson-NIH equations. Discordance rates were clinically meaningful [>10 mg/dL (0.26 mmol/L)], and highest at low LDL-C [<70 mg/dL (<1.81 mmol/L)] and TG levels ≥150 mg/dL (≥1.69 mmol/L).
Steyn N. et al. (17) 2022	64 763	South Africa	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald Hattori Anandaraja	Direct chemical assay	Pediatric patients and adult patients with uncontrolled diabetes mellitus	In the pediatric cohort, the Sampson-NIH equation correlated best with the direct LDL-C assays, however, tended to underestimate LDL-C levels (more so than the Martin–Hopkins method). In adults with diabetes, the Martin–Hopkins equation correlated the best. In hypertriglyceridemia the Extended Martin–Hopkins equation correlated best with the direct LDL-C assays.
Rossouw H. et al. (18) 2021	9995	South Africa	11 total equations including: Martin–Hopkins Sampson-NIH Friedewald and more	Direct chemical assays (Abbott and Roche)	Adult lipid samples analyzed by the Abbott and Roche analyzers	On the Abbott platform there was no difference between the Martin–Hopkins and Sampson-NIH methods; however, with the Roche assay, the Martin–Hopkins method outperformed the Sampson-NIH. The authors suggested the replacement of the Friedewald equation with Martin–Hopkins equation in clinical practice to improve the quality of LDL-C across analyzers, whereas caution was advised regarding the Sampson-NIH equation.
Sajja A. et al. (7) 2021	111 939	USA	Martin–Hopkins Extended Martin–Hopkins Sampson-NIH Friedewald	VAP ultracentrifugation	Hyperlipidemia: 85% primary care clinics 15% hospital inpatients	The extended Martin–Hopkins equation showed greater LDL-C accuracy compared with the Friedewald and Sampson-NIH equations in patients with TG levels of 400 to 799 mg/dL (4.52–9.02 mmol/L).

FH, familial hypercholesterolemia; CETP, cholesteryl ester transfer protein.

This Feature Is Available To Subscribers Only