A Study to Evaluate the Accuracy of Calculated Serum LDL Cholesterol Levels in Hypertriglyceridemic Individuals

  • Tariq Mahmood Associate Professor and HOD Dept. of Biochemistry SRMS IMS, Bhojipura, Bareilly.
  • Sanjay Bhatt Associate Professor Dept. of Biochemistry SRMS IMS, Bhojipura, Bareilly.
  • Rajeev Goyal Associate Professor Dept. of Biochemistry LHMC. New Delhi.
  • Manoj Gupta Associate Professor Dept. of Biochemistry SRMS IMS, Bhojipura, Bareilly.
  • Saba Khan Demonstrator Dept. of Biochemistry SRMS IMS, Bhojipura, Bareilly.
Keywords: Musculoskeletal Disorder, Farmers, Backache, Shoulder Pain.


Background: Farmers are vulnerable to a range of MSDs including osteoarthritis of the hip and knee, low back pain (LBP), upper limb disorders, and hand/arm vibration syndrome, as well as to the consequences of trauma such as sprains, fractures, and dislocations. The present study was conducted to assess prevalence of musculoskeletal disorders among agricultural workers in a known area.

Methods: A community based cross sectional study was done for a period of 3 months. The study included agricultural workers aged more than 20 years and 390 agricultural workers were selected. A pretested, structured, interviewer administered questionnaire was used for data collection. Modified Nordic musculoskeletal questionnaire was used for assessing the presence of musculoskeletal problem. The recorded data was compiled, and data analysis was done using SPSS Version 22.0 (SPSS Inc., Chicago, Illinois, USA).

Results: Pearson’s test for correlation shows a positive and significant correlation with the directly measured LDLc levels with all calculated values. But on application of two tailed t test only Chen’s method satisfied the null hypothesis question that the difference between the calculated and the directly measured LDLc level was zero. (r=0.923 with a p=0.000 and t=0.343 and p value of 0.732.)

Among the three groups defined on bases of TG:TC level only Modified Friedewald’s method showed a statistically significant r value and t value in group 1. (r=0.965 with p=0.000 and t=-1.056 with a p=0.296) No other group showed any statistically significant t value even though the r value was significant for all methods in all groups except for Hattori’s method in group 3.

Conclusion: Our study suggests that most commonly used methods of calculating LDLc fail in hypertriglyceridemics with TG levels over 400mg/dl. Our study also shows importance of t tests and Band Altman plot when comparing two diagnostic methods.


Download data is not yet available.


1. World Health Organization. (2004). “Global Burden of Disease.” Retrieved from https://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf?ua=1
2. Jagannathan, Ram; Patel, Shivani A.; Ali, Mohammed K.; Narayan, K. M. Venkat (2019). Global Updates on Cardiovascular Disease Mortality Trends and Attribution of Traditional Risk Factors. Current Diabetes Reports, 19(7); 44.
3. Prabhakaran, Dorairaj; Jeemon, Panniyammakal; Roy, Ambuj (2016). Cardiovascular Diseases in India. Circulation; 133(16), 1605–1620.
4. Mortensen, M. B., & Nordestgaard, B. G. (2020). Elevated LDL cholesterol and increased risk of myocardial infarction and atherosclerotic cardiovascular disease in individuals aged 70–100 years: a contemporary primary prevention cohort. The Lancet;396 (10263), 1644-1652.
5. Ueda, Peter; Gulayin, Pablo; Danaei, Goodarz; Shimosawa, Tatsuo (2018). Long-term moderately elevated LDL-cholesterol and blood pressure and risk of coronary heart disease. PLOS ONE;13(7), e0200017.
6. Miller WG, Myers GL, Sakurabayashi I, et al (2010). Seven direct methods for measuring HDL and LDL cholesterol compared with ultracentrifugation reference measurement procedures. Clin Chem.;56(6):977-986.
7. W. T. Friedewald, R. I. Levy, and D. S. Fredrickson (1972), Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge, Clinical Chemistry.;18(6):499–502.
8. Knopfholz, José; Disserol, Caio César Diniz; Pierin, et al (2014), Validation of the Friedewald Formula in Patients with Metabolic Syndrome. Cholesterol.; 2014, Article ID 261878: 1–5.
9. Wilai Puavilai , Donpichit Laoragpongse (2004), Is calculated LDL-C by using the new modified Friedewald equation better than the standard Friedewald equation? J Med Assoc Thai. ;87(6):589-93.
10. Chen Y, Zhang X, Pan B, et al. (2010), Short paper A modified formula for calculating low-density lipoprotein cholesterol values. Lipids in Health Dis ;9:52.
11. Vujovic A, Kotur-Stevuljevic J, Spasic S (2010), et al. Evaluation of different formulas for LDL-C calculation. Lipids in Health Dis ;9:27.
12. Anandaraja S, Narang R, Godeswar R, Laksmy R, Talwar KK. (2005), Lowdensity lipoprotein cholesterol estimation by a new formula in Indian population. Int J Cardiol ;102:117-120.
13. de Cordova CM, de Cordova MM (2013). A new accurate, simple formula for LDL-cholesterol estimation based on directly measured blood lipids from a large cohort. Ann Clin Biochem ;50(1):13-9.
14. Hattori Y, Suzuki M, Tsushima M, et al. (1998), Development of approximate formula for LDL-chol, LDL-apo B and LDL-chol/LDL-apo B as indices of hyperapobetalipoproteinemia and small dense LDL. Atherosclerosis; 138:289-99.
15. Seth S. Martin, Michael J. Blaha, Mohamed B. Elshazly, Eliot A. Brinton, Peter P. Toth, John W. McEvoy, et.al., Friedewald-Estimated Versus Directly Measured Low-Density Lipoprotein Cholesterol and Treatment Implications, Journal of the American College of Cardiology,Volume 62, Issue 8,2013,Pages 732-739,ISSN 0735-1097,https://doi.org/10.1016/j.jacc.2013.01.079.
16. Puavilai W, Laoragpongse D. Is calculated LDL-C by using the new modified Friedewald equation better than the standard Friedewald equation? J Med Assoc Thai. 2004 Jun;87(6):589-93. PMID: 15279333.
17. Gupta S., Verma M., Singh K. Does estimation using Anandaraja’s formula give a better agreement with different LDL-c estimation than the Friedewald’s formula. Ind J Clin Biochem. 2012;27:127–133.
18. Kapoor R., Chakraborty M., Singh N. A leap above Friedewald formula for calculation of low − density lipoprotein cholesterol. J Lab Physicians. 2015;7:11–16.
19. Kumar Nigam P. Calculated low density lipoprotein cholesterol: Its relevance in Indian perspective. Indian Heart J. 2017 May-Jun;69(3):420-421. doi: 10.1016/j.ihj.2017.01.007. Epub 2017 Jan 20. PMID: 28648448; PMCID: PMC5485401.
20. Karkhaneh, A., Bagherieh, M., Sadeghi, S. et al. Evaluation of eight formulas for LDL-C estimation in Iranian subjects with different metabolic health statuses. Lipids Health Dis 18, 231 (2019). https://doi.org/10.1186/s12944-019-1178-1
21. Choi, Hansol; Shim, Jee-Seon; Lee, Myung Ha; Yoon, Young Mi; Choi, Dong Phil; Kim, Hyeon Chang (2016). Comparison of Formulas for Calculating Low-density Lipoprotein Cholesterol in General Population and High-risk Patients with Cardiovascular Disease. Korean Circulation Journal, 46(5), 688–. doi:10.4070/kcj.2016.46.5.688.
How to Cite
Mahmood T, Bhatt S, Goyal R, Gupta M, Khan S. A Study to Evaluate the Accuracy of Calculated Serum LDL Cholesterol Levels in Hypertriglyceridemic Individuals. Int Arch BioMed Clin Res [Internet]. 2021Jul.12 [cited 2021Jul.25];7(2):BC1-BC5. Available from: https://iabcr.org/index.php/iabcr/article/view/722