Assessment of LDL-C Calculation Using the Newly Adopted NIH LDL-C Equation in a Pediatric Population

Extract

To the Editor:

Cardiovascular disease continues to be the leading cause of morbidity and mortality in much of the world and especially in the United States. Exposures to risk factors often begin in youth; therefore, accurate monitoring of lipid status is crucial during childhood (1, 2). The recent American Academy of Pediatrics/American Heart Association/National Heart, Lung and Blood Institute/National Lipid Association guidelines advocate for universal screening to target treatment for high-risk children identified by increased total cholesterol and LDL cholesterol (LDL-C; >170 mg/dL [4.40 mmol/L] and >110 mg/dL [2.85 mmol/L], respectively) (3). Accurate monitoring of LDL-C is crucial as its concentration is used in dose adjustments of statin therapies for pediatric patients (4). The Friedewald equation for calculating LDL-C has been widely adopted for clinical use since its introduction in 1972; however, it does not always provide an accurate estimation of LDL-C at low concentrations and in patients with high triglyceride (TG) concentrations (5). In 2020, using residual samples from patients tested at the NIH Clinical Center, Sampson et al. formulated a new equation for more accurate estimation (5). We aimed to compare the NIH equation with the Friedewald equation for LDL-C estimation in a retrospective analysis of a pediatric population.