| Title: | Lipid Ratio Plot: A Simple Graphical Approach for Investigating the Accuracy of LDL Cholesterol Equations or Direct Assays |
| Journal: | The Journal of Applied Laboratory Medicine |
| Published: | 23 Jul 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/40696992/ |
| DOI: | https://doi.org/10.1093/jalm/jfaf093 |
Publication 16115
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Abstract
BACKGROUND: β-Quantification (BQ) is the reference method for low-density lipoprotein cholesterol (LDL-C) determination. It is not widely available, making it challenging for laboratories to assess the accuracy of LDL-C methods. Our goal was to develop an indirect graphical approach for comparing LDL-C test results to the BQ reference method.</p>
METHODS: BQ results from Mayo Medical Laboratories (n = 39 969) and the National Institutes of Health (n = 17 825) were used to investigate the interrelationships between lipid panel tests. A plot of LDL-C/non high-density lipoprotein cholesterol (nonHDL-C) vs (triglyceride (TG)/nonHDL-C)0.5 (lipid ratio plot) resulted in a negative linear regression line (y = -34.2x + 115). Based on simulation analysis, the minimum sample size for calculating its slope and intercept with a coefficient of variation of about 7.5% was 80.</p>
RESULTS: The regression lines for the lipid ratio plot of LDL-C calculated by the Sampson-NIH (y = -37.6x + 118) and enhanced Sampson-NIH (y = -33.1x + 116) equations closely overlapped with the BQ method. In contrast, the Martin-Hopkins equation showed a positive bias with an increasing TG/nonHDL-C ratio and exceeded the recommended bias limit of 4% on hypertriglyceridemic samples (y = -25.5x + 107). The Friedewald equation showed an even larger negative bias with hypertriglyceridemia (y = -47.5x + 126). Lipid ratio plots of the Roche direct assay revealed a fixed positive bias of approximately 4% (y = -33.9x + 120), whereas a much larger proportional positive bias was observed with increasing triglycerides for the Beckman direct assay (y = -14.6x + 97.8).</p>
CONCLUSIONS: The lipid ratio plot is a simple graphical approach that can be readily performed by clinical laboratories for investigating the accuracy of LDL-C assays by calculation methods or direct assays.</p>
8 Authors
- Thando Gcingca
- Maureen Sampson
- Rafael Zubirán
- Anna Wolska
- Jeffrey Meeusen
- Leslie Donato
- Allan Jaffe
- Alan Remaley
1 Application
| Application ID | Title |
|---|---|
| 97500 | Use of a new lipid classification system for lipoprotein phenotypes to evaluate health outcomes and underlying genotypes. |
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