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Friedewald Equation for Low-Density Lipoprotein Cholesterol (LDL-C)

LDL calculation from total cholesterol, HDL and triglycerides.

CréateurDr. William Friedewald, MD
Essayer
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Instructions

  • Triglycerides should only be calculated when fasting.

  • The Friedewald formula is known to be inaccurate at extremely high triglyceride (>400 mg/dL) and total cholesterol levels. A direct LDL level should be measured if there is any question about accuracy.

 

Min 0 – Max 1000

Introduction

The Friedewald formula allows clinicians to estimate LDL based on total serum cholesterol, HDL and triglyceride levels. However, this formula is known to be inaccurate at extremely high triglyceride (> 400 mg/dL) and total cholesterol levels (Cordova, 2004). Additionally, triglycerides should only be calculated when fasting.

The Friedewald Formula provides an estimation of LDL cholesterol which can serve as a proxy for direct measure of serum cholesterol. A direct level of serum LDL should be measured if there is any question about accuracy.

LDL cholesterol = total cholesterol - HDL - (triglycerides / 5)

Classification of calculated LDL level according to the ATP III guidelines.

LDL Level (mg/dL)

Classification

<100

Optimal

100-129

Near optimal/above optimal

130-159

Borderline high

160-189

High

≥ 190

Very high

 

Classification of triglyceride level according to the ATP III guidelines.

Triglyceride Level (mg/dL)

Classification

< 150

Normal

150-199

Borderline high

200-499 

High

≥ 500

Very high

 

Classification of HDL level according to the ATP III guidelines.

HDL Level (mg/dL)

Classification

< 40

Low

≥ 60

High*

 *HDL ≥60 mg/dL counts as a "negative" risk factor; its presence removed one risk factor from the total count.

Classification of total cholesterol level according to the ATP III guidelines.

Total Cholesterol Level (mg/dL)

Classification

< 200

Desirable

200-239

Borderline high

≥ 240

High

 

Management Considerations

The ATP III cholesterol guidelines suggests additional steps after determining lipoprotein levels.   

  1. Identify presence of clinical atherosclerotic disease and major risk factors.

  2. Determine risk category.

  3. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.

  4. Consider adding drug therapy if LDL exceeds levels based on risk category.

  5. Identify metabolic syndrome and treat, if present, after 3 months of TLC.

  6. Treat elevated triglycerides.

LDL targets (mg/dL)*

"Very" high risk.

< 70

Data may suggest there is little incremental benefit to this extreme, and high associated cost.

High risk.

< 100

Known CAD or other atherosclerotic disease, diabetes, etc.

Moderate risk.

<130

> 1 risk factor^

Lower risk.

<160

0-1 risk factors

 *From NCEP 2004 Guidelines

^Risk Factors include:

  • Diabetes

  • Cigarette smoking

  • HTN (BP ≥ 140/90 or on antihypertensive medication)

  • Low HDL cholesterol (<40 mg/dL)

  • Family history of premature CAD (CAD in male first-degree relative, or father < 55 years, or female first-degree relative or mother <65 years)

Toutes les questions et résultats possibles

GuidanceTitre non visible
Total cholesterol

A number between 0 and 1000, in mg/dL or mm/L.

HDL cholesterol

A number between 0 and 500, in mg/dL or mmol/L.

Triglycerides

A number between 0 and 5000, in mg/dL or mmol/L.

Résultats possibles
LDL Level: Optimal (<100)

Classification of calculated LDL level according to the ATP III guidelines.

 

The ATP III cholesterol guidelines suggests additional steps after determining lipoprotein levels.   

  1. Identify presence of clinical atherosclerotic disease and major risk factors.
  2. Determine risk category.
  3. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.
  4. Consider adding drug therapy if LDL exceeds levels based on risk category.
  5. Identify metabolic syndrome and treat, if present, after 3 months of TLC.
  6. Treat elevated triglycerides.

 

LDL targets (mg/dL)*

 

"Very" high risk< 70Data may suggest there is little incremental benefit to this extreme, and high associated cost.
High risk< 100Known CAD or other atherosclerotic disease, diabetes, etc.
Moderate risk<130> 1 risk factor^
Lower risk<1600-1 risk factors

 

*From NCEP 2004 Guidelines

^Risk Factors include:

  • Diabetes
  • Cigarette smoking
  • HTN (BP ≥ 140/90 or on antihypertensive medication)
  • Low HDL cholesterol (<40 mg/dL)
  • Family history of premature CAD (CAD in male first-degree relative, or father < 55 years, or female first-degree relative or mother <65 years)
Total Cholesterol Level: High (≥240)

Classification of total cholesterol level according to the ATP III guidelines.

Triglyceride Level: Very high (≥500)

Classification of triglyceride level according to the ATP III guidelines.

Triglyceride Level: Normal (<150)

Classification of triglyceride level according to the ATP III guidelines.

Total Cholesterol Level: Borderline high (200-239)

Classification of total cholesterol level according to the ATP III guidelines.

LDL Level: Borderline high (130-159)

Classification of calculated LDL level according to the ATP III guidelines.

 

The ATP III cholesterol guidelines suggests additional steps after determining lipoprotein levels.

  1. Identify presence of clinical atherosclerotic disease and major risk factors.
  2. Determine risk category.
  3. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.
  4. Consider adding drug therapy if LDL exceeds levels based ib risk category.
  5. Identify metabolic syndrome and treat, if present, after 3 months of TLC.
  6. Treat elevated triglycerides.

 

LDL targets (mg/dL)*

 

"Very" high risk< 70Data may suggest there is little incremental benefit to this extreme, and high associated cost.
High risk< 100Known CAD or other atherosclerotic disease, diabetes, etc.
Moderate risk<130> 1 risk factor^
Lower risk<1600-1 risk factors

 

*From NCEP 2004 Guidelines

^Risk Factors include:

  • Diabetes
  • Cigarette smoking
  • HTN (BP ≥ 140/90 or on antihypertensive medication)
  • Low HDL cholesterol (<40 mg/dL)
  • Family history of premature CAD (CAD in male first-degree relative, or father < 55 years, or female first-degree relative or mother <65 years)
Triglyceride Level: High (200-499)

Classification of triglyceride level according to the ATP III guidelines.

LDL Level: Near optimal/above optimal (100-129)

Classification of calculated LDL level according to the ATP III guidelines.

 

The ATP III cholesterol guidelines suggests additional steps after determining lipoprotein levels.

  1. Identify presence of clinical atherosclerotic disease and major risk factors.
  2. Determine risk category.
  3. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.
  4. Consider adding drug therapy if LDL exceeds levels based ib risk category.
  5. Identify metabolic syndrome and treat, if present, after 3 months of TLC.
  6. Treat elevated triglycerides.

 

LDL targets (mg/dL)*

 

"Very" high risk< 70Data may suggest there is little incremental benefit to this extreme, and high associated cost.
High risk< 100Known CAD or other atherosclerotic disease, diabetes, etc.
Moderate risk<130> 1 risk factor^
Lower risk<1600-1 risk factors

 

*From NCEP 2004 Guidelines

^Risk Factors include:

  • Diabetes
  • Cigarette smoking
  • HTN (BP ≥ 140/90 or on antihypertensive medication)
  • Low HDL cholesterol (<40 mg/dL)
  • Family history of premature CAD (CAD in male first-degree relative, or father < 55 years, or female first-degree relative or mother <65 years)
LDL Level: High (160-189)

Classification of calculated LDL level according to the ATP III guidelines.

 

The ATP III cholesterol guidelines suggests additional steps after determining lipoprotein levels.

  1. Identify presence of clinical atherosclerotic disease and major risk factors.
  2. Determine risk category.
  3. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.
  4. Consider adding drug therapy if LDL exceeds levels based ib risk category.
  5. Identify metabolic syndrome and treat, if present, after 3 months of TLC.
  6. Treat elevated triglycerides.

 

LDL targets (mg/dL)*

 

"Very" high risk< 70Data may suggest there is little incremental benefit to this extreme, and high associated cost.
High risk< 100Known CAD or other atherosclerotic disease, diabetes, etc.
Moderate risk<130> 1 risk factor^
Lower risk<1600-1 risk factors

 

*From NCEP 2004 Guidelines

^Risk Factors include:

  • Diabetes
  • Cigarette smoking
  • HTN (BP ≥ 140/90 or on antihypertensive medication)
  • Low HDL cholesterol (<40 mg/dL)
  • Family history of premature CAD (CAD in male first-degree relative, or father < 55 years, or female first-degree relative or mother <65 years)
HDL Level: Low (<40)

Classification of HDL level according to the ATP III guidelines.

LDL Level: Very high (≥ 190)

Classification of calculated LDL level according to the ATP III guidelines.

 

The ATP III cholesterol guidelines suggests additional steps after determining lipoprotein levels.

  1. Identify presence of clinical atherosclerotic disease and major risk factors.

  2. Determine risk category.

  3. Initiate therapeutic lifestyle changes (TLC) if LDL is above goal.

  4. Consider adding drug therapy if LDL exceeds levels based ib risk category.

  5. Identify metabolic syndrome and treat, if present, after 3 months of TLC.

  6. Treat elevated triglycerides.

 

LDL targets (mg/dL)*

 

"Very" high risk

< 70

Data may suggest there is little incremental benefit to this extreme, and high associated cost.

High risk

< 100

Known CAD or other atherosclerotic disease, diabetes, etc.

Moderate risk

<130

> 1 risk factor^

Lower risk

<160

0-1 risk factors

 

*From NCEP 2004 Guidelines

^Risk Factors include:

  • Diabetes

  • Cigarette smoking

  • HTN (BP ≥ 140/90 or on antihypertensive medication)

  • Low HDL cholesterol (<40 mg/dL)

  • Family history of premature CAD (CAD in male first-degree relative, or father < 55 years, or female first-degree relative or mother <65 years)

Triglyceride Level: Borderline high (150-199)

Classification of triglyceride level according to the ATP III guidelines.

HDL Level: High (≥60)

Classification of HDL level according to the ATP III guidelines.

  • HDL ≥60 mg/dL counts as a "negative" risk factor; its presence removed one risk factor from the total count.
Total Cholesterol Level: Desirable (<200)

Classification of total cholesterol level according to the ATP III guidelines.

Citation

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972 Jun;18(6):499-502.

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