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LDL-콜레스테롤의 추정: Friedewald 공식과 Martin 방법의 비교

Comparison of the Friedewald formula and the Martin method for estimating LDL-cholesterol levels

손희정|이종석|장성옥
국가데이터연구원 (Statistics Research Institute)|2015.10|통계연구 (Journal of the Korean Official Statistics)|제20권 제2호|pp. 160-178

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키워드

국민건강영양조사LDL-콜레스테롤Friedewald 공식Martin 방법LDL-cholesterol EstimationFriedewald’s FormulaMartin’s MethodThe Korea National Health and Nutrition Examination Survey
주제분류경제학

초록

LDL-콜레스테롤은 심근경색이나 뇌졸중 같은 심뇌혈관질환의 주된 위험인자로서, 그 정확한 측정값을 임상에 적용하는 것이 중요하다. 하지만 이의 측정은 실측값이 아닌 Friedewald 공식에의한 추정값이 널리 이용되고 있다. Friedewald 공식은 비용-효과적인 장점을 가지지만, 중성지방이 높은 수준에서 LDL-콜레스테롤을 과소평가한다는 문제점이 제기되어 왔다. 본 연구의 목적은 Friedewald 공식의 대안으로서 최근에 제시된 Martin 방법의 성과를 평가하는 것이다. 이를위해 국민건강영양조사 3개년(2009-2011) 자료를 이용하여 20세 이상의 성인 5,665명을 대상으로, 중성지방 농도 400 mg/dL 미만에서 두 가지 추정 방법의 정확도를 비교하였다. Friedewald 공식은 중성지방 농도 100 mg/dL 이상과 HDL-콜레스테롤 농도 50 mg/dL 미만에서 LDL-콜레스테롤을 과소평가하는 경향이 있었다. Friedewald 추정값과 비교했을 때, Martin 추정값들은 LDL- 콜레스테롤 실측값에 더 근접했다(p < 0.001). Friedewald 추정값의 LDL-콜레스테롤 위험수준 분류 일치도는 82.9%인 반면, Martin 추정값들의 일치도는 85.5% 수준이었다(p < 0.001). 특히 중성지방 농도가 200-399 mg/dL일 때 일치도를 크게 향상시켰는데, Friedewald 추정값은 70.4%인반면 Martin 추정값들은 80% 수준이었다. 이러한 결과는 Friedewald 공식과 비교했을 때, Martin 방법이 LDL-콜레스테롤 추정을 유의하게 개선한다는 것을 제시한다. 우리나라 국가건강검진에서 중성지방 농도 400 mg/dL 미만인 사람들에 대해서 Friedewald 추정값을 사용하는데, 이는 전체 수검자의 98% 정도에 해당한다. 향후 Friedewald 공식을 대체할 만큼 Martin 방법이탁월한지에 대한 다양한 표본을 이용한 타당성 평가를 통해, 국가건강검진의 LDL-콜레스테롤 추정에 있어 새로운 방법의 채택을 고려해볼 필요가 있다.

Abstract

Low-density lipoprotein cholesterol (LDL-C) is a major risk factor for cardio-cerebrovascular disease such as myocardial infarction and stoke. While its accurate assessment is important, It is typically calculated using the Friedewald formula as a cost-effective method. In the Korea National Health Screening Program, LDL-C is calculated for subjects accounting for nearly 98% of its total participants when triglycerides are lower than 400 mg/dL. However, previous studies have suggested that the formula underestimates LDL-C, particularly at high triglyceride levels. In a recent study, the Martin Method as an alternative to the Friedewald formula was proposed to improve estimation of LDL-C. The aim of this study was to compare the performance of the Martin method and the Friedewald equation using a sample of 5,665 Korean adults with LDL-C measured by an enzymatic homogeneous assay (LDL-CD). The Friedewald LDL-C (LDL-CF) tended to underestimate LDL-C for subjects with triglycerides of ≥ 100 mg/dL and HDL-cholesterol levels of < 50 mg/dL. Based on the N strata of triglyceride and non-HDL- cholesterol and triglyceride levels, we generated the Martin LDL-C (LDL-CN) estimates including LDL-C5, LDL-C10, LDL-C20, LDL-C25, and LDL-C50. Compared with LDL-CF, each of LDL-CN estimates more closely approximated LDL-CD and exhibited a significantly higher overall concordance in the guideline risk classification with LDL-CD (p < 0.001 for each comparison). Overall concordance was 82.9% for LDL-CF, 85.5% for LDL-C5, and 85.8% for LDL-C25. The Martin method achieved the greatest improvement in concordance with LDL-CD at triglyceride levels of 200-399 mg/dL. In this triglyceride category, concordance was 70.4% for LDL-CF versus 80.0% for LDL-C5. Our findings suggest that the Martin method significantly improves LDL-C estimation when compared to the Friedewald formula. However, the new method requires validation in various populations to evaluate whether improvements over the Friedewald calculation are compelling enough to justify its adoption.

참고문헌 (25)

  1. 2013 건강검진통계연보, "국민건강보험", 국민건강보험공단, ~ (2014)
  2. 2015 건강검진실시안내, "국민건강보험", 국민건강보험공단, ~ (2015)
  3. 조영규, "국내외 이상지질혈증 치료지침의 비교 및 한국인에서의 치료지침의 적절성", Korean Journal of Family Medicine, 31(3), pp.171~181 (2010), 대한가정의학회
  4. 국민건강영양조사 제4기 3차년도 제5기 1-2차년도, "질병관리본부", ~ (2011)
  5. 2013년 사망원인통계, "통계청", ~ (2014)
  6. Bachorik, P. S., "National Cholesterol Education Program recommendations for measurement of low-density lipoprotein cholesterol : executive summary. The National Cholesterol Education Program Working Group on Lipoprotein Measurement", Clinical Chemistry, 41(10), pp.1414~1420 (1995)
  7. Branchi, A., "Accuracy of calculated serum low-density lipoprotein cholesterol for the assessment of coronary heart disease in NIDDM patients", Diabetes Care, 21(9), pp.1397~1402 (1998)
  8. de Cordova, C. M., "A new accurate, simple formula for LDL-cholesterol estimation based on directly measured blood lipids from a large cohort", Annals of Clinical Biochemistry, 50(1), pp.13~19 (2013)
  9. DeLong, D. M., "A comparison of methods for the estimation of plasma low-and very low-density lipoprotein cholesterol : the Lipid Research Clinics Prevalence Study", The Journal of the American Medical Association, 256(10), pp.2372~2377 (1986)
  10. Friedewald, W. T., "Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge", Clinical Chemistry, 18(6), pp.499~502 (1972)
  11. Gaziano, J. M., "What’s new with measuring cholesterol?", The Journal of the American Medical Association, 310(19), pp.2043~2044 (2013)
  12. Hirany, S., "A more valid measurement of low-density lipoprotein cholesterol in diabetic patients", The American Journal of Medicine, 102(1), pp.48~53 (1997)
  13. Jeong, E., "Comparison of direct measurement of LDL cholesterol with calculation using Friedewald’s equation", Clinical Diabetes, 8(3), pp.253~260 (2007)
  14. Jun, K. R., "Effects of total cholesterol and triglyceride on the percentage difference between the LDL-C concentration measured directly and calculated using the Friedewald formula", Clinical Chemistry and Laboratory Medicine, 46(3), pp.371~375 (2008)
  15. Kazi-Aoul, T., "The Friedewald formula : another restriction?", Clinical Chemistry, 33(7), pp.1301~ (1987)
  16. Kulkarni, K. R., "Cholesterol profile measurement by VAP method", Clinics in Laboratory Medicine, 26, pp.787~802 (2006)
  17. Lindsey, C. C., "A clinical comparison of calculated versus direct measurement of low-density lipoprotein cholesterol level", Pharmacotherapy, 24(2), pp.167~172 (2004)
  18. Martin, S. S., "Comparison of a Novel Method vs the Friedewald Equation for Estimating Low-Density Lipoprotein Cholesterol Levels From the Standard Lipid Profile", The Journal of the American Medical Association, 310(19), pp.2061~2068 (2013)
  19. Matas, C., "Limitations of the Friedewald formula for estimation lowdensity lipoprotein cholesterol in alcoholics with liver disease", Clinical Chemistry, 40(3), pp.404~406 (1994)
  20. McNamara, J. R., "Calculated values for low-density lipoprotein cholesterol in the assessment of lipid abnormalities and coronary disease risk", Clinical Chemistry, 36(1), pp.36~42 (1990)
  21. Meeusen, J. W., "Validation of a Proposed Novel Equation for Estimating LDL Cholesterol", Clinical Chemistry, 60(12), pp.1519~1523 (2014)
  22. Scharnagl, H., "The Friedewald formula underestimates LDL cholesterol at low concentrations", Clinical Chemistry and Laboratory Medicine, 39(5), pp.426~431 (2001)
  23. Sibal, L., "Friedewald equation underestimates LDL-C at low concentrations in young people with and without type 1 diabetes", Diabetic Medicine, 27(1), pp.37~45 (2010)
  24. Stein, E. A., "Measuring LDL Cholesterol : for Old and New Calculations, Is There an Optimal Formula?", Clinical Chemistry, 60(12), pp.1466~1468 (2014)
  25. Steinberg, D., "Thematic review series; the pathogenesis of atherosclerosis;an interpretive history of the cholesterol controversy, part III : mechanistically defining the role of hyperlipidemia", Journal of Lipid Research, 46, pp.2037~2051 (2005)

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