Impact of Improved Low-Density Lipoprotein Cholesterol Assessment on Guideline Classification in the Modern Treatment Era – Results from a Racially Diverse Brazilian Cross-Sectional Study

Abstract Background The Martin/Hopkins low-density lipoprotein cholesterol equation (LDL-C N ) was previously demonstrated as more accurate than Friedewald estimation (LDL-C F ) in a North American database not able to take race into account. Objectives We hypothesized that LDL-C N would be more accurate than LDL-C F and correlate better with LDL particle number (LDL-P) in a racially diverse Brazilian cohort. Methods We performed a cross-sectional analysis of 4,897 participants in the Brazilian Longitudinal Study of Adult Health, assessing LDL-C F and LDL-C N accuracy via overlap with ultracentrifugation-based measurement among clinical guideline LDL-C categories as well as mg/dL and percent error differences. We analyzed by triglyceride categories and correlated LDL-C estimation with LDL-P. Results LDL-C N demonstrated improved accuracy at 70- F at LDL-C D fell within appropriate categories of estimated LDL-C F and LDL-C N , respectively (p N vs. LDL-C F had a 58.5% and 41.5% higher LDL-P than those with concordance (p Conclusions In a diverse Brazilian cohort, LDL-C N was more accurate than LDL-C F at low LDL-C and high triglycerides. LDL-C N may avoid underestimation of LDL-C and better reflect atherogenic lipid burden in low particle size, high particle count states.