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November 21, 2001

Guidelines for Diagnosis and Treatment of High Cholesterol

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(19):2400-2402. doi:10.1001/jama.286.19.2398

To the Editor: The NCEP-ATP III Executive Summary1 does not mention the illogical formula used by many laboratories to estimate LDL-C. The formula (LDL-C = total cholesterol−HDL−[TG/5]) underestimates the LDL level if the triglycerides (TGs) are elevated and overestimates the LDL-C level if they are low. To illustrate, assume that an adult tested after a 14-hour fast shows an excellent TG level of 75 mg/dL and an HDL-C level of 60 mg/dL. If the total cholesterol were a reasonable 195 mg/dL, the formula will result in the following: LDL = 195−60−(75/5) = 120 mg/dL. An LDL-C of 120 mg/dL would indicate probable treatment with medication by the new guidelines. On the other hand, if the TG were a less healthy 150 mg/dL, her LDL-C would be 105.

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