Martin-Hopkins LDL equation best predicts cardiovascular risk
In 10,550 young adults followed for 22.7 years, elevated Martin-Hopkins LDL-C yielded a hazard ratio of 1.69 for cardiovascular events versus 1.47 for the Friedewald equation.
Circulation Population Health and Outcomes
In a study of 10,550 young adults from seven international cohorts, researchers evaluated how different LDL-C calculation equations predicted long-term atherosclerotic cardiovascular disease. The participants, who had a mean baseline age of 29.8 years and were 56.8% female, experienced 376 cardiovascular events over a mean follow-up of 22.7 years.
Elevated LDL-C by all equations was associated with cardiovascular events, but the Martin-Hopkins equation showed the strongest association (subdistribution hazard ratio 1.69), compared with Sampson (1.52) and Friedewald (1.47). Between 2.3% and 2.9% of participants had discordant classifications between pairs of equations. Participants classified as normal by Friedewald but elevated by Martin-Hopkins had a higher cardiovascular risk (subdistribution hazard ratio 3.32) compared to those with concordant normal levels, whereas the reverse discordance showed no excess risk.
Why it matters
Atherosclerotic cardiovascular disease develops over decades of cumulative vascular exposure to circulating lipids. Identifying elevated LDL-C accurately in early adulthood enables targeted prevention well before clinical cardiovascular aging manifests.
Caveats
The findings come from observational cohort data, and the overall proportion of participants with discordant equation classifications was relatively small, ranging from 2.3% to 2.9%.
The paper
Show 13 more authors
David R. Jacobs, Lydia Bazzano, Stephen R. Daniels, Terence Dwyer, Mika A. P. Kähönen, Alan R. Sinaiko, Julia Steinberger, Elaine M. Urbina, Alison Venn, Jorma S.A. Viikari, Kara M. Whitaker, Jessica Graus Woo, Olli Tuomas Raitakari,Turku University Hospital
Circulation Population Health and Outcomes · 30 Sep 2026