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Background  Limited data are available for validation of low-density lipoprotein cholesterol (LDL) calculation (LDL cal ) in the adult Korean population. The aim of this study was to develop and validate a new equation for LDL cal  and to compare it with previous such equations in a Korean population.    Methods  A new equation for LDL cal  was developed (LDL Choi ). LDL Choi  and 11 other previously published equations were applied and compared with directly measured LDL concentration (LDL direct ) in a development cohort (population 1), an independent validation cohort in the same laboratory (population 2), and the Korea National Health and Nutrition Examination Survey 2017 cohort (population 3).    Results  Among the 12 equations, the newly-developed equation (LDL Choi  = total cholesterol – 0.87 x high-density lipoprotein cholesterol – 0.13 x triglycerides) had the highest intraclass correlation coefficient (ICC) and the lowest mean systemic difference and median absolute percentage error in populations 1 and 2 but not in population 3. Subgroup analysis showed good agreement between LDL Choi  and LDL direct  (ICC > 0.75) in population 2, whose LDL direct  < 70 mg/dL. For samples with high triglycerides (> 400 mg/dL), equation accuracy varied. Categorization concordance according to the National Cholesterol Education Program Adult Treatment Panel III criteria with the other 11 equations were less than 80%; that of LDL Choi  was 87.6 and 87.4% in populations 1 and 2, respectively.    Conclusions  Accuracy of 12 equations for LDL cal  varied by cohort and subgroup based on LDL direct  and triglycerides. A laboratory-specific equation for LDL cal  and/or LDL direct  may be needed for accurate evaluation of LDL status.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12944-021-01525-6.

Validation of multiple equations for estimating low-density lipoprotein cholesterol levels in Korean adults