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The association between TC and the risk of developing atherosclerosis has been established by the Framingham Heart Study.1 Nowadays, there is change in guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), which mainly centers based on TC and LDL-C for diagnosis and treatment effects. Therapy is targeted at lowering LDL-C value below a target value, i.e., the primary basis for treatment and appropriate number of patient classification in risk categories.2 The reference method for LDL-C concentration measurement combines ultracentrifugation-precipitation.3 Beta quantitation is costly, tough, laborious, large sample volume is required, and ultracentrifugation is also required. That is why it is not used routinely.4 So, a new generation of direct homogeneous assays for LDL-C determination in serum has been developed with satisfactory degree of accuracy, but it is expensive for using in developing countries.5,6 However, mainly due to the costs of the reagents, Indian laboratories still do not use this.6 Friedewald et al7 described a formula to estimate LDL-C in serum calculated using Friedewald formula (FF) based on used concentration of TC, TG, and HDL-C as an alternative to tedious ultracentrifugation. Because of economic reasons, the calculated method was widely used in clinical laboratories. There are certain limitations of FF, such as use of this formula required fasting sample, TG should be <400, and patients should not have any comorbidities like diabetes mellitus, nephrotic syndrome, hepatic failure, and on hormone replacement therapy because when chylomicron-rich TG is present in serum, it leads to falsely high very-low-density lipoprotein (VLDL) cholesterol and low LDL-C.6,8 Therefore, modified LDL-Cal formulas have been established for estimate LDL-C to be suitable for ethnics pacific population.9-11 Modified Friedewald formula was given by Puavilai and Laorugpongse,11 which assumes that VLDL constitutes one-sixth of total TGs and it is costly for serum LDL test from direct measurement, especially if it has to be tested several times in a year. The authors found that when one-sixth of total TGs was used 1Tutor, 2Head 1,2Department of Biochemistry, GMERS Medical College & Hospital, Valsad, Gujarat, India

Comparison of Different estimated Formulas with Direct Estimation of Low-density Lipoprotein Cholesterol