Multi-National Evaluation of Low-Density Lipoprotein Cholesterol Equations in Young Adulthood for Long-Term Risk of Atherosclerotic Cardiovascular Disease
Authors' conclusion
The Martin-Hopkins equation provides more accurate LDL-C-based risk classification, identifying high-risk young adults missed by other equations and minimizing misclassification of those at normal risk.
Study context
- Population
- Young adults (aged 20–39 years) with low-density lipoprotein cholesterol (LDL-C) measurements and follow-up data for incident atherosclerotic cardiovascular disease (ASCVD)56.8% females, mean baseline age 29.8 years
- Participants
- 10,550 adults
- Exposure
- Friedewald, Martin-Hopkins, and Sampson equations; discordant vs concordant normal LDL-C groups
Methodological detailsInternational Childhood Cardiovascular Cohort Consortium, Fine-Gray regressions
- International Childhood Cardiovascular Cohort Consortium
- Fine-Gray regressions
Main finding
As reported in the abstract
ASCVD events, elevated LDL-C (≥130 mg/dL) by each equation · mean follow-up of 22.7 years
Subdistribution hazards ratio (95% CI)
Elevated LDL-C (Martin-Hopkins)
1.69(1.35–2.12)
Elevated LDL-C (Sampson)
1.52(1.22–1.90)
Elevated LDL-C (Friedewald)
1.47(1.17–1.84)
Each equation, as printed
- ASCVD events
- 376
Observational data: associations, not effects.
Further findings
| Outcome | Subdistribution hazards ratio (95% CI) | |
|---|---|---|
| ASCVD risk by discordance — normal LDL-C by Friedewald but elevated by Martin-Hopkins vs concordant normal LDL-C group | 3.32 (1.94–5.66) | |
| ASCVD risk by discordance — reverse discordance (Friedewald elevated, Martin-Hopkins normal) vs concordant normal LDL-C group · no excess risk | 1.19 (0.47–3.05) | |
| ASCVD risk by discordance — Normal Friedewald but elevated Sampson LDL-C vs concordant normal LDL-C group · no participants had the reverse discordance | 1.69 (0.93–3.05) | |
| ASCVD risk by discordance — Normal Sampson LDL-C but elevated Martin-Hopkins LDL-C vs concordant normal LDL-C group | 3.94 (1.80–8.64) | |
| ASCVD risk by discordance — reverse discordance (Sampson elevated, Martin-Hopkins normal) vs concordant normal LDL-C group · no increased risk | 0.86 (0.39–1.91) | |
| 0.10.31310Subdistribution hazards ratio (log scale) |
Total discordance
- Total discordance ranged
- 2.3% to 2.9%
Original publication
Multi-National Evaluation of Low-Density Lipoprotein Cholesterol Equations in Young Adulthood for Long-Term Risk of Atherosclerotic Cardiovascular Disease. Circ Popul Health Outcomes. Published 30 September 2026. doi:10.
Summarised from the published abstract; every number is checked against it