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Friedewald LDL Equation

Friedewald LDL Equation: Estimates LDL cholesterol from standard lipid panel measurements (Total Cholesterol, HDL, and Triglycerides).

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Use

To estimate Low-Density Lipoprotein (LDL) cholesterol when a direct LDL measurement is not available (which is the standard in most clinical laboratories).

Do Not Use If

Triglycerides are severely elevated (>400 mg/dL or >4.5 mmol/L). The formula assumes a fixed ratio of triglycerides to VLDL cholesterol, which breaks down entirely in severe hypertriglyceridemia.

How it Works

The Formula

LDL = Total Cholesterol - HDL - Very Low Density Lipoprotein (VLDL). Since VLDL is difficult to measure directly, it is estimated as Triglycerides / 5 (if using mg/dL) or Triglycerides / 2.2 (if using mmol/L).

Underestimation Risk

01
The absolute ratio of TG to VLDL-C is rarely exactly 5. It varies across the spectrum of triglyceride and cholesterol levels.
02
When triglycerides are high (e.g., 200-399 mg/dL) or LDL is very low (<70 mg/dL), the Friedewald equation systematically underestimates true LDL levels.
03
This underestimation can falsely reassure clinicians and lead to undertreatment of high-risk patients.

Clinical Pearls

The Martin/Hopkins Alternative

The newer Martin/Hopkins equation replaces the fixed dividing factor of "5" with an adjustable factor derived from a 180-cell lookup table (ranging from 3.1 to 11.9) based on the patient's non-HDL cholesterol and triglyceride levels. It is significantly more accurate, especially when LDL is <70 mg/dL.

Non-HDL Cholesterol

In patients with hypertriglyceridemia, diabetes, or metabolic syndrome, calculating Non-HDL Cholesterol (Total Cholesterol - HDL) is often a better predictor of cardiovascular risk than estimated LDL, as it accounts for all atherogenic apolipoprotein B-containing lipoproteins.

The Evidence

Original Derivation

Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.

Friedewald WT et al. • Clin Chem.. 1972;18(6):499-502. The seminal paper outlining the calculation.

Next Steps

Complementary Calculators

Martin/Hopkins LDL Calculation
Non-HDL Cholesterol
ASCVD Risk — Pooled Cohort Equations (PCE)
SCORE2 CVD Risk

Last Comprehensive Review: 2026-07-17

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Use

To estimate Low-Density Lipoprotein (LDL) cholesterol when a direct LDL measurement is not available (which is the standard in most clinical laboratories).

Do Not Use If

Triglycerides are severely elevated (>400 mg/dL or >4.5 mmol/L). The formula assumes a fixed ratio of triglycerides to VLDL cholesterol, which breaks down entirely in severe hypertriglyceridemia.

How it Works

The Formula

LDL = Total Cholesterol - HDL - Very Low Density Lipoprotein (VLDL). Since VLDL is difficult to measure directly, it is estimated as Triglycerides / 5 (if using mg/dL) or Triglycerides / 2.2 (if using mmol/L).

Underestimation Risk

01
The absolute ratio of TG to VLDL-C is rarely exactly 5. It varies across the spectrum of triglyceride and cholesterol levels.
02
When triglycerides are high (e.g., 200-399 mg/dL) or LDL is very low (<70 mg/dL), the Friedewald equation systematically underestimates true LDL levels.
03
This underestimation can falsely reassure clinicians and lead to undertreatment of high-risk patients.

Clinical Pearls

The Martin/Hopkins Alternative

The newer Martin/Hopkins equation replaces the fixed dividing factor of "5" with an adjustable factor derived from a 180-cell lookup table (ranging from 3.1 to 11.9) based on the patient's non-HDL cholesterol and triglyceride levels. It is significantly more accurate, especially when LDL is <70 mg/dL.

Non-HDL Cholesterol

In patients with hypertriglyceridemia, diabetes, or metabolic syndrome, calculating Non-HDL Cholesterol (Total Cholesterol - HDL) is often a better predictor of cardiovascular risk than estimated LDL, as it accounts for all atherogenic apolipoprotein B-containing lipoproteins.

The Evidence

Original Derivation

Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.

Friedewald WT et al. • Clin Chem.. 1972;18(6):499-502. The seminal paper outlining the calculation.

Next Steps

Complementary Calculators

Martin/Hopkins LDL Calculation
Non-HDL Cholesterol
ASCVD Risk — Pooled Cohort Equations (PCE)
SCORE2 CVD Risk

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

No new significant updates or guidelines matching this topic were found today. We will check again soon.