Patients with low triglycerides on statin/ezetimibe therapy
Lean or athletic individuals (naturally low TG)
Women (typically lower TG than men)
Patients on PCSK9 inhibitors or bempedoic acid (aggressive LDL lowering)
Limitations
Not widely adopted in routine clinical labs (yet)
Requires TG <400 for accuracy; unreliable if TG >400
Limited long-term outcome validation vs. Friedewald
More relevant for research than acute clinical decisions
Section 4
Next Steps
Therapy Adjustments
If Martin/Hopkins LDL significantly lower than Friedewald → may have greater residual risk than calculated
Use for better risk stratification in guidelines (ACC/AHA target LDL <70 post-ACS)
Particularly valuable when assessing statin/ezetimibe/PCSK9i response
Consider sequential assessment over single calculation
Complementary Calculators
Friedewald LDL Equation
Non-HDL Cholesterol
ASCVD Risk — Pooled Cohort Equations (PCE)
SCORE2 CVD Risk
Section 5
Evidence Appraisal
Primary Publication
Comparison of a Novel Method vs. the Friedewald Equation for Estimating Low-Density Lipoprotein Cholesterol Levels from the Standard Lipid Profile.
Martin SS et al. • JAMA.. 2013;n=1.35 million. Validated the superior accuracy of the adjustable divisor approach.
Section 6
Literature
Development
Developed by Dr. Steven Martin at Johns Hopkins, published in 2013. Represents a refinement of the decades-old Friedewald equation to accommodate modern dyslipidaemia phenotypes and aggressive lipid lowering strategies.
