한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제16권8호
  • /
  • Pages.5492-5500
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  • 2015
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  • 1975-4701(pISSN)
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  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
권호 표지
DOI QR코드

DOI QR Code

LDL-콜레스테롤의 Friedewald 계산값과 실측값 비교: 국민건강영양조사 2009-2010

Friedewald-Estimated Versus Directly Measured LDL-Cholesterol: KNHANES 2009-2010

  • 장성옥 (한국건강관리협회) ;
  • 이종석 (한림대학교 경영학부, 한림경영연구소)
  • 투고 : 2015.07.20
  • 심사 : 2015.08.06
  • 발행 : 2015.08.31
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초록

LDL-콜레스테롤(LDL-C)은 심뇌혈관질환의 주된 교정 가능한 위험인자로서, 정확한 측정값을 임상에 적용하는 것이 중요하다. 하지만 LDL-C의 측정은 실제 측정이 아닌 Friedewald 공식에 의한 계산방법이 널리 이용되고 있다. 본 연구의 목적은 LDL-C의 Friedewald-추정값과 실측값을 비교하고, 두 방법의 LDL-C 위험수준 분류 일치도를 평가하는 것이다. 표본은 국민건강영양조사 2개년(2009년과 2010년)의 공개된 자료에서 추출되었고, 혈액 검사에서 총 콜레스테롤, HDL-콜레스테롤, 직접 측정한 LDL-C, 그리고 중성지방 중 어느 한 결측치도 없는 4,319명을 연구대상으로 하였다. 중성지방 400 mg/dL 미만일 때, Friedewald-추정값과 실측값은 높은 상관관계를 보였고 (r = 0.958, p < 0.001), 위험수준 분류 일치 백분율은 82.7%이었다. 중성지방 수준이 높을수록, 일치 백분율은 낮았다. 중성지방 수준 150 mg/dL 미만, 150-200 mg/dL, 그리고 200-399 mg/dL일 때, 일치 백분율은 각각 85.4%, 78.2%, 그리고 71.4%이었다. Friedewald 공식은 중성지방 농도 150 mg/dL 미만에서는 LDL-C를 과대평가하는 반면, 중성지방 농도 150 mg/dL 이상에서는 과소평가하는 경향이 있었다. 이에 따라 LDL-C 위험수준 분류에 있어 그 범주가 과대평가된 사람은 382명 (9.1%)인 반면, 과소평가된 사람은 348명 (8.3%)이었다. 이러한 결과는 Friedewald-추정값의 LDL-C 과소평가뿐만 아니라, 과대평가도 심각한 문제일 수 있음을 제시한다.

Low-density lipoprotein cholesterol (LDL-C) is a major modifiable risk factor for cardio- cerebrovascular disease. In clinical practice, however, it is primarily calculated using the Friedewald formula as a cost-effective method. The aim of this study was to compare Friedewald-estimated and directly measured LDL-C values and assess the concordance in guideline LDL-C risk classification between the two methods. The data were derived from the 2009 and 2010 Korea National Health and Nutrition Survey (KNHANES). Analysis was done for 4,319 subjects with lipid panels-total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), directly measured LDL-C using an enzymatic homogeneous assay, and triglycerides (TG). For subjects with TG lower than 400 mg/dL, Friedewald-estimated and directly measured LDL-C were highly correlated (r = 0.958, p < 0.001) and overall concordance was 82.7%. As TG increased, overall concordance decreased. Overall concordance was 85.4% at TG lower than 150 mg/dL; 78.2% at TG of 150-199 mg/dL; and 71.4% at TG of 200-399 mg/dL. The Friedewld equation tended to overestimate LDL-C when TG are of < 150 mg/dL; however, underestimate LDL-C when TG are of ${\geq}150mg/dL$. As a result, Friedewald estimation misclassified 382 subjects (9.1%) in a higher category versus 348 subjects (8.3%) in a lower category. Our findings suggest that overestimation of LDL-C by the Friedewald formula can be a great problem as well as underestimation.

키워드

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피인용 문헌

  1. Prevalence and Management of Dyslipidemia Among Korean Adults: KNHANES 2010-2012 vol.16, pp.11, 2015, https://doi.org/10.5762/KAIS.2015.16.11.7978