Faculty of Medicine

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COMPARATIVE ACCURACY OF LDL-CHOLESTEROL ESTIMATION: OMPARATIVE ACCURACY OF LDL-CHOLESTEROL ESTIMATION: A META-ANALYSIS OF THE FRIEDEWALD AND MARTIN-HOPKINS EQUATION META-ANALYSIS OF THE FRIEDEWALD AND MARTIN-HOPKINS EQUATION
(Bulgarian Society of Cardiology and Pensoft Publishers, 2025-12-04)
Kostovska, Irena
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Introduction: Low-density lipoprotein cholesterol (LDL-C) is a cornerstone biomarker for cardiovascular risk. The Friedewald formula has long been the standard for estimating LDL-C, however, it has limitations, particularly in patients with hypertriglyceridemia or low LDL-C levels. Several alternative equations, including the Martin–Hopkins (M/H) and Sampson formulas, have been developed to improve accuracy. Among them, M/H has gained recognition for its performance in specific populations, but it represents only one of several refined methods used across professional communities. This study aimed to perform a meta-analysis comparing the accuracy and precision of the Friedewald and M/H formulas in diverse populations, acknowledging that other approaches also exist. Methods: A systematic review of articles published between 2018 and 2024 was conducted using PubMed, Embase, Scopus (Elsevier), and Web of Science-eligible studies directly compared both formulas against direct LDL-C measurement in adult populations. A random-effects model was used to pool mean absolute errors (MAEs), root mean square errors (RMSEs), correlation coefficients, and p-values. Heterogeneity was assessed using the I² statistic. Results: Eight novel studies, involving a total of 192,094 participants, were included. The M/H formula showed significantly lower MAE (3.6 mg/dL vs. 8.4 mg/dL, p < 0.001), lower RMSE (5.1 mg/ dL vs. 9.8 mg/dL, p < 0.001), and a stronger correlation with direct LDL-C (r = 0.92 vs. r = 0.84) compared to the Friedewald formula. The superiority of the M/H formula was especially evident in patients with triglycerides >200 mg/dL or LDL-C <70 mg/dL. Conclusion: The M/H formula provides more accurate and precise LDL-C estimation than Friedewald, particularly in clinically vulnerable groups. However, it should be considered one of several improved approaches, alongside other equations such as Sampson, which may perform better in certain populations. M/H can be recommended as a strong option, but is not the sole alternative for routine lipid profiling.
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Менопауза, липиден профил и кардиоваскуларни болести
(MACEDONIAN ASSOCIATION OF ANATOMISTS AND MORPHOLOGISTS, 2008)
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Pashoska, Milkica
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Mishevska, Petranka
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DYSLIPIDEMIC PROFILE IN HEALTHY WOMEN IN RELATION TO BODY FAT DISTRIBUTION
(Macedonian Pharmaceutical Association, 2020)
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Abdominal obesity is associated with particularly adverse lipidemic profile. The aim of this study was to determine the characteristics of the dyslipidemic profile in healthy women with extreme abdominal obesity determined anthropometrically. Lipid profile and atherogenic indexes were determined in 80 healthy women, grouped in 4 groups according to their body mass index (BMI) and grouped in 3 groups according to their body fat distribution (BFD) by means of nthropometric indexes waist/hip ratio (WHR) and waist/thigh ratio circumference (WTR): group M with normal BFD (WHR<0.85 and WTR<1.45), group N with moderate (WHR 0.85-1 and WTR 1.45-1.7) and group O with extremely expressed abdominal BFD. HDL-cholesterol (HDL-C) levels (0.84±0.26mmol/L) were significantly lowest in group O (p<0.002), and significantly lower compared to group N (1.14±0.43mmol/L) (p<0.006). Triglyceride (TG) levels were significantly higher in group O compared to group M (p<0.001) and also higher in group N compared to group M (p<0.044). Atherogenic indexes C/HDL-C, LDL/HDL-C and TG/HDL-C values in group O were significantly higher compared to the corresponding values in group M (p<0.004; p< 0.006; p<0.001), and their values were also higher in group O compared to group N, but with lower significance of the difference (p<0.05) indicating lower increase of the atherogenic indexes in moderate and significant increase in women with extreme abdominal obesity. Dyslipidemic profile and high atherogenic indexes in women with abdominal obesity with significantly highest WHR, WTR and BMI values indicated the need to intervene earlier and more effectively in the prevention and treatment of cardiovascular and metabolic risks.
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Lipid profile changes relations to body fat distribution changes determined with dual-energy x-ray absorptiometry during the weight loss
(Institute of Knowledge Management, 2019)
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Janicevic Ivanovska, Danijela
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Obesity and central body fat distribution are known risk factors for cardiovascular and metabolic diseases. Dual-energy x-ray absorptiometry (DXA) enables precise, accurate body composition and body fat distribution assessment and it measures and monitors body composition changes in obese patients undergoing weight loss. Obesity is associated with dyslipidemic profile. Low HDL-C levels are frequently associated with raised levels of plasma triglycerides and increased risk of cardiovascular disease and TG/HDL-C ratio may be a better predictor of insulin resistance and cardiovascular disease. LDL-C is one of the major culprits in the development of atherosclerotic heart disease and reduction of LDL-C levels is the primary target of therapy. The effect of weight loss on body fat distribution was examined through android, legs and ndroid/legs tissue and fat mass ratios indexes of central, abdominal obesity determined by DXA and their relationship with lipid profile hanges. The following parameters were determined before and after weight loss: body mass index (BMI), body weight (BW), android (A) and legs (L) tissue mass (TM) and fat mass (FM), their % with DXA, their ratios, indexes of abdominal fat distribution A/L-TM and TM% and A/L-FM and FM%, as well as lipid profile: total cholesterol (C), triglycerides (TG), HDL-C, LDL-C, LDL/HDL-C, C/HDL-C and TG/HDL-C. BW of 62.96±1.2 kg and BMI value of 28.98±0.78 kg/m2 before the weight loss lowered to 49.96±1.3 kg (p<0.012), and normal BMI 22.81±0.62 kg/m2 (p<0.012). A-TMf% value decrease from 50.41±1.7% to 29.55±1.34% after weight loss was significant (p<0.006) and A-FM% 49.92±1.2% decrease to 29.25±1.34% was also highly significant (p<0.005). A-TM 5.43±0.71 kg and A-FM 2.74±0.71 kg lowered to 3.76±0.25 kg and 1.11±0.12 kg after weight loss (p<0.05). L-TMf% 50.31±1.7% lowered to 35.2±2.12% (p<0.018) and L-TM 19.69±0.71 kg lowered to 16.15±0.55 kg (p<0.033). L-FM% 48.51±1.14% lowered to 33.8±1.98% (p<0.009) and L-FM 9.89±0.64 kg lowered to 5.68±0.16 kg (p<0.0002). A/L-TMf% value decrease from 1.01±0.07% to 0.84±0.014% and A/L-FM% value decrease from 1.03±0.04 to 0.87±0.07 were also significant (p<0.05). TG values decrease from 1.21±0.01 mmol/l to 0.83±0.07 mmol/l was significant (p<0.002) and C values decrease from 6.5±0.01 mmol/l to 5.43±0.37 mmol/l was also significant (p<0.05). LDL-C values 4.3±0.1 mmol/l lowered to 3.39±0.34 mmol/l (p<0.026) and TG/HDL-C ratio 0.73±0.01 lowered to 0.52±0.03 (p<0.011). This study showed that A-TMf% and A-FM% lowered highly significantly, indicating significant FM% reduction in android, abdominal TM. Atherogenic lipids TG, C and LDL-C and atherogenic index TG/HDL-C ratio lowered significantly. Also, it was confirmed that DXA indexes of central, abdominal obesity A/L-TM% and A/L-FM% were increased in overweight subjects before the weight loss and lowered highly significantly after the weight loss and increased A/L TM and A/L FM values lowered to normal values, indicating that normal BMI and BW reached after the weight loss were associated with normalized body fat distribution, and significant reduction of the atherogenic lipid profile indicating reduced atherogenic risk.
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BODY FAT DISTRIBUTION CHANGES DURING WIGHT LOSS DETERMINED BY DXA ANDROID/GYNOID INDEXES OF ABDOMINAL OBESITY
(Medical faculty, Ss Cyril and Methodius University Skopje, 2019)
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Janicevikj Ivanovska, Daniela
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The effect of weight loss on body fat distribution was examined through central obesity indexes (COI), which are android/gynoid tissue and fat mass ratios determined by dual-energy X-ray absorptiometry (DXA) and their relationship with lipid profile changes. The following parameters were determined before and after weight loss in 4 postmenopausal women: body mass index (BMI), body weight (BW), android (A) and gynoid (G) tissue mass (TM) and fat mass (FM) and their % with DXA, and their ratios as indexes of abdominal fat distribution COI1 (A/G-TM), COI2 (A/G-FM), COI3 (A/G-TMfat%) and COI4 (A/G-FM%), as well as lipid profile: total cholesterol (C), triglycerides (TG), HDL-C, LDL-C, LDL/HDL-C, C/HDL-C and TG/HDL-C. BW of 63±1.4 kg and BMI value of 29±0.65 kg/m2 lowered after the weight loss to 49±1.6 kg and normal BMI 22.62±0.74 kg/m2 (p<0.012). COI1 value decreased significantly from 0.5±0.01 to normal value 0.42±0.02 (p<0.003). COI2 value decreased significantly from 0.45±0.02 to normal value 0.34±0,02 (p<0.0004). COI3 value decrease from 0.95±0.026 to 0.74±0.012 was significant (p<0.0009) and COI4 value decrease from 0.95±0.01 to 0.74±0.02 was also significant (p<0.0001). Atherogenic indexes TG/HDL-C, LDL/HDL-C and C/HDL lowered significantly after the weight loss (p<0.002; p<0.03 and p<0.05) as well as TG, C and LDL values (p<0.001; p<0.01; p<0.01). It was confirmed that DXA indexes of central, abdominal obesity COI1 and COI2 were increased in overweight women before the weight loss and lowered significantly after the weight loss to normal values, indicating that normal BMI and BW reached after the weight loss were associated with normalized body fat distribution, and significant reduction of the atherogenic lipid profile indicating reduced atherogenic risk.
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Effect of synbiotic soymilk on intestinal microbiota and lipid profile in adult spontaneously hypertensive rats
(SHMSHM/AAMD, 2015)
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Mladenovska K
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Petreska Ivanovska T
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The aim of the study was to examine the influence of a new synbiotic fermented soymilk on microbiota and lipid profile in rats. In addition body weight, and stool consistency were also investigated. Мaterial and methods: Soy milk fortified with prebiotic (Synergy1) was fermented with probiotic L casei-01. The viable L casei-01 counts in fermented end product were 11.49±0.13 log10 cfu mL-1. 1 ml of synbiotic fermented soymilk was administered daily to six months old male spontaneously hypertensive rats (SHR’s). After 4 weeks treatment, jejunal, illeal, colon and fecal samples were analyzed for Lactobacillus spp, E coli, Enterococcus spp and Staphylococcus spp viable counts. Cholesterol, triglycerides and HDL concentrations in blood samples were determined. Results: The significantly higher viable Lactobacillus spp counts followed with significantly decreased E coli and Enterococcus spp counts in all samples were observed in treated vs. control group. Staphylococcus spp counts were significantly decreased in colon samples. The difference in lipide profile was insignificant. In conclusion, synbiotic fermented soymilk significantly improved the composition of the intestinal microbiota in rats. The lipid profile of healthy adult spontaneously hypertensive rats was not altered.

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