Background: Low-density lipoprotein cholesterol (LDL-C) estimation is commonly used in Madagascar due to cost-effectiveness. However, genetic variability and formula limitations may affect accuracy.
Objective: To compare LDL-C estimated by the Friedewald and Martin–Hopkins formulae with directly measured LDL-C in a Malagasy population.
Methods: LDL-C values estimated using both formulae were compared with direct LDL-C in 346 samples from patients ≥ 18 years analysed in a biochemistry laboratory. Samples were divided into four groups based on triglyceride levels: < 1.13 mmol/L; 1.13 mmol/L – 1.69 mmol/L; 1.69 mmol/L – 2.26 mmol/L; ≥ 2.26 mmol/L.
Results: Both formulae showed a strong, statistically significant correlation with direct LDL-C (r = 0.89). Mean comparison revealed overestimation by both formulae, more pronounced with Friedewald (mean difference 0.15 mmol/L) than Martin–Hopkins (0.21 mmol/L). Differences increased with rising triglyceride levels. Both formulae demonstrated good agreement with direct measurement, acceptable biases and similar limits, but Friedewald had a lower overall percentage error.
Conclusion: The Friedewald formula showed better correlation, higher concordance and lower mean difference than Martin–Hopkins. Both formulae showed limitations depending on triglyceride concentration.
What this study adds: This study evaluates Friedewald and Martin–Hopkins LDL-C estimation against direct measurement in a Malagasy population, highlighting their validity in Africa and implications for clinical decisions in resource-limited settings.

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African Journal of Laboratory Medicine    |    ISSN: 2225-2002 (PRINT)    |    ISSN: 2225-2010 (ONLINE)