LDL Cholesterol from Lipid Panel
mg/dL (normal <200)
mg/dL (normal ≥40 M / ≥50 F)
mg/dL — must be fasting
—
LDL Cholesterol (mg/dL)
Total Chol
—
mg/dL
LDL (Friedewald)
—
mg/dL
HDL
—
mg/dL
Non-HDL-C
—
mg/dL
LDL Calculation Formulas
Friedewald (mg/dL): LDL = TC − HDL − (TG ÷ 5)
Friedewald (mmol/L): LDL = TC − HDL − (TG ÷ 2.2)
Non-HDL Cholesterol = TC − HDL
(Non-HDL includes LDL + VLDL + IDL — better predictor in hypertriglyceridaemia)
Friedewald (mmol/L): LDL = TC − HDL − (TG ÷ 2.2)
Non-HDL Cholesterol = TC − HDL
(Non-HDL includes LDL + VLDL + IDL — better predictor in hypertriglyceridaemia)
LDL Statin Targets — AHA/ACC 2019
| Risk Category | LDL Target (mg/dL) | LDL Target (mmol/L) | Statin Intensity |
|---|---|---|---|
| Very High Risk (ASCVD, diabetes + ≥2 major risk factors, LDL >190) | <55 | <1.4 | High-intensity ± ezetimibe ± PCSK9i |
| High Risk (10-year ASCVD ≥20%, or diabetes 40–75y) | <70 | <1.8 | High-intensity statin |
| Intermediate Risk (10-year ASCVD 7.5–20%) | <100 | <2.6 | Moderate-intensity statin |
| Low Risk (<7.5% 10-year ASCVD, LDL <190) | <130 | <3.4 | Lifestyle first; statin if LDL ≥160+ |
| Familial Hypercholesterolaemia (LDL >190) | <100 (<70 if ASCVD) | <2.6 | High-intensity statin — always treat |
When Friedewald Formula is INACCURATE
- TG >400 mg/dL (4.5 mmol/L): Friedewald substantially underestimates LDL. Use direct LDL measurement or Martin-Hopkins formula (validated up to TG 800 mg/dL)
- Non-fasting sample: TG is elevated after meals, making the VLDL estimate incorrect. Always request a fasting lipid panel (12-hour fast, water allowed)
- Type III hyperlipoproteinaemia (dysbetalipoproteinaemia): Unusual VLDL composition means TG/5 overestimates VLDL — use direct LDL
- Very low LDL (<70 mg/dL): Friedewald can give falsely low or even negative values. Martin-Hopkins or direct LDL preferred
High-Intensity Statin Options (India)
- Atorvastatin 40–80 mg OD: Reduces LDL by 49–60%. Most widely used high-intensity statin in India. Available as generic
- Rosuvastatin 20–40 mg OD: Reduces LDL by 52–63%. Preferred in CKD, Asian patients (lower dose for equivalent effect). Less CYP3A4 metabolism than atorvastatin
- Ezetimibe 10 mg OD (add-on): Reduces LDL by additional 15–25%. IMPROVE-IT trial: adds 6% relative CVD risk reduction on top of statin. First-line add-on if statin alone insufficient
- PCSK9 inhibitors (evolocumab/alirocumab): Reduce LDL by 50–60% on top of statin. Expensive in India. Reserved for FH, very high-risk patients not at goal on statin + ezetimibe
Related Calculators
⚠ Medical Disclaimer: Friedewald-calculated LDL is an estimate. Always request direct LDL measurement when TG >400 mg/dL or sample is non-fasting. Statin decisions require comprehensive cardiovascular risk assessment including ASCVD calculation, shared decision-making, and clinical context. Consult a cardiologist or physician for personalised lipid management.