Measurement of low-density lipoprotein cholesterol and other circulating lipids in Brazil: a systematic literature review.

David G A Conti; Livia Souza Tosetti; Fernando Jablonka; Sonia Hix; Anna Wolska; Marcelo Amar; Alan T Remaley; Fernando Luiz Affonso Fonseca

doi:10.1016/j.cca.2026.121215

PubMed · 42401080

Measurement of low-density lipoprotein cholesterol and other circulating lipids in Brazil: a systematic literature review.

David G A Conti·Livia Souza Tosetti·Fernando Jablonka·Sonia Hix·Anna Wolska·Marcelo Amar·Alan T Remaley·Fernando Luiz Affonso Fonseca

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Abstract

Accurate laboratory assessment of circulating lipids underpins cardiovascular risk stratification, yet clinical interpretation depends not only on the assays but on the formula chosen to estimate low-density lipoprotein cholesterol (LDL-C). This review integrates the 2019-2025 evidence on laboratory methods for triglycerides (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDLC), and on the formulas estimating LDL-C, VLDL-C, and non-HDL cholesterol, to determine how these should be measured, reported, and harmonized in Brazil, where lipid thresholds are adapted from international consensus. A PRISMA 2020 systematic search (PROSPERO CRD420251241064) of PubMed/MEDLINE, Scopus, SciELO, LILACS, Web of Science, and Embase retrieved 57,915 records; after removing 38,210 duplicates, 19,705 titles/abstracts were screened, 312 full texts assessed, and 25 sources included. Enzymatic colorimetric assays remain standard for TG, TC, and HDLC. For LDL-C, Martin/Hopkins classifies more accurately than Friedewald (89.6% vs 83.2% correct categorization in 5,051,467 patients), particularly at high TG and low LDL-C, while Sampson/NIH and modified Sampson/NIH extend reliable estimation into hypertriglyceridemia and very low LDL-C; direct measurement is reserved for TG beyond the validated range. Although the review centers on the Friedewald, Martin/Hopkins, and Sampson/NIH families that dominate guideline practice, other published equations exist and are addressed in context. In Brazil, atherogenic-lipid thresholds are risk-based decision limits rather than reference intervals; national surveys describe lipid distributions but were not designed to establish them. Analytical standardization through traceability programs, multicenter validation of formulas, and-where the distribution-based construct applies (HDLC, pediatrics)-nationally derived reference intervals are priorities for equitable cardiovascular risk assessment in Brazil.

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Humans Brazil Cholesterol, LDL Lipids Blood Chemical Analysis Colorimetry Lipoproteins, HDL Reference values Systematic review Triglycerides Journal Article Systematic Review Review

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David G A Conti, Livia Souza Tosetti, Fernando Jablonka, Sonia Hix, Anna Wolska, Marcelo Amar, Alan T Remaley, Fernando Luiz Affonso Fonseca. 2026-07-04. Measurement of low-density lipoprotein cholesterol and other circulating lipids in Brazil: a systematic literature review.. https://doi.org/10.1016/j.cca.2026.121215

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Blood Chemical Analysis subject Brazil subject Cholesterol, LDL subject Colorimetry subject Humans subject Journal Article subject Journal Article; Systematic Review; Review resource Lipids subject Lipoproteins, HDL subject Systematic reviews study

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