{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:59:27Z","timestamp":1790762367375,"version":"4.1.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Population Health and Outcomes"],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Accurate low-density lipoprotein cholesterol (LDL-C) assessment in young adulthood is critical for atherosclerotic cardiovascular disease (ASCVD) prevention, yet the optimal estimation equation remains uncertain. We compared the Friedewald, Martin-Hopkins, and Sampson equations for evaluating long-term ASCVD risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We included participants from 7 population-based cohorts within the International Childhood Cardiovascular Cohort Consortium who had LDL-C measurements in young adulthood (aged 20\u201339 years) and follow-up data for incident ASCVD. LDL-C levels were estimated using the Friedewald, Martin-Hopkins, and Sampson equations. For each pair of equations, participants were categorized into concordant (normal\/normal, elevated\/elevated) and discordant (normal\/elevated, elevated\/normal) groups based on LDL-C classifications (normal &lt;130 mg\/dL versus elevated \u2265130 mg\/dL). ASCVD events (myocardial infarction, stroke, transient ischemic attack, ischemic heart failure, angina, peripheral artery disease, carotid intervention, abdominal aortic aneurysm, coronary revascularization) were adjudicated from medical records. Associations between discordance and incident ASCVD were estimated using Fine-Gray regressions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Among 10\u2009550 participants (56.8% females; mean baseline age [SD], 29.8 [4.3] years), 376 ASCVD events occurred over a mean follow-up of 22.7 years. Elevated LDL-C by all equations was associated with ASCVD events (subdistribution hazards ratio [95% CI]: Martin-Hopkins, 1.69 [1.35\u20132.12]; Sampson, 1.52 [1.22\u20131.90]; Friedewald, 1.47 [1.17\u20131.84]). Total discordance ranged from 2.3% to 2.9%. Compared with the concordant normal LDL-C group, normal LDL-C by Friedewald but elevated by Martin-Hopkins had higher ASCVD risks (3.32 [1.94\u20135.66]), with no excess risk in the reverse discordance (1.19 [0.47\u20133.05]). Normal Friedewald but elevated Sampson LDL-C had higher ASCVD risks (1.69 [0.93\u20133.05]); no participants had the reverse discordance. Normal Sampson LDL-C but elevated Martin-Hopkins LDL-C had higher ASCVD risks (3.94 [1.80\u20138.64]), whereas the reverse discordance showed no increased risk (0.86 [0.39\u20131.91]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The Martin-Hopkins equation provides more accurate LDL-C\u2013based risk classification, identifying high-risk young adults missed by other equations and minimizing misclassification of those at normal risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.125.013678","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:01:12Z","timestamp":1790758872000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-National Evaluation of Low-Density Lipoprotein Cholesterol Equations in Young Adulthood for Long-Term Risk of Atherosclerotic Cardiovascular Disease"],"prefix":"10.1161","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2173-8325","authenticated-orcid":true,"given":"Yaxing","family":"Meng","sequence":"first","affiliation":[{"name":"Research Centre of Applied and Preventive Cardiovascular Medicine (Y.M., O.T.R., C.G.M.), University of Turku, Finland."},{"name":"Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (Y.M., O.T.R., C.G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3753-974X","authenticated-orcid":true,"given":"Feitong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui (F.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9498-364X","authenticated-orcid":true,"given":"Markus","family":"Juonala","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland."},{"name":"Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7232-0543","authenticated-orcid":true,"suffix":"Jr","given":"David R.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8958-1352","authenticated-orcid":true,"given":"Lydia A.","family":"Bazzano","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-6952","authenticated-orcid":true,"given":"Stephen R.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine, Children\u2019s Hospital Colorado, Aurora (S.R.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2091-7663","authenticated-orcid":true,"given":"Terence","family":"Dwyer","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.J.V.)."},{"name":"Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia (T.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4510-7341","authenticated-orcid":true,"given":"Mika","family":"K\u00e4h\u00f6nen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Finland (M.K.)."},{"name":"Department of Clinical Physiology, Tampere University Hospital, Finland (M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8277-3493","authenticated-orcid":true,"given":"Alan R.","family":"Sinaiko","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School, Minneapolis (A.R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2892-8594","authenticated-orcid":true,"given":"Julia","family":"Steinberger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis (J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5640-6777","authenticated-orcid":true,"given":"Elaine M.","family":"Urbina","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children\u2019s Hospital Medical Center, and Department of Pediatrics (E.M.U.), University of Cincinnati College of Medicine, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7090-1398","authenticated-orcid":true,"given":"Alison J.","family":"Venn","sequence":"additional","affiliation":[{"name":"Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.J.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6452-010X","authenticated-orcid":true,"given":"Jorma S. A.","family":"Viikari","sequence":"additional","affiliation":[{"name":"Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland."},{"name":"Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-4162","authenticated-orcid":true,"given":"Kara M.","family":"Whitaker","sequence":"additional","affiliation":[{"name":"Department of Health and Human Physiology and Department of Epidemiology, University of Iowa (K.M.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3644-8432","authenticated-orcid":true,"given":"Jessica G.","family":"Woo","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, and Department of Pediatrics (J.G.W.), University of Cincinnati College of Medicine, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9365-3702","authenticated-orcid":true,"given":"Olli T.","family":"Raitakari","sequence":"additional","affiliation":[{"name":"Research Centre of Applied and Preventive Cardiovascular Medicine (Y.M., O.T.R., C.G.M.), University of Turku, Finland."},{"name":"Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (Y.M., O.T.R., C.G.M.)."},{"name":"Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Finland."},{"name":"InFLAMES Research Flagship, University of Turku, Finland (O.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6238-5730","authenticated-orcid":true,"given":"Costan G.","family":"Magnussen","sequence":"additional","affiliation":[{"name":"Research Centre of Applied and Preventive Cardiovascular Medicine (Y.M., O.T.R., C.G.M.), University of Turku, Finland."},{"name":"Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (Y.M., O.T.R., C.G.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.12.016"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.064"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz455"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000625"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx144"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.3508"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/18.6.499"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.5114\/aoms\/186191"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2022.03.019"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.280532"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0013"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.5334\/gh.1214"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2018.04.009"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2109191"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.106.25.3143"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(02)11911-8"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1551"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000534"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.16.1720"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014381"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001779"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2929"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-11-200812020-00009"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064296"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.28817"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/hvaf073"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.529"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfaf093"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-014-0440-2"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2021.09.046"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.5935\/abc.20170039"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2019-1253"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaf388"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00439-017-1782-y"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jegh.2015.02.002"}],"container-title":["Circulation: Population Health and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.125.013678","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:01:21Z","timestamp":1790758881000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.125.013678"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":35,"alternative-id":["10.1161\/CIRCOUTCOMES.125.013678"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.125.013678","relation":{},"ISSN":["3068-563X"],"issn-type":[{"value":"3068-563X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"2026-03-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e013678"}}