• LDL calculation when triglycerides <400 mg/dL
• Particularly useful when TG <150 mg/dL (superior to Friedewald)
• Fine-tuning of dyslipidaemia assessment
• Research-grade lipid analysis; evolving clinical adoption

• Adjustable TG:VLDL ratio based on TG levels (not fixed 5:1)
• More accurate at low triglycerides (<150 mg/dL)
• Better prediction of cardiovascular risk in lean phenotypes
• Particularly useful in HFpEF and diabetes populations

• Patients with low triglycerides on statin/ezetimibe therapy
• Lean or athletic individuals (naturally low TG)
• Women (typically lower TG than men)
• Patients on PCSK9 inhibitors or bempedoic acid (aggressive LDL lowering)

• Not widely adopted in routine clinical labs (yet)
• Requires TG <400 for accuracy; unreliable if TG >400
• Limited long-term outcome validation vs. Friedewald
• More relevant for research than acute clinical decisions

• If Martin/Hopkins LDL significantly lower than Friedewald → may have greater residual risk than calculated
• Use for better risk stratification in guidelines (ACC/AHA target LDL <70 post-ACS)
• Particularly valuable when assessing statin/ezetimibe/PCSK9i response
• Consider sequential assessment over single calculation

Developed by Dr. Steven Martin at Johns Hopkins, published in 2013. Represents a refinement of the decades-old Friedewald equation to accommodate modern dyslipidaemia phenotypes and aggressive lipid lowering strategies.