Lipids

Data gathering

  • When to suspect familial hypercholesterolaemia
    • total cholesterol > 7.5
    • LDL > 4.9
    • premature heart disease
      • NB: QRISK2 underestimates in these groups
  • Triglycerides
    • 4.5-9.9 mmol/l – look at non-HDL cholesterol, refer if non-HDL is > 7.5
    • 10-20 mmol/l – repeat sample after fasting – if still elevated, seek advice (?alcohol, diabetess, hypothyroidism, liver disease, nephrotic syndrome)
    • >20 mmol/L – refer

 

Clinical management

  • Starting a statin
    • QRISK2 > 10% – discuss statins with patient
    • Atorvastatin 20mg – first line for primary prevention
    • Atorvastatin 80mg – first line for secondary prevention
    • Repeat LFTs in 3 months then 1 year
      • only stop if AT/ALT > 3x upper limit
    • Aim for 40 percent reduction in non-HDL cholesterol
      • total cholesterol minus HDL = Non-HDL cholesterol (not same as LDL)
  • Refer
    • Total cholesterol >9
    • non HDL > 7.5
    • Triglycerides > 20