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Referral is appropriate for patients with the following clinical presentations:
1) Failure to achieve lipid targets despite maximal tolerated lipid modifying therapy:
• Primary prevention target: greater than 40% reduction in non-HDL
• Secondary prevention target: LDL equal to/lower than 2.0 mmol/l or non-HDL-C equal to/lower than 2.6mmol/l
2) Fasting Triglycerides greater than 10mmol/l
(having ruled out secondary causes – see ‘Investigations’)
3) Total cholesterol greater than 9mmol/l or LDL greater than 6.5 mmol/l or non-HDL-C greater than 7.5mmol/l
(having ruled out secondary causes – see ‘Investigations’)
4) Patients with suspected Familial Hypercholesterolaemia
(see FH referral guideline)
Prior to referral to the lipid clinic a full CVD assessment should be undertaken to:
OR
A family history of CVD or very high cholesterol levels may alert to the possibility of Familial Hypercholesterolaemia (see FH pathway for further evaluation)
Differential Diagnosis
Secondary causes of raised cholesterol should be excluded, including:
Refer urgently if:
Secondary causes of raised cholesterol should be excluded, including:
1. Lifestyle Advice and risk factor modification
All patients with raised lipids will benefit from lifestyle advice and review of modifiable cardiovascular risk factors. This should be addressed at first consultation irrespective of whether medication is to be started.
Lifestyle advice includes:
Do not delay starting lipid lowering treatment in secondary prevention patients.
2. Start lipid-regulating medication in primary care as outlined in:
Aim to achieve lipid targets with maximal tolerated lipid modifying therapy:
• Primary prevention target: greater than 40% reduction in non-HDL
• Secondary prevention target: LDL equal to/lower than 2.0 mmol/l or non-HDL-C equal to/lower than 2.6mmol/l
Referral is appropriate for patients with the following clinical presentations:
1) Failure to achieve lipid targets despite maximal tolerated lipid modifying therapy:
2) Fasting Triglycerides greater than 10mmol/l
(having ruled out secondary causes – see ‘Investigations’)
3) Total cholesterol greater than 9mmol/l or LDL greater than 6.5 mmol/l or non-HDL-C greater than 7.5mmol/l
(having ruled out secondary causes – see ‘Investigations’)
4) Patients with suspected Familial Hypercholesterolaemia
(see FH referral guideline)
a) Referral Indication (see above)
b) Secondary causes excluded (see ‘Investigations’ section)
c) Investigations results (within the last 12 months)
d) Names and doses of all lipid lowering drugs that have not been tolerated
Referrals without this information may be returned.
Once a referral is received it will be triaged by a member of the Lipid team. The patient will either be offered an outpatient ‘face-to-face’ appointment or assigned to our virtual clinic.
Referral Instructions
e-Referral Service Selection
Specialty: Endocrinology
Clinic Type: Lipid Clinic
Service: DRSS-Eastern and Northern-Endocrinology-Devon ICB- 15N
This guideline has been signed off on behalf of NHS Devon
Publication date: September 2024