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Patients with undiagnosed/untreated familial hypercholesterolaemia have a very high risk of MI. Untreated 50% of men and 30% of women will have had an MI by age 60 (BJGP 2009;59:777).
Patients with suspected Familial Hypercholesterolaemia
Patients with a fasting TG greater than 2.3 – see Appendix 4 on attached Referral pathway
Use the Dutch Lipid Clinic Network Score (DLCNS) to make a clinical diagnosis of FH.
Note, an LDL-cholesterol result (rather than total cholesterol) is required to generate this score alongside other clinical features and details of family history.
To aid completion of DLCN, please see attached Age specific 95th centile LDL – cholesterol values.
Refer the person to a lipid clinic if:
If you feel your patient needs a specialist assessment for suspected FH but doesn’t quite meet the above referral criteria (for example, DLCN score of 4, but with significant family history of premature atherosclerotic cardiovascular disease), then it is recommended that you submit a referral as it will still be considered.
1. Investigations prior to referral - Fasting Lipids, Liver function tests, TFT, Renal, HbA1c
2. Secondary causes excluded
3. Completed Family history questionnaire – please add a comment if family history is not possible to obtain
Prior to referral to the Lipid Clinic for suspected Familial Hypercholesterolaemia, it is essential that a family history questionnaire is completed, and the answers attached to the referral.
Familial Hypercholesterolemia Family History Questionnaire
We have reviewed your cholesterol results and would like some information on your family history to help inform your treatment. Please answer the following questions:
1. Have any of your first-degree blood relatives (mother, father, brother, or sister) had a heart attack under the age of 60?
If Yes, which relative (mention how they are related to you) and how old were they when they had the heart attack?
2. Have any of your second-degree blood relatives (grandparents, aunts, uncles, nephews, nieces and half-brothers and half-sisters) had a heart attack aged 50 or under?
If Yes, which relative (mention how they are related to you) and how old were they when they had the heart attack?
Clinical features of FH include:
Secondary causes of raised cholesterol include:
Please do not refer a patient on the basis of one abnormal lipid profile. Always:
AND
Investigations prior to referral:
Secondary causes of raised cholesterol include:
1. Lifestyle advice
Advise lifestyle changes (and weight loss if required); the majority of patients’ lipid profiles improve following three months of lifestyle modifications
2. Start treatment in primary care:
3. Refer to secondary care for further input and consideration of genetic testing/ cascade testing (see attached pathway).
Refer the person to a lipid clinic if:
1. Investigations prior to referral - Fasting Lipids, Liver function tests, TFT, Renal, HbA1c
2. Secondary causes excluded
3. Completed Family history questionnaire – please add a comment if family history is not possible to obtain
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.
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: January 2023
Updated: January 2024