Secondary Hypercholesterolaemia

Scope

Exclude secondary causes of hypercholesterolaemia before a diagnosis of familial hypercholesterolaemia is considered.

Investigations

  • The following conditions may cause hypercholesterolaemia (without hypertriglyceridaemia):
    • Hypothyroidism
    • Cholestatic liver disease (such as primary biliary cirrhosis)
    • Nephrotic syndrome
    • Cushing's syndrome
    • Anorexia nervosa
    • The use of drugs such as androgens and ciclosporin
  • The following conditions may also cause hypercholesterolaemia, but, usually, Hypertriglyceridaemia would also be present:
    • Diabetes mellitus or obesity (although hypertriglyceridaemia alone is the more common presentation)
    • Pregnancy
    • Renal replacement therapy or end stage chronic kidney disease
    • Monoclonal gammopathy
    • Excess alcohol consumption
    • HIV infection
    • The use of drugs such as thiazide diuretics, corticosteroids, retinoic acid derivatives, beta-blockers, and anti-retrovirals (protease inhibitors and nucleoside analogue reverse transcriptase inhibitors such as stavudine)

Supporting Information

Evidence

NICE clinical guidance on the management of familial hypercholesterolaemia (CG71, published 2008). NICE Clinical Knowledge Summaries website (accessed here 26th September 2016).

Pathway Group

This guideline has been signed off by the Pathology Optimisation Clinical Group on behalf of NEW Devon CCG.

Publication date: 16 June 2017

 

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