Hyperlipidaemia

Services

Western General Hospital

Wednesday morning clinic (Professor Simon Maxwell)
Secretary telephone: 01315371753

Royal Infirmary of Edinburgh

Wednesday morning clinic (Dr Jonathan Malo, Dr Sara Jenks & Dr Nicola Shand)
Secretary telephone 0131 242 6870

St John’s Hospital

Tuesday morning clinic (Dr Nicola Shand)
Secretary telephone: 01506 523841

Lothian lipid guidelines.PDF

Who to refer:

Prior to referral

Please ensure lipids have been checked at least twice (including at least once fasting if TGs are raised) and that secondary causes of hypercholesterolaemia (hypothyroidism, nephrotic syndrome, diabetes etc) have been excluded.

Suspected Familial hypercholesterolaemia (FH)

FH affects 1 in 500 people in Scotland and over half of untreated men will have an MI before 50. Please refer any suspected cases to the lipid clinic for advice on management, genetic testing and family cascade screening. Referral is recommended if the answers below are ‘yes’ to:(1 and/or 2)..plus (3 or 4 or 5):

1. Highest total cholesterol >7.5……….	.yes/no
2. Highest LDL cholesterol >4.9.	.yes/no
3. Total cholesterol >7.5 in 1st or 2nd degree relative…	.yes/no
4. Tendon Xanthoma in patient or 1st or 2nd degree relative…	.yes/no
5. MI < 60yrs in 1st or <50yrs in 2nd degree relative	.yes/no

Please note that below 16 years the corresponding cut-offs are total cholesterol >6.7 mmol/L, LDL-C >3.9 mmol/L. These guidelines should not be used to decide on referral of relatives of known cases of Familial Hypercholesterolaemia and first degree relatives have a 50% pre-test probability of being affected, and lower cholesterol cut-offs apply. If your patient does not meet the above criteria but you still strongly suspect an inherited hyperlipidaemia please contact the lipid clinic via e-mail for further advice.

Other suspected familial hyperlipidaemias

Familial combined hyperlipidaemia should be considered in patients with a mixed hyperlipidaemia and strong family history of premature IHD.

Hypertriglyceridaemia

Fasting TGs > 10mmol/L

Fasting TGs persistently 5–10mmol/L in a high cardiovascular risk patient not responding to statin treatment, especially in the absence of a secondary cause such as poorly controlled diabetes or alcohol excess

Lipid Clinics (WGH CVR)

Advice on lipid lowering therapy, in particular intolerance to ≥3 different statins
Complex cardiovascular risk assessment
Familial hyperlipidaemia
- Definite: Total cholesterol >7.5mmol/L or LDL >4.9 mmol/L PLUS tendon xanthomas in the patient or a first/second degree relative
- Probable: Total cholesterol >7.5mmol/L or LDL >4.9mmol/L PLUS, one of
  - Family history of MI: <60 years in a first degree relative or <50 years in a second degree relative
  - Total cholesterol >7.5mmol/L in a first/second degree relative
Hypertriglyceridaemia

Who not to refer:

Advice on the management of patients who, for whatever reason, are unable to tolerate treatment, especially statin therapy.
Specific advice as to whether or not to use drug therapy in a patient with abnormal lipid results.
Advice on the management of patients already under treatment but where there has apparently been a poor response to treatment and/or target lipid levels have not been achieved.
Advice on the significance of abnormal liver function test results either prior to contemplating starting treatment, or arising during the course of drug therapy.
Advice on the significance of raised CK results again either before initiating treatment or having been found to be elevated during the course of drug treatment.
Questions as to the significance of mildly raised triglyceride levels in patients and how these are best managed.

Lipid clinics (WGH CVR)

Patients on lipid-lowering therapy with sustained total cholesterol reduction >25%
Dyslipidaemia where secondary causes e.g. excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome has not been excluded/managed.
Rationalisation (if possible) of drugs associated with dyslipidaemia e.g. thiazide, β-blockers, retinoids, anti-retrovirals, synthetic oestrogen/ progesterone