Lipid Clinics

Lipid service secretary: 01225 824710

Lipid clinic referrals and letters for clinical advice should be sent electronically via the eRAS system.

Any referral letters from Consultants colleagues should be emailed to ruh-tr.biochemistry@nhs.net

Lipid clinics are held on Tuesday and Thursday mornings (Dr O'Doherty). Cascade testing of relatives of an index case with Familial Hypercholesterolaemia (FH) is managed by a specialist nurse, Lisa Gritzmacher.

General advice

• Common secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome) should be excluded before referral. In general, a referral should only be made if a patient's dyslipidaemia persists after treatment of secondary causes and 3 months targeted management of adverse lifestyle/metabolic features.
• Use any clinical findings, lipid profile and family history to judge the likelihood of a familial lipid disorder rather than relying on the use of strict lipid cut-off values alone.
• We would like any patient who is referred to have had a full lipid profile, TSH, HbA1c or fasting glucose, U+E and LFTs.
• Please see the this guidance for further advice on referrals and management.

Hypercholesterolaemia

• Refer patients with a total cholesterol >7.5mmol/L or LDL-cholesterol >4.9mmol/L AND a family history of premature coronary heart disease (CHD) in a 1st degree relative (defined as <60 years old) or a 2nd degree relative (defined as <50 years old).
• Recommend referral in patients with a total cholesterol >9.0mmol/L or a non-HDL cholesterol >7.5mmol/L even in the absence of a family history of premature coronary heart disease. Hypertriglyceridaemia
• If the triglycerides are >20mmol/L urgently discuss with one of the lipid Consultants. May require urgent referral to secondary care as there is a significant risk of pancreatitis.
• If the triglyceride concentration is between 10-20mmol/L repeat a full lipid profile (after an interval of 5 days but within 2 weeks) and review for possible secondary causes.
• If triglycerides are >10mmol/L on two separate occasions referral is advised.

Mixed dyslipidaemia

If a patient has a mixed dyslipidaemia with total cholesterol >5mmol/L and raised triglycerides, please also consider contacting the Lipid service for advice. There should be a low threshold for seeking advice/referral especially if the patient has a family history of premature cardiovascular disease.

Such patients may have Familial Combined Hyperlipidaemia (FCH), which is an autosomal dominantly inherited condition associated with an increased risk of cardiovascular disease.

Tools for improving detection of FH in Primary Care

Consider systematically searching primary care records for the following patients

• Younger than 30 years old with a total cholesterol concentration >7.5mmol/L
• 30 years or older with a total cholesterol concentration < 9.0mmol/L

These patients should be referred to the specialist lipid clinic in line with the NICE QS41 (Sept 2013)