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Lipid Service

ADULT Lipid Service Referral Criteria

 

A completed Family history questionnaire must be attached, or referral will be rejected.

 

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 and instead advice and guidance will be given.

 

Outpatient Lipid clinics are held at the Diabetes Centre at the Royal Cornwall Hospital and at West Cornwall Hospital.

 

The clinic aims to identify and treat patients with familial dyslipidaemia, including:

1)      Confirm the correct diagnosis

2)      Optimise treatment

3)      Implement cascade screening of relatives

 

 

Referral Criteria(1)(2):

 

  • For Familial Hypercholesterolaemia (FH) cascade screening (irrespective of lipid profile)
  • PersistentTotal Cholesterol >7.5mmol/L and/or LDL-cholesterol >4.9 mmol/L despite lifestyle changes (see above)
    • +/- FHx prem CVD
    • +/- FHx familial hyperlipidaemia
  • Persistentfasting triglycerides >7.5 mmol/L despite lifestyle changes(see above)
    • +/- FHx prem CVD
    • +/- FHx familial dyslipidaemia
  • Despite appropriate medication, unable to achieve target lipid profile in patients treated for secondary prevention (exclude poor concordance)
  • Patient is intolerant of lipid-lowering medication
  • Patient has had a significant side effect to lipid-lowering medication e.g. ALT >3x ULN or CK >5x ULN

(ULN- upper limit normal)

 

PRIOR TO REFERRAL:

Please do not refer a patient on the basis of one abnormal lipid profile, always repeat on a FASTING blood sample, and exclude/manage potential secondary causes including:

  • Profound hypothyroidism
  • Undiagnosed  or poorly controlled diabetes mellitus
  • Excessive alcohol intake
  • Poor diet              
  • Obesity
  • Medications
  • Pregnancy
  • Nephrotic syndrome

 

•              Advise lifestyle changes (and weight loss if required); the majority of patients’ lipid profiles improve following three months of lifestyle modifications:

Please direct the patient to HEART UK websitefor information and recipes etc. (https://www.heartuk.org.uk/)

  • Dietary changes resulting in improvement in the lipid profile include(1):
    • Reduced fat intake                              ?  Include soluble fibre
    • Plant sterols                                          ?  Soya protein

 

  • Increase exercise
  • Reduce alcohol intake if excessive

 

 

Investigations prior to referral:

  • Lipids
  • Liver function tests
  • TFT
  • U&E
  • Glucose
  • CK ( if relevant)

 

 

References:

  1. Morrell J, Wierzbicki T. (2009). 10 Steps before you refer for: Lipids. Br J Cardiol 2009; 16:242-5. Available from: https://bjcardio.co.uk/2009/09/10-steps-before-you-refer-for-lipids/
  2. National Institute for Clinical Excellence guidance. Familial Hypercholesterolaemia: identification and management (CG 71). London: NICE, 2017. Available from: https://www.nice.org.uk/guidance/cg71

 

 

Guideline reviewed 01/04/2019

Next review due 01/04/2020

Dr B Wesson- RMS GP Sifter Lead for Endocrinology

Contributors- Dr Rachel Cooper (SpR Chemical Pathology/Metabolic Medicine) & Dr Simon Fleming (Consultant Biochemistry and Metabolic Medicine), RCHT

 

Version 1.0

Advice & Guidance