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Hyperlipidaemia and Cardiovascular Risk

  

Hyperlipidaemia is abnormally elevated levels of any or all lipids and/or lipoproteins in the blood.


Identification

  • People older than 40 should have their estimate of CVD risk reviewed on an ongoing basis
  • Prioritise people for a full formal risk assessment if their estimated 10‑year risk of CVD is 10% or more

Assessment

  • CVD risk assessment tools can provide only an approximate value for CVD risk (Interpretation should always reflect informed clinical judgement)
  • Use QRISK2 risk assessment tool to assess CVD risk for the primary prevention of CVD up to / including 84 years
  • QRISK2 risk assessment tool can be used to assess CVD risk in type 2 diabetes but not type 1 diabetes
  • Do not use a risk assessment tool to assess CVD risk in people with an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2and/or albuminuria (at increased risk of CVD).
  • Do not use a risk assessment tool for people with pre‑existing CVD.
  • Do not use a risk assessment tool for people who are at high risk of developing CVD because of familial hypercholesterolaemia (click link for Familial Hyperlipidaemia)
  • Severe obesity (body mass index greater than 40 kg/m2) increases CVD risk.
  • Consider people aged 85 or older to be at increased risk of CVD because of age alone, particularly people who smoke or have raised blood pressure

Standard CVD risk scores will underestimate risk in groups including:

  • HIV
  • Serious Mental Health Problems
  • Medications causing dyslipidaemia e.g. antipsychotics, corticosteroids or immunosuppressants
  • Autoimmune disorders e.g. SLE systemic lupus erythematosus
  • Patients taking antihypertensive or lipid modification therapy, or who have recently stopped smoking.

Referral

Consider referral to Community Diabetes & Lipid Clinic (GPWSI) for difficulties managing patients with raised CVD risk (see link right)

Consider referral to West Midlands Familial Hypercholesterolaemia Service where TC 9mmol/l or more AND TGs 5.0mmol/l or less (see link right)

Consider referral to UHCW Lipid Clinic where TGs persistently above 10mmol/l or for advice on other problematic hyperlipidaemia

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