Referral criteria from primary care - high cholesterol

Suggested referral guidance from NICE (1):

• use the clinical findings, lipid profile and family history to judge the likelihood of a familial lipid disorder rather than the use of strict lipid cut-off values alone
  
  
• exclude possible common secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome) before referring for specialist review
  
  
• consider the possibility of familial hypercholesterolaemia if they have:
  • a total cholesterol concentration more than 7.5 mmol/litre
  • and a family history of premature coronary heart disease
    
    
• arrange for specialist assessment of people with a total cholesterol concentration of more than 9.0 mmol/litre or a non-HDL cholesterol concentration of more than 7.5 mmol/litre even in the absence of a first-degree family history of premature coronary heart disease
  
  
• refer for urgent specialist review if a person has a triglyceride concentration of more than 20 mmol/litre that is not a result of excess alcohol or poor glycaemic control
  • in people with a triglyceride concentration between 10 and 20 mmol/litre:
    • repeat the triglyceride measurement with a fasting test (after an interval of 5 days, but within 2 weeks) and review for potential secondary causes of hyperlipidaemia
    • and seek specialist advice if the triglyceride concentration remains above 10 mmol/litre
  • in people with a triglyceride concentration between 4.5 and 9.9 mmol/litre:
    • be aware that the CVD risk may be underestimated by risk assessment tools and optimise the management of other CVD risk factors present
    • and seek specialist advice if non-HDL cholesterol concentration is more than 7.5 mmol/ litre

Reference:

• (1) NICE (May 2014).Lipid modification - Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease