Cholesterol

  • Reduce CVD risk for all
  • Treat to target
  • Think Familial Hyperlipidaemia

TOP TIPS

1.      The C&M Lifespan Pathway for Lipid Management 2023 provides a clear direction on when, why, and how to use lipid therapies effectively in our population.

2.      The NHS lipid pathway on a page is a simple treatment decisions aid for sequencing lipid therapies in primary to secondary prevention, as well as suspecting a diagnosis of familial hypercholesterolaemia. 

3.     1 in 250 people have familial hyperlipidaemia yet we diagnose <5%; ALWAYS think FH when reviewing cholesterol results. Many remained undiagnosed and undertreated, risking not only the patient’s health but failing to cascade test their family. Offer a cholesterol test to ALL adults at least once under 40 years to avoid missing FH.

4.      Use high intensity statins (atorvastatin and rosuvastatin) when prescribing for secondary and primary prevention.

5.      Always record CVD risk for primary prevention using QRISK3 for patients who may need primary prevention.

6.      Treatment target recommendations vary between guidelines, but the consensus is always to treat as low as possible to provide maximal CVD risk reduction.

7.      Ezetimibe is recommended for all patients not to target as an add on therapy or alternative if statins are not tolerated.

8.     Bempedoic acid is a new drug treatment, working like a statin, to add to Ezetimbe or use as monotherapy when other treatments are not tolerated

9.      PCSK9i remain underutilised and are available from specialist lipid services (see NHS lipid pathway for details).

10.  UCLP lipid stratification tool is easy to run on GP systems and allows a practice to quickly identify patients who are undertreated requiring review.

Professional: Cholesterol resources