Lipids
Primary prevention ( QRISK >10, CKD, T1DM, Familial Hyperchol, >/=85)
Lifestyle
High intensity statin
Atorvastatin 20mg
40% reduction in non HDL
Secondary prevention
high intensity statin
80mg atorvastatin
lifestyle in addition
LDL <2.0 or non-HSL < 2.6
manage uncontrolled diabetes and excess alcohol intake
Baseline tests: smoking, alcohol, BP, BMI, lipid profile, LFTs, renal func and diabetes status. CK if muscle pain. TFTs if symptomatic
Statins not suitable or not tolerated EXETIMIBE
Titration
If the maximum dose of tolerated stain does not achieve target by 2-3 months consider adding addition lipid lowering treatments
Ezetimibe
Inclisiran
Alirocumab
Evolocumab
T1DM
Over 40
diabetes over 10 years
nephropathy
CVD RF
CKD
eGFR <60 /albuminuria
85
consider frailty and comorbidities
Additional risk factors
HIV, severe mental illness, medications that cause dyslipidaemia, SLE , impaired fasting glycaemia,
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Retest in 3 months
When to suspect Familial HC
Total chol >7.5
LDL- c >4.9
non-HDL >5.9
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Use the Simon Broome or Dutch
Lipid Clinic Network (DLCN) criteria
to make a clinical diagnosis of FH
Take fasting lipids and repeat lipid profile
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