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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