referral criteria from primary care - high cholesterol
Last reviewed 12/2022
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
- in people with a triglyceride concentration between 10 and 20 mmol/litre:
Reference: