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Practice 10-Minute Consultation

Dyslipidaemia and cardiovascular risk

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k835 (Published 23 March 2018) Cite this as: BMJ 2018;360:k835

This article has a correction. Please see:

  1. Aidan Ryan, academic clinical fellow1,
  2. Simon Heath, partner, general practice2,
  3. Paul Cook, consultant in chemical pathology and metabolic medicine3
  1. 1Metabolic medicine, Department of Laboratory Medicine, University Hospital Southampton, Southampton, UK.
  2. 2Hazelwood Group Practice, Warwickshire, UK
  3. 3Department of Laboratory Medicine, University Hospital Southampton, Southampton, UK
  1. Correspondence to A Ryan aidan.ryan{at}uhs.nhs.uk
  • Accepted 12 January 2018

What you need to know

  • Full lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein, and triglyceride) is necessary for the diagnosis of hypercholesterolaemia

  • Ask about a family history of premature ischaemic heart disease and rule out secondary causes, such as type 2 diabetes mellitus or alcohol

  • Statins are first line management based on global cardiovascular disease risk assessment

A 40 year old man visits his general practitioner for annual antipsychotic monitoring. He is taking risperidone and sertraline for a previous diagnosis of psychotic depression. Recent blood tests showed a total cholesterol of 6.0, low density lipoprotein (calculated) (LDLc) 3.8, high density lipoprotein (HDL) 0.8, non-HDL 5.2, and triglyceride of 3.0 mmol/L; other blood tests were within the reference range.

Patients may require consideration of dyslipidaemia and cardiovascular risk for a number of reasons, including pre-existing physical health conditions such as chronic kidney disease; medications such as antipsychotics; family history such as hypercholesterolaemia or ischaemic heart disease; or due to age thresholds, such as cardiovascular disease (CVD) screening in over-40s.

This article provides a framework for diagnosing and managing dyslipidaemia, with the aim of reducing patients’ CVD risk.

What you should cover

History

Ask about

  • Whether the person has a family history of either premature ischaemic heart disease or hypercholesterolaemia. Without this information, patients might undergo inappropriate risk score assessments which are not indicated for familial causes and might result in delayed diagnosis or undertreatment (fig 1).

  • The person’s diet (is it high in fat and/or sugar?)

  • Whether they smoke (or have recently stopped)

  • Their levels of physical activity

  • Alcohol consumption (does the person regularly consume more than 3 units/day (men) or 2 units/day (women)?).

Fig 1

Approach to diagnosis and management of hypercholesterolaemia (based on guidance from the National Institute of Health and Care Excellence)

The patient advice leaflet, included as a supplementary file with this …

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