Which patients with hyperlipidaemia should be considered for referral to a specialist for further management?

Patients with hyperlipidaemia who should be considered for referral to a specialist for further management include:

• Those with a total blood cholesterol level greater than 9.0 mmol/L or a non-high-density lipoprotein (non-HDL) cholesterol level greater than 7.5 mmol/L, even if there is no first-degree family history of premature coronary heart disease. These patients should be arranged for specialist assessment.
• Patients with triglyceride concentrations above 20 mmol/L that are not due to excess alcohol intake or poor glycaemic control should be referred for urgent specialist review.
• Patients with triglyceride concentrations between 10 and 20 mmol/L should have a repeat fasting triglyceride measurement within 2 weeks, be reviewed for secondary causes of hyperlipidaemia, and if levels remain above 10 mmol/L, specialist advice should be sought.
• Patients with triglyceride concentrations between 4.5 and 9.9 mmol/L should have optimized management of other cardiovascular risk factors, and specialist advice should be sought if their non-HDL cholesterol concentration is above 7.5 mmol/L.
• People suspected of having familial hypercholesterolaemia (FH) based on clinical findings, lipid profile, and family history should be referred to an FH specialist service for further evaluation and DNA testing if they meet diagnostic criteria (e.g., Simon Broome or Dutch Lipid Clinic Network criteria).
• Adults with FH who are at very high risk of coronary events (e.g., established coronary heart disease, family history of premature coronary heart disease, or two or more other cardiovascular risk factors) should be referred to a specialist with expertise in FH.
• People with homozygous FH should be referred to a specialist centre for evaluation and management.
• Patients with persistent unexplained muscle symptoms and raised creatine kinase (CK) levels should be considered for specialist advice before starting or adjusting statin therapy.

These referral criteria ensure that patients with severe hyperlipidaemia, high cardiovascular risk, or suspected genetic lipid disorders receive appropriate specialist assessment and management to reduce their risk of cardiovascular disease.

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