11/13/24, 7\:33 PM Guide | Lipid profile interpretation

Lipid pro

Table of contents

Introduction

This guide provides a structured approach to interpreting a lipid pro
Kingdom. NICE guidance is updated periodically, so it is essential to ensure that you are always following the most recent NICE
guidelines or the guidelines in your area.

Lipids

Lipids are fats the body requires for energy, energy storage and cell membrane structure.
The main groups of lipids are cholesterol, triglycerides (comprised of glycerol and fatty acids), free fatty acids and
phospholipids. They are obtained through dietary intake and manufactured in the liver. Since lipids are not water-soluble, they
are transported in the lymphatic system and bloodstream in combination with proteins, creating structures which are called
lipoproteins.
When lipids, especially cholesterol, are present in the plasma in high concentrations, they are a risk factor for cardiovascular
disease due to their role in forming atheromatous plaques in the walls of blood vessels.
For more information, see the Geeky Medics guides to lipids and cholesterol metabolism.

Lipid pro

A lipid pro

Cholesterol

Cholesterol values are reported as follows\:
Total cholesterol
High-density lipoprotein cholesterol (HDL-C)\: cholesterol which is being carried in HDL. HDL-C is often described to
patients as ‘good’ cholesterol, because it mediates the transport of cholesterol to the liver, where it is excreted from the
body, in a process known as reverse cholesterol transport. There is an inverse relationship between HDL cholesterol and
the risk of cardiovascular disease.
Non-high-density lipoprotein cholesterol (non-HDL-C)\: cholesterol carried in lipoproteins other than HDL, including low-
density lipoprotein cholesterol (LDL-C). Non-HDL-C is calculated by subtracting HDL-C from total cholesterol. Non-HDL
cholesterol is described as ‘bad’ cholesterol because of its central role in the pathogenesis of atherosclerosis.
Total cholesterol to HDL ratio\: a measure of HDL-C concentration relative to the total cholesterol.

Triglycerides

Elevated concentrations of triglycerides are associated with post-prandial hyperlipidaemia and reduced HDL-C, making
hypertriglyceridaemia an independent risk factor for cardiovascular disease. At concentrations over 10mmol/L, triglycerides
are also associated with pancreatitis.

Why perform a lipid pro

There are three sets of circumstances in which a lipid pro
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Screening

Adults between the ages of 40 and 74 years without cardiovascular disease may be o
check. The result can be used as part of the QRISK3 score, which estimates an individual’s risk of cardiovascular disease in
the next ten years.
Additionally, a patient of any age who is noted to have features of hyperlipidaemia on physical examination, such as tendon
xanthoma, xanthelasma or corneal arcus, should have a lipid pro

Recent cardiovascular event

Patients who have had a recent cardiovascular event (e.g. myocardial infarction, stroke) should have a lipid pro
future risk reduction strategies.

Monitoring

Patients with hyperlipidaemia and those who have had a cardiovascular event should have lipid pro
the e
Do patients need to fast?
Since 2014, NICE guidance has stated that most patients do not need to fast before a lipid pro
However, a fasting sample should be obtained in certain circumstances (e.g. initial test shows severe hyperlipidaemia,
hypertriglyceridaemia).
Acute illness/injury
A lipid pro
cholesterol during this period.

Interpreting a lipid pro

Does the patient have severe hyperlipidaemia?

The
Severe hyperlipidaemia is de
Total cholesterol >7.5mmol/L (hypercholesterolaemia) and/or
Non-HDL-C >5.9 mmol/L (hypercholesterolaemia) and/or
Triglycerides >4.5mmol/L (hypertriglyceridaemia)
Some patients will have predominant hypercholesterolaemia, some will have predominant hypertriglyceridemia, and others
will have mixed hyperlipidaemia.
Identify any secondary causes
Any secondary causes of hypercholesterolaemia or hypertriglyceridemia should be identi
elevated results.
Secondary causes of hypercholesterolaemia include\:
Pregnancy
Hypothyroidism
Cholestatic liver disease
Nephrotic syndrome
Drugs (e.g. diuretics, ciclosporin, corticosteroids, androgens)
Secondary causes of hypertriglyceridaemia include\:
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Uncontrolled diabetes mellitus
Chronic kidney disease
Hepatocellular liver disease
Alcohol excess
Metabolic syndrome (including impaired glucose tolerance, hypertension, central obesity)
Drugs (e.g. beta-blockers, retinoids and corticosteroids)
These conditions should be identi
Arrange specialist review
Patients who do not have a secondary cause, or if hyperlipidaemia persists following management of the secondary cause, will
need further investigation and, often, referral to a specialist lipid clinic for consideration of conditions such as familial
hypercholesterolaemia, familial hypertriglyceridaemia, or familial combined hyperlipidaemia.
Patients in whom the secondary cause cannot be modi
comorbidities) may also require referral to a specialist lipid clinic.
Familial hypercholesterolaemia
Familial hypercholesterolaemia causes elevated levels of low-density lipoprotein cholesterol (LDL-C). Patients often
have a family history of cardiovascular disease and may develop clinical signs of hyperlipidaemia (e.g. tendon
xanthoma).
Familial hypercholesterolaemia is usually caused by mutations in the low-density lipoprotein receptor (LDLR) gene,
resulting in an autosomal dominant inheritance pattern.
Familial hypertriglyceridaemia and familial combined hyperlipidaemia are both also dominantly inherited disorders.

Why was the lipid pro

Further interpretation of results will depend on why the lipid pro
Screening
Where the test was done for screening, ask\: what do these results tell me about this patient’s risk of future cardiovascular
disease?
NICE does not de
lipid-lowering drug treatments are based upon the QRISK3 calculator (so-called because it is the third version of the
calculator). QRISK3 combines the lipid pro
and weight.
There are certain groups for whom QRISK3 is not suitable, as they should all be considered to be at increased risk of CVD\:
Age >85
Type 1 diabetes
Chronic kidney disease (eGFT \<60)
Inherited lipid metabolism disorder
The QRISK3 score estimates the likelihood of an individual patient developing cardiovascular disease over the next ten years.
If the risk is 10% or greater, the patient should be given lifestyle advice regarding modi
obesity, and physical activity). The patient should also be o
as lifestyle advice or later if lifestyle modi
primary prevention.
2
In some groups of patients, for example, those who are severely obese (BMI >40kg/m ), those with serious mental illness and
those with autoimmune disorders (e.g. systemic lupus erythematosus), the QRISK3 score may be an underestimate of their
cardiovascular risk. This is also the case in patients with signi
necessary to initiate lipid-lowering treatment even when the estimated risk is less than 10%.
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Target cholesterol levels
Although NICE does not recommend the use of lipid pro
patients on the following cholesterol treatment target levels\:
Total cholesterol\: should be 5mmol/L or less
HDL-C\: should be >1 mmol/L in men and >1.2 mmol/L in women
Total cholesterol to HDL ratio\: should be \<6
Primary prevention of cardiovascular disease
NICE recommend atorvastatin 20mg once daily as lipid-lowering therapy for the primary prevention of cardiovascular
disease.
For more information, see the Geeky Medics guide to statin counselling.
Recent cardiovascular event
Where a lipid pro
patient’s risk of further cardiovascular events?
The QRISK3 tool cannot be used in these patients, as it is only validated for patients without established cardiovascular
disease.
Most patients who have su
values (secondary prevention). First-line treatment for secondary prevention is atorvastatin 80mg once daily. Baseline lipid
values will be used to assess the e
Monitoring
Where the test was done for monitoring purposes, ask\: what do these results tell me about the e
treatment strategy?
In primary and secondary prevention, the target is to reduce non-HDL-C ('bad cholesterol') by >40% from baseline levels after
three months of treatment with a statin.

References

t h
Boon, NA. Colledge, NR, Walker, BR (eds). D a v i d s o n’ s P r i n c i p l e s & P r a c t i c e o f M e d i c i n e 2 0 E d . Churchill Livingstone Elsevier,
2006
Lab Tests Online UK. C h o l e s t e r o l T e s t . Available from\: [LINK]
Marshall, William J and Bangert, Stephen K. C l i n i c a l C h e m i s t r y ( S i x t h E d i t i o n ) . Elsevier Limited, 2008
S u m m a r y o f N a t i o n a l G u i d a n c e f o r L i p i d M a n a ge m e n t f o r P r i m a r y a n d S e c o n d a r y P r e v e n t i o n o f C V D . NHS England. from\: [LINK]
Available
NHS [LINK]
Health Check. R e s u l t s a n d A c t i o n P l a n o n l i n e p a t i e n t i n f o r m a t i o n l e a
NICE CKS. H y p e r c h o l e s t e r o l a e m i a – f a m i l i a l . Available from\: [LINK]
NICE CKS. L i p i d t h e r a p y – p r i m a r y p r e v e n t i o n o f C V D . Available from\: [LINK]
ClinRisk Ltd. Q R I S K 3 c a l c u l a t o r . Available from\: [LINK]
Source\: geekymedics.com
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