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Cholesterol and Lipids
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Screening of healthy people without other risk factors is recommended every 5 years starting at 45 years of age (A for men, C for women). High risk patients should be screened as part of absolute cardiovascular risk assessment (A)
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Risk of vascular disease or dyslipidaemia
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Who is at higher risk?
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What should be done?
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How often?
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Increased risk
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Patients 45 years of age and over
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Fasting blood lipids
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Every 5 years
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High risk
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Patients 45 years of age and over with:
Risk factors such as smoking, hypertension, overweight
Family history of premature CVD in first degree blood relatives (<60 years of age)
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Fasting blood lipids
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Every 1-2 years
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Very high risk
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Patients with an absolute cardiovascular risk >15% over the next 5 years
Patients with the following existing diagnoses:
- diabetes mellitus (types 1 and 2) or impaired glucose tolerance
- CVD, peripheral arterial disease or ischaemic cerebrovascular disease
- familial hypercholesterolaemia or familial combined hyperlipidaemia
- chronic kidney disease
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Fasting blood lipids
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Every 12 months
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Clinical Considerations
- TC and HDL-C can be measured on non-fasting or fasting samples.
- Abnormal results should be confirmed by a repeated sample on a separate occasion, and the average of both results should be used for risk assessment. Although measuring both TC and HDL-C is more sensitive and specific for assessing coronary heart disease risk, TC alone is an acceptable screening test if available laboratory services cannot provide reliable measurements of HDL. In conjunction with HDL-C, low-density lipoprotein cholesterol (LDLC) and TC provide comparable information, but measuring LDL-C requires a fasting sample and is more expensive. In patients with elevated risk on screening results, lipoprotein analysis, including fasting triglycerides, may provide information that is useful in choosing optimal treatments.
- Screening is recommended for men aged 20 to 35 years and for women aged 20 to 45 years in the presence of any of the following:
- Diabetes.
- A family history of cardiovascular disease before age 50 years in male relatives or age 60 years in female relatives.
- A family history suggestive of familial hyperlipidemia.
- Multiple coronary heart disease risk factors (e.g., tobacco use, hypertension).
Intervention
Fasting blood lipids
Fasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. If total cholesterol (TC) is raised > 156 mg/dl (>4 mmol/L) or LDL >98 mg/dl (>2.5 mmol/L), a second confirmatory sample should be taken on a separate occasion (as levels may vary between tests) before a definitive diagnosis is made.
Absolute cardiovascular risk assessment
Assessment of the risk of a coronary event or stroke in the next 5-10 years (derived from the Framingham and other studies).
Dietary advice
All people regardless of their cholesterol level should be given dietary advice. In patients whose cholesterol is raised, absolute cardiovascular risk should be determined. Those at low to moderate absolute risk of CVD should be given dietary and other lifestyle advice and monitored more closely over the next year.
Cholesterol lowering therapy (Refer to Hyperlipidaemia Guidelines of PHC, DOHMS)
Cholesterol lowering therapy should be considered in patients with overt CVD, in patients with diabetes with LDL >98 mg/dl (>2.5 mmol/L), or TG >178 mg/dl (>2 mmol/L), or in patients with elevated cholesterol due to familial hypercholesterolaemia.
- In other patients, cholesterol lowering therapy should be considered when the absolute cardiovascular risk is elevated (above 15% risk in the next 5 years) and there has been an insufficient response to lifestyle changes. See Australian Heart Foundation Lipid guidelines at www.heartfoundation.com.au
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