Review of referral criteria to lipid clinics and outcomes of treatment in four UK centres.

Abstract

Little data exist on the referral patterns and effectiveness of lipid clinics. An audit was conducted in four clinics of 100 consecutive referrals each. Data were recorded on referral criteria, cardiovascular disease (CVD) risk factors, drug history, investigations, diagnoses, therapies, results and referrals. Patients were aged 56±14years, 47% were male and 87% were primary prevention. Risk factors included smoking (16%), type 2 diabetes (13%) and hypertension (13%). Referrals were made for hypercholesterolaemia (68%), diagnosis of FH (31%), statin intolerance (23%) and hypertriglyceridaemia (23%). Initial total cholesterol (TC) was 7.65±2.64mmol/L, triglycerides (TG) 2.17 (0.41-76.9mmol/L) mmol/L, HDL-C 1.53±0.71mmol/L, LDL-C 4.57±1.66mmol/L with non-HDL-C 5.90±2.09mmol/L. Criteria for FH were met in 21% with genetic testing in 13% and lipid cascade testing in 30% of index cases. Triglycerides >20mmol/L were present in 4%. The diagnosis was changed in 21%: hypercholesterolaemia (7%), mixed hyperlipidaemia (7%) and hypertriglyceridaemia (7%). Hepatic steatosis was identified in 14.5%. Lipoprotein(a) levels >125nmol/L occurred in 41% in one clinic. Therapy changes included altered statins (40%), addition of a fibrate (11%) or ezetimibe (8%). These reduced TC by 1.92mmol/L (19%; P=0.0001), LDL-C 1.07mmol/L (15%; P=0.02), non-HDL-C 1.50mmol/L (16%; P<0.001), and TG 2.3 (-4 to 38) mmol/L (16%; P<0.001) with 11% extra achieving TG <5mmol/L while HDL-C increased by 7% (P=0.37). Lipid clinics have diverse functions including diagnosis of FH, managing severe hypercholesterolaemia, mixed hyperlipidaemia and statin intolerance. Effectiveness criteria of average reductions of 1.5mmol/L in TC or non-HDL-C, 1mmol/L in LDL-C and 2mmol/L in TG would be reasonable for newly referred patients.