Secondary hyperlipidaemia: beyond the primary debate.

Abstract

There has been much recent controversy over the benefit and risks of the treatment of primary hyperlipidaemia. I Although clear guidelines exist from the British Hyperlipidaemia Association (BHA) and European Atherosclerosis Society (EAS)2,3 there are differing opinions over the merits of screening for and treating hyperlipidaemia. Secondary hyperlipidaemia is, however, a less contentious subject. If an underlying cause is identified, appropriate treatment may allow early intervention in the disease, avoid subsequent complications, restore normal lipoprotein patterns and may also obviate the need for lipid-lowering therapy. Series et al, have demonstrated that by using a total serum cholesterol cut-off of 8· 0 mrnollL an unequivocal increase in the frequency of undiagnosed hypothyroidism is observed in hyperlipidaemic patients. The most frequently encountered and previously unsuspected causes in the lipoprotein clinic at Glasgow Royal Infirmary are alcohol excess, hypothyroidism, chronic renal failure and diabetes mellitus, although rarer conditions including nephrosis have also been discovered. Questionnaires were sent to 46 practices in Glasgow, where public and practitioner awareness of hyperlipidaemia is high through local screening schemes, to assess general practitioner (GP) policies towards the systematic biochemical exclusion of causes of secondary hyperlipidaemia. As a secondary objective, GPs policies towards the referral of patients with hyperlipidaemia were also examined.