SIGNIFICANT RESULTS REQUIRING ACTION, TREATMENT PLAN

SIGNIFICANT RESULTS REQUIRING ACTION 

• Total cholesterol >7.5 with family history of premature CHD (<60 & 1^st degree relative): suspect familial hypercholesterolaemia & refer – Total cholesterol >9 or non-HDL >7.5:

specialist input

• Triglycerides >20: urgent referral
• Triglycerides 10-20: repeat fasting lipids, if persistent, refer
• Triglycerides 4.5-9.9: consider specialist input
• CK >5x upper limit: contraindicated to start
• CK <5x upper limit: start lower dose

TREATMENT PLAN 

Primary Prevention:

• Atorvastatin 20mg OD
• Target: 40% reduction in non-HDL cholesterol
• If not achieved on max dose: consider adding ezetimibe
• If atorvastatin is contraindicated, use ezetimibe

Secondary Prevention:

• Atorvastatin 80mg OD
• Target: non-HDL cholesterol ≤2.6 mmol/L
• If atorvastatin is contraindicated, consider ezetimibe

Monitoring:

• Review at 2-3 months: lipids, LFTs
• Annual review: lipids, LFTs
• Additional monitoring if side effects are present

Contraindications:

• Active liver disease
• Pregnancy/breastfeeding
• Stop 3 months before conception

Drug interactions:

• Avoid clarithromycin: risk of rhabdomyolysis

Side effects:

• MSK: muscle aches, pains
• GI symptoms

KEY INFORMATION 

• Different dosing/targets for primary vs secondary prevention
• Comprehensive baseline testing required
• Regular monitoring is essential
• Important to recognise when specialist input is needed.

Lipid Modification Reference
MI Secondary Reference