The lipid profile includes: Total Cholesterol, Triglycerides, HDL-Cholesterol, LDL-Cholesterol, Total Cholesterol:HDL-Cholesterol ratio, and Non-HDL Cholesterol.
From 25/11/2024, the Sampson equation completely replaced the Friedewald equation for calculating all LDL-Cholesterol. Friedewald values will no longer be reported. For most patients,
there will be minimal change in the calculated LDL-C (~0.1 mmol/L from local audit data) and so re-baselining is not required.
Key messages:
The Sampson equation is more accurate when triglycerides are elevated (up to 9.0 mmol/L) and when LDL-C is low (<1.8 mmol/L, a clinically important therapeutic target range). As such, the Sampson equation is less likely to result in under-treatment and is widely supported in the literature and by local lipidologists.
LDL-C can be calculated in fasting and non-fasting samples.
For most patients, calculated LDL-C values will be comparable to historic estimations.
LDL-C will now be reportable in patients with triglycerides of 4.6-9.0 mmol/L.
When triglycerides > 9.0 mmol/L, use non-HDL cholesterol and consider repeating in a fasting state.
Please direct any queries or concerns to dutybiochemist@liverpoolft.nhs.uk
General Recommendations
Use JBS3 risk calculator to estimate both 10-year risk and lifetime risk of CVD in all individuals except for those with existing CVD or certain high risk diseases i.e. diabetes age >40 years, patients with chronic kidney disease (CKD) stages 3-5, or familial hypercholesterolaemia (FH).
Total cholesterol and HDL-cholesterol from a non-fasting blood sample should be used for lipid profile estimate of CVD risk in the JBS3 calculator
Non-HDL-cholesterol, measured from a non-fasting blood sample as total cholesterol minus HDL-cholesterol, should be used in preference to LDL-cholesterol as the treatment goal for lipid-lowering therapy.
Intensive risk factor modification with diet, lifestyle intervention and pharmacological therapy in patients with existing CVD, without the need for estimation of CVD risk.
Intensive risk factor modification with diet, lifestyle intervention and pharmacological therapy, in individuals at particularly high risk of developing CVD: i.e. diabetics age >40 years, patients with CKD stages 3 - 5, or FH without the need for estimation of CVD risk.
Diet, lifestyle intervention and pharmacological therapy in people at high short-term risk. Thresholds for treatment with statins based on 10-year CVD risk will be informed by NICE guidelines.
Diet, lifestyle intervention and for some people, pharmacological therapy, in those with increased modifiable lifetime risk as informed by JBS3 calculator metrics.
Overview Cardiovascular disease: risk assessment and reduction, including lipid modification | Guidance | NICE (https://www.nice.org.uk/guidance/ng238)
Link to NICE Guidance on Familial Hypercholesterolaemia: identification and management.
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