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Type 2 Diabetes
very (very) high triglyceride level
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<blockquote data-quote="Bluetit1802" data-source="post: 2080168" data-attributes="member: 94045"><p>This is what NICE has to say about it.</p><p></p><p><span style="font-size: 12px"><strong>Lipid measurement and referral</strong></span></p><p>1.3.3 Measure both total and high‑density lipoprotein (HDL) cholesterol to achieve the best estimate of CVD risk. <strong>[2008]</strong></p><p></p><p>1.3.4 Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. This should include measurement of total cholesterol, HDL cholesterol, non‑HDL cholesterol and triglyceride concentrations. A fasting sample is not needed. <strong>[new 2014]</strong></p><p>For information about implementing this recommendation, see <a href="http://www.nice.org.uk/guidance/cg181/chapter/implementation-getting-started" target="_blank">implementation: getting started</a>.</p><p></p><p>1.3.5 Use the clinical findings, lipid profile and family history to judge the likelihood of a familial lipid disorder rather than the use of strict lipid cut‑off values alone. <strong>[new 2014]</strong></p><p></p><p>1.3.6 Exclude possible common secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome) before referring for specialist review. <strong>[new 2014]</strong></p><p></p><p>1.3.7 Consider the possibility of familial hypercholesterolaemia and investigate as described in <a href="http://www.nice.org.uk/guidance/cg71" target="_blank">familial hypercholesterolaemia</a> (NICE guideline CG71) if they have:</p><p></p><ul> <li data-xf-list-type="ul">a total cholesterol concentration more than 7.5 mmol/litre <strong>and</strong><br /> <br /> </li> <li data-xf-list-type="ul">a family history of premature coronary heart disease. <strong>[new 2014]</strong><br /> </li> </ul><p>1.3.8 Arrange for specialist assessment of people with a total cholesterol concentration of more than 9.0 mmol/litre or a non‑HDL cholesterol concentration of more than 7.5 mmol/litre even in the absence of a first‑degree family history of premature coronary heart disease. <strong>[new 2014]</strong></p><p></p><p><span style="color: #ff0000"><strong>1.3.9 Refer for urgent specialist review if a person has a triglyceride concentration of more than 20 mmol/litre that is not a result of excess alcohol or poor glycaemic control. [new 2014]</strong></span></p><p></p><p>1.3.10 In people with a triglyceride concentration between 10 and 20 mmol/litre:</p><p></p><ul> <li data-xf-list-type="ul">repeat the triglyceride measurement with a fasting test (after an interval of 5 days, but within 2 weeks) <strong>and</strong><br /> <br /> </li> <li data-xf-list-type="ul">review for potential secondary causes of hyperlipidaemia <strong>and</strong><br /> <br /> </li> <li data-xf-list-type="ul">seek specialist advice if the triglyceride concentration remains above 10 mmol/litre. <strong>[new 2014]</strong><br /> </li> </ul><p>1.3.11 In people with a triglyceride concentration between 4.5 and 9.9 mmol/litre:</p><p></p><ul> <li data-xf-list-type="ul">be aware that the CVD risk may be underestimated by risk assessment tools <strong>and</strong><br /> <br /> </li> <li data-xf-list-type="ul">optimise the management of other CVD risk factors present <strong>and</strong><br /> <br /> </li> <li data-xf-list-type="ul">seek specialist advice if non‑HDL cholesterol concentration is more than 7.5 mmol/litre. <strong>[new 2014]</strong><br /> </li> </ul><p><a href="https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations#identifying-and-assessing-cardiovascular-disease-cvd-risk-2" target="_blank">https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations#identifying-and-assessing-cardiovascular-disease-cvd-risk-2</a></p><p></p><p></p><p>.</p></blockquote><p></p>
[QUOTE="Bluetit1802, post: 2080168, member: 94045"] This is what NICE has to say about it. [SIZE=3][B]Lipid measurement and referral[/B][/SIZE] 1.3.3 Measure both total and high‑density lipoprotein (HDL) cholesterol to achieve the best estimate of CVD risk. [B][2008][/B] 1.3.4 Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. This should include measurement of total cholesterol, HDL cholesterol, non‑HDL cholesterol and triglyceride concentrations. A fasting sample is not needed. [B][new 2014][/B] For information about implementing this recommendation, see [URL='http://www.nice.org.uk/guidance/cg181/chapter/implementation-getting-started']implementation: getting started[/URL]. 1.3.5 Use the clinical findings, lipid profile and family history to judge the likelihood of a familial lipid disorder rather than the use of strict lipid cut‑off values alone. [B][new 2014][/B] 1.3.6 Exclude possible common secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome) before referring for specialist review. [B][new 2014][/B] 1.3.7 Consider the possibility of familial hypercholesterolaemia and investigate as described in [URL='http://www.nice.org.uk/guidance/cg71']familial hypercholesterolaemia[/URL] (NICE guideline CG71) if they have: [LIST] [*]a total cholesterol concentration more than 7.5 mmol/litre [B]and[/B] [*]a family history of premature coronary heart disease. [B][new 2014][/B] [/LIST] 1.3.8 Arrange for specialist assessment of people with a total cholesterol concentration of more than 9.0 mmol/litre or a non‑HDL cholesterol concentration of more than 7.5 mmol/litre even in the absence of a first‑degree family history of premature coronary heart disease. [B][new 2014][/B] [COLOR=#ff0000][B]1.3.9 Refer for urgent specialist review if a person has a triglyceride concentration of more than 20 mmol/litre that is not a result of excess alcohol or poor glycaemic control. [new 2014][/B][/COLOR] 1.3.10 In people with a triglyceride concentration between 10 and 20 mmol/litre: [LIST] [*]repeat the triglyceride measurement with a fasting test (after an interval of 5 days, but within 2 weeks) [B]and[/B] [*]review for potential secondary causes of hyperlipidaemia [B]and[/B] [*]seek specialist advice if the triglyceride concentration remains above 10 mmol/litre. [B][new 2014][/B] [/LIST] 1.3.11 In people with a triglyceride concentration between 4.5 and 9.9 mmol/litre: [LIST] [*]be aware that the CVD risk may be underestimated by risk assessment tools [B]and[/B] [*]optimise the management of other CVD risk factors present [B]and[/B] [*]seek specialist advice if non‑HDL cholesterol concentration is more than 7.5 mmol/litre. [B][new 2014][/B] [/LIST] [URL]https://www.nice.org.uk/guidance/cg181/chapter/1-Recommendations#identifying-and-assessing-cardiovascular-disease-cvd-risk-2[/URL] . [/QUOTE]
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