QRISK & statins: Use QRISK3 for 10-year risk (25–84 years). Offer statin at QRISK ≥ 10%; atorvastatin 20 mg is recommended as the starting option for primary prevention.
Secondary prevention targets: Aim for LDL ≤ 2.0 mmol/L (or non-HDL ≤ 2.6 if LDL not recorded). Consider escalation (ezetimibe, PCSK9, inclisiran) if target not met.
Referral thresholds: Specialist assessment if total cholesterol > 9.0 mmol/L or non-HDL > 7.5 mmol/L. Urgent referral if TG > 20 mmol/L. For TG 10–20 mmol/L, repeat fasting TG after ~5 days (within 2 weeks) and seek specialist advice if >10 mmol/L.
Monitoring: Measure LFTs and full lipid profile at 2–3 months after starting or changing lipid-lowering treatment; measure LFT at 12 months and thereafter only if indicated. Measure CK only if symptomatic.
