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4.2.2. Referring to a Clinical Lipid Specialist
Table 9. Considerations for Referral to a Lipid Specialist*
Patients with diagnosed or suspected FH
Patients with homozygous FH
Patients with heterozygous FH who do not achieve treatment targets on maximally
tolerated statin plus nonstatin therapy
Patients with heterozygous FH with statin-attributed side effects on ≥2 statins,
including at the lowest dose or with alternate dosing regimens
Patients with ASCVD or at high risk of ASCVD
Patients with premature ASCVD (onset age <40 years)
Patients who do not achieve ≥50% LDL-C reduction and LDL-C (or non–HDL-C)
targets on maximally tolerated statin plus nonstatin therapy
Patients with statin-attributed side effects on ≥2 statins, including at the lowest dose or
with alternate dosing regimens
Patients who have elevated Lp(a) (≥200 nmol/L or ≥75 mg/dL)
Patients <40 years old with diabetes and dyslipidemia
Patients at high risk for ASCVD or with ASCVD who are on complex
medication regimens
Patients receiving treatment for HIV
Patients receiving treatment for cancer
Patients receiving treatments to prevent transplant rejection
Individuals who are considering pregnancy, are pregnant, or are breastfeeding
Patients with heterozygous FH
Patients with hypertriglyceridemia (TG ≥400 mg/dL)
Patients with ASCVD or at high risk of ASCVD requiring LLT
Patients with inherited hyperlipidemias who need genetic testing for diagnosis
Patients with severe/extreme primary hypertriglyceridemia after secondary
causes have been ruled out
Patients who may be candidates for treatment with evinacumab, lomitapide,
olezarsen, or lipoprotein apheresis
* Especially if patients are not achieving lipid/lipoprotein goals on recommended therapies.
ASCVD indicates atherosclerotic cardiovascular disease; FH, familial hypercholesterolemia;
LDL-C, low-density lipoprotein-cholesterol; LLT, lipid-lowering therapy; LP(a), lipoprotein
(a); HDL-C, high-density lipoprotein-cholesterol; HIV, human immunodeficiency virus; and
TG, triglycerides.
