Abnormal lipid profile (raised LDL/TG, low HDL) increasing ASCVD risk.
Risk factors
- • Family history premature CVD
- • Diabetes, hypertension
- • Smoking, obesity
- • Hypothyroidism, CKD
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Fasting lipid profile
- • HbA1c, TSH, LFT, eGFR
- • Calculate 10-yr ASCVD risk (QRISK3/ASCVD)
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Lifestyle for all
- • Statin per risk and LDL target
Drug therapy
- • Atorvastatin 20–80 mg ON
- • Rosuvastatin 10–40 mg ON
- • Add ezetimibe 10 mg if LDL above target
- • Fenofibrate 145 mg if TG >500 mg/dL
Lifestyle advice
- • Mediterranean diet, reduce saturated fat
- • Soluble fibre 10–25 g/day
- • Aerobic exercise
Follow-up advice
- • Recheck lipids 6–12 weeks
- • LFT/CK only if symptoms
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Statin myalgia in ~5%; check CK only if symptomatic
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
