Screening

Dyslipidaemia is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD) and can be treated with appropriate interventions. The American College of Cardiology/American Heart Association (ACC/AHA) recommends that in adults without ASCVD, traditional ASCVD risk factors, including lipid levels, are assessed every 4-6 years.[2]​ The Centers for Disease Control and Prevention (CDC) recommend more regular screening than this in adults with cardiovascular risk factors (e.g., existing cardiovascular disease [CVD], diabetes, positive family history of lipid disorders).[57]​ The use of a validated tool or calculator to predict future risk of ASCVD is recommended.[58]

In the UK and Europe, lipid screening may begin at age 40 years, although UK guidance recommends a systematic but opportunistic risk-assessment approach targeting adults at increased risk who are above this age, rather than universal screening.[10][59]​​​ The European Society of Cardiology (ESC) and European Atherosclerosis Society recommend CVD risk factor screening, including lipid profile testing, be considered in men >40 years old and in women >50 years old and/or who are menopausal, which may then be followed by use of a formal risk assessment tool (such as Systemic Coronary Risk Evaluation-2 [SCORE-2]) in those without ASCVD to decide on prevention strategies in adults over the stated risk thresholds.[10][60]​ Note that although the ESC recommends the SCORE-2 risk assessment tool, ideally risk calculators should be population-specific, and clinicians should follow the risk-assessment tools endorsed in their own region or national guidelines.[10]​ Screening may begin earlier for those with diabetes in childhood or a family history of dyslipidaemia.

In addition to cardiovascular risk assessment, a positive screening result with markedly raised triglycerides should prompt further evaluation and management to reduce the risk of acute pancreatitis, on an urgent basis.[10][58]

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