Abbreviated lipid guidelines for clinical practice : Based on ESC lipid guidelines 2019 and ESC cardiovascular disease prevention in clinical practice guidelines 2021.

BACKGROUND: Lipid disorders are now considered causal for atherosclerotic cardiovascular disease (ASCVD) which remains one of the most important contributors to morbidity and mortality in the developed world. Identification and early treatment of lipid disarrays remains the cornerstone of good clinical practice to prevent, halt and even reverse ASCVD. Guidelines for lipid management are imperative to help promote good clinical practice. Given the detail involved in comprehensive guidelines and the multiple areas of knowledge required by clinical practitioners, abbreviated, easy to understand, practical versions of guidelines are required to ensure dissemination of the most important information. The recent ESC lipid guidelines 2019 and the ESC guidelines on CVD prevention in clinical practice 2021 (1,2), provide an excellent detailed summary of all the latest evidence supporting lipid interventions that reduce ASCVD. METHOD: We therefore developed a single-page document with hyperlinks to help practitioners gain easy access to practical information on lipid management. It has been developed for future electronic use in clinical practice. CONCLUSION: It is presented here in a tabular format together with printable versions of the associated hyperlinks that provide the additional information required in decision making. It is hoped to audit the impact of this approach to help guide future ways of disseminating the latest clinical guideline updates.

Evaluation of lipid services in the Republic of Ireland.

BACKGROUND: Abnormal cholesterol profiles are a major risk factor for cardiovascular disease and severe triglyceride disorders cause life threatening pancreatitis. Identification and treatment of these disorders are essential. AIM: We evaluated the services available in Ireland to manage these problems. METHODS: We contacted key personnel in 40 hospitals, 32 public and 8 private providing lipid measurements to assess investigation and treatment availability during 2017/2018. RESULTS: In public hospitals, 4 had designated lipid clinics (Dublin 3, Galway 1) (2.9 times < UK), 19 had general clinics and 9 had no service. In private hospitals, 2 had designated clinics, Limerick and Cork, and others had interested physicians. Clinics were run by cardiologists, chemical pathologists, endocrinologists or clinical pharmacologists. One clinic had a lipid nurse versus 75% in the UK. All but one provided full lipid profiles, 15 ordered Lp(a), 9 apoproteins B/A-1 and 9 genetic testing. Lp(a) and apoprotein measurements were provided locally in one hospital and one provided genetic testing. Lipid-lowering drugs were used in all hospitals and 45% had access to PCSK-9 inhibitors. No hospital provided LDL apheresis or plasma exchange. Limitations for service provision included lack of physician interest n = 9, nursing support n = 22, office space n = 13, clinic space n = 22, laboratory support n = 16, nutritional support n = 12 and pharmacy support n = 5. CONCLUSIONS: There are very limited resources available to manage lipid problems in the republic of Ireland relative to the under-resourced UK. Most services rely on interested physicians but ancillary resources are lacking. Where services are available, all drug treatments are utilised.

A snapshot of lipid levels in the Republic of Ireland in 2017.

BACKGROUND: Abnormalities in blood lipid levels are causally linked with cardiovascular disease and pancreatitis. Data is limited regarding lipid abnormalities in Ireland. AIMS: As part of a cholesterol awareness campaign, we performed a pilot study of current lipid levels to preliminarily assess the extent and pattern of lipid abnormalities in Ireland. METHODS: Non-fasting, full lipid profiles and glucose measurements were performed in 259 people (32 on lipid-lowering medication and 225 untreated) using a validated Cholestech LDX machine. Untreated participants included 95 men and 130 women, aged 51 ± 16 years. RESULTS: The mean ± SD, total, low-density lipoprotein (LDL), high-density lipoprotein cholesterol (HDL) and median(IQR) non-HDL cholesterol and triglyceride levels in untreated individuals were 5.0 ± 1.1, 2.8 ± 1.0, 1.5 ± 0.5 and 3.4 (2.8-4.3), 1.6 (1.0-2.3) mmol/l respectively. Glucose was 5.3 (4.8-5.8) mmol/l. Glucose > 7.8 mmol/l occurred in 10 individuals (4%). Using defined criteria for non-fasting lipid levels, 60% of participants had some form of lipid abnormality with a frequency of 47% having a total cholesterol > 5, 35% with LDL > 3.0, 26% with HDL < 1.0/1.2, 33% with triglycerides > 2.0 and 32% with non-HDL cholesterol > 3.9 mmol/l. Three individuals had untreated LDL > 5 mmol/l (i.e. a ratio of 1:75 of those tested) and eight people had HDLc < 0.7 (1:28) and four had triglyceride above 7.3 mmol/l (1:56). CONCLUSIONS: This pilot study reveals significant lipid abnormalities which require further larger more detailed lipid studies to assess the true burden of lipid abnormalities in Ireland. Cascade screening and genetic testing of relatives of those with severe lipid abnormalities should be considered.

Renal failure and specialist palliative care: an assessment of current referral practice.

AIMS: This retrospective audit assessed the referral practice for patients with end-stage renal failure from the nephrology service to the specialist palliative care team in a large teaching hospital in the north-west of England. METHODS: Forty-nine referrals with 'renal' as a primary diagnosis over a two-year period were identified from referral data. General and palliative care notes were reviewed and a data collection tool was designed. RESULTS: Most common reasons for referral were for 'placement' (38.6%) and 'dying/distressed' patients (22.7%), although psychological support was also prevalent (15.9%). Renal teams discussed stopping dialysis in the majority of cases (89%), but documented preferred place of care less frequently (48.3%) and achieved discharge to these locations in less than half of cases (21.4%). CONCLUSION: There was well-established referral practice between the renal and the specialist palliative care team at the hospital examined. The renal team appropriately referred for symptom control and support in the dying phase of patients. There are issues surrounding placement and increased implementation of end-of-life care tools, including the Liverpool Care Pathway, Gold Standards Framework and Preferred Place of Care documentation for renal patients, which needs to be an ongoing priority.