Lipid Tests - FOI Response Register

1. Can you send to me any guidelines or guidance utilised for Health Care Professionals on completing lipid tests?

NHS Shetland clinicians use Grampian Guidelines – GRAM-Guidance, Lipid Lowering – Primary prevention

Lipid Lowering - Primary Prevention.pdf

The Primary Care Cluster refer to NHS England’s guideline for more detailed look at the use of statins: lipid-management-pathway-v7.pdf

2. Are lipid tests fasted or non-fasted in Primary Care and in Secondary Care as standard?

The lab does not stipulate if they are to be fasted or not. Requests are marked accordingly if it is stated on the form

3. Can all clinicians see Triglyceride results when lipid tests are completed?

Yes

4. What calculation is used within NHS Shetland (in Primary Care and Secondary Care) when creating a triglyceride result - Samson or Friedwald?

Triglyceride is not calculated. It is measured using enzymatic hydrolysis, followed by phosphorylation and a series of further reactions resulting in the production of hydrogen peroxide which catalyses a colour reaction which is read at 604 nm and is proportional to the concentration of triglyceride present. Absorbance is compared to a standard curve using a calibrator of known value.

Both the Sampson and Friedewald equations are used to calculate LDL cholesterol from measured parameters. NHS Shetland utilises the Friedewald equation.

5. Does the guidance on completing lipid test match the SMC advice for prescribing of all medications accepted for use within Scotland? Ie if the SMC advice is for a "fasted test" but common practice or local guidance states "non-fasting" tests to be completed - how do patients access these medications?

The use of fasting lipids is determined following an initial test which is likely to be non-fasted. The guidance stipulates when a fasting lipid is recommended.