Lipid service

The service is divided across several clinic sessions:

Paediatric familial hypercholesterolemia clinics are held at the Royal Free Hospital on Monday or Friday afternoon in children’s outpatients. Families are given the option to join face-to-face clinics as well as, if clinically suitable (stable cases), by telephone.

We regret we cannot see patients without an appointment. Referrals to the lipid clinic team can be made via a GP or a hospital doctor (for inpatients). 

Electronic referrals from a GP may be made through the NHS e-Referral Service system.

If you have any general enquiries about cholesterol or cardiovascular risk, please contact our clinical nurse specialists. Please note this is for clinical enquiries only.

For administration enquiries, please call our clinic.

Lipids comprise various different types of fatty substances such as cholesterol and triglycerides. They occur naturally in the body and form part of the building blocks that make up our cells and protect our nerves.

When lipid levels in the blood exceed normal levels, this can lead to problems such as heart disease. High cholesterol and triglycerides can be caused by poor lifestyle choices, genetic conditions or medical problems such as diabetes.

Treatment is generally a combination of statin therapy with some lifestyle intervention. 

Triglycerides are a form of dietary fat found in meats, dairy produce and cooking oils, but the liver also makes triglycerides. 

Whether they come from the digestion of foods or from the liver, triglycerides are used for one of two purposes. They may be taken up by cells and tissues and used for energy, or they may be stored as fat.
After eating a meal, the blood is rich in triglycerides. It usually takes a few hours for triglyceride levels to return to normal. 

Having high triglycerides may indicate lipid disorders such as familial combined hyperlipidaemia, type 3 hyperlipidaemia or lipoprotein lipase deficiency, but in a large number of patients it may indicate pre-diabetes, or be a sign of obesity, excessive alcohol intake, or may be a side-effect of some prescribed medications.

Treatment for slightly raised triglycerides is often with statin therapy (depending on overall risk of developing cardiovascular disease). But for substantially raised triglycerides, this may include the addition of a drug called fibrate.

High levels can normally be reduced by dietary intervention and/or drug treatments.

When you first arrive at the clinic, one of the clinic nurses will check your height, weight and blood pressure and ask you to provide a urine sample.

The lipid team is made up of doctors and clinical nurse specialists, so you may be seen by any one of the team. They will ask you various questions about your lifestyle, medications, medical history and your family history. It is helpful if you could find out some information about your family history before you come to see us. They will then perform a clinical examination. You may be asked to then go to have a blood test (if appropriate).

As a centre involved in many clinical trials of innovative injectable therapy for reducing cholesterol and triglycerides, there are specific clinics for patients receiving these injectable therapies (Evolocumab, Alirocumab and Inclisiran) under NICE guidance. Currently we are recruiting patients with familial hypercholesterolaemia to an innovative clinical trial programme of a new gene editing therapy.

Our lipid clinic has active research and development activities linked to improving the management of patients. The team run community programmes to access hard to reach populations in a community setting on an ad hoc basis. The clinic’s research laboratory supports sample processing for collaborative research projects. Several local and national collaborative research and development activities are currently run under the lipid service.

Hyperlipidaemia is an inherited disorder that affects the metabolism or proteins in the body associated with abnormally high cholesterol or another form of blood fat called triglycerides.

This lipid clinic has a team who have specialised in the treatment of these disorders, which is commonly caused by a mix of genetic and environmental factors. The major conditions managed are below.

Familial hypercholesterolaemia is a genetic disorder characterised by high cholesterol levels. It is caused by an abnormal gene passed on from your parents. This faulty gene results in exceptionally high cholesterol levels that are present from birth and continue throughout life. If left untreated, it can lead to a greater risk of developing heart disease, which could mean having a heart attack at an earlier age. Affected and untreated men have a greater than 50% risk of coronary heart disease by the age of 50 years, and affected women have a greater than 30% by the age of 60.

This cholesterol disorder is surprisingly common and many people with it are undiagnosed. Only 15,000 cases are known out of 120,000 people who may have the disease. Early identification leads to better care and outcomes. Patients with this disorder can attend this lipid clinic and a genetic screening clinic is run as part of the family support centre, offering DNA tests and cascade screening for families who fit our criteria. 

Paediatric Familial Hypercholesterolemia clinics are held at Royal Free hospital on Monday afternoon or Friday afternoon in children’s OPD. Families are given the option for face-to-face clinics as well as if clinically suitable (for stable cases) by phone.

The Royal Free Hospital was one of the first hospitals to open a family support centre for people with inherited cholesterol disorders. 

Our clinical nurse specialist provides the support to test the whole family. 

As this is a genetic disorder, doing cascade testing of family members allows early diagnosis and intervention.

This is another type of blood fat disorder. 

There is evidence that these blood fats can aggravate the cardiovascular disease in association with raised cholesterol levels. 

At high levels of more than 10mmol/L, it can lead to a more fatal condition like pancreatitis. 

Our lipid specialists provide the support for managing this condition by providing access to specialist testing, including genetic testing in appropriate cases and appropriate management.

The outreach lipid clinic at Edgware Community Hospital is run weekly on Friday afternoon and provides a full range of diagnostic and treatment services for adults with cholesterol/ triglyceride disorders. 

People with HIV may experience high cholesterol as a side effect of their medications. 

The dedicated HIV lipid clinic provides a consultant-led comprehensive service for patients on antiretroviral drugs experiencing cholesterol problems.

People at very risk of developing heart disease because they have a genetic condition and have very high cholesterol levels, or people who cannot tolerate high doses of statin and other oral lipid lowering drugs, if eligible for PCSK9 inhibitor therapy, as per National Institute of Clinical Excellence guidelines, are given the appropriate medication (Alirocumab. Evolocumab or Inclisiran ) in our specialist clinic .