[2014] 1.4.6 Exclude possible common secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome) before referring for specialist review. [2014] 1.4.7 Consider the possibility of familial hypercholesterolaemia and investigate as described in NICE's guideline on familial hypercholesterolaemia if they have: a total cholesterol concentration more than 7.5 mmol/litre and a family history of premature coronary heart disease. [2014] 1.4.8 Arrange for specialist assessment of people with a total cholesterol concentration of more than 9.0 mmol/litre or a non-HDL cholesterol concentration of more than 7.5 mmol/litre even in the absence of a first-degree family history of premature coronary heart disease. [2014] 1.4.9 Refer for urgent specialist review if a person has a triglyceride concentration of more than 20 mmol/litre that is not a result of excess alcohol or poor glycaemic control. [2014] 1.4.10 In people with a triglyceride concentration between 10 and 20 mmol/litre: repeat the triglyceride measurement with a fasting test (after an interval of 5 days, but within 2 weeks) and review for potential secondary causes of hyperlipidaemia and seek specialist advice if the triglyceride concentration remains above 10 mmol/ 1.4.11 In people with a triglyceride concentration between 4.5 and 9.9 mmol/ litre: be aware that the CVD risk may be underestimated by risk assessment tools and optimise the management of other CVD risk factors present and seek specialist advice if non-HDL cholesterol concentration is more than Statins for the prevention of CVD Recommendations in this section update and replace those in statins for the prevention of cardiovascular events (NICE technology appraisal guidance 94). There is a NICE patient decision aid to support discussions about statin therapy to reduce the risk of coronary heart disease and stroke. 