Dyslipidaemia

Fasting laboratory tests

• Lipid profile
• Fasting plasma glucoseif neededDepending on the clinical context.

Laboratory tests (fasting is not necessary)

• Lipid profile (total cholesterol, HDL-cholesterol, triglycerides, LDL-cholesterol)
• Fasting plasma glucose (if diabetes has not been screened for; the sample must then be taken fasting)if neededIf never measured: ESC/EAS proposes measuring it at least once in every adult to identify Lp(a) > 180 mg/dL (> 430 nmol/L), with a risk comparable to heterozygous familial hypercholesterolaemia ^[5,6]. The 2026 French consensus recommends it at least once in certain situations: premature coronary artery disease, familial hypercholesterolaemia, family history of premature atheroma, coronary recurrence despite well-conducted lipid-lowering treatment, diabetes or chronic kidney disease ^[4]. See the tab “Lipoprotein(a)”.
• Lipoprotein(a) [Lp(a)], once in a lifetime (not reimbursed in France)if needednon-French guidelineIf never measured: ESC/EAS proposes measuring it at least once in every adult to identify Lp(a) > 180 mg/dL (> 430 nmol/L), with a risk comparable to heterozygous familial hypercholesterolaemia ^[5,6]. See the tab “Lipoprotein(a)”.

Laboratory tests (fasting is not necessary) in 8 to 12 weeks

• Lipid profile
• ALT
• Creatine kinase (CK)if neededUnexplained muscle pain, cramps or weakness on a statin: CK is measured for these symptoms ^[9,12] (permanent discontinuation beyond 10 ULN, suspension between 4 and 10 ULN ^[4]). Before starting, in patients at risk of myopathy: renal failure (GFR < 60 mL/min/1.73 m²), hypothyroidism, age > 80 years, known muscle disease, previous CK elevation, statin-fenofibrate combination ^[4].

Then every year (fasting is not necessary)

• Lipid profile
• ALTif neededThe 2026 French consensus asks for a transaminase measurement every year once treatment is stable ^[4]. NICE does it once only, at 12 months ^[9]; ESC/EAS and INESSS do not ask for it routinely, except for signs of liver damage ^[6,13].

Laboratory tests (once)

• Lipoprotein(a) [Lp(a)], preferably in nmol/L (not reimbursed in France)

Fasting laboratory tests

• Lipid profile (follow-up)
• TSH
• AST
• ALT
• GGT
• Serum creatinine with eGFR
• Fasting plasma glucose

Urine tests

• Urine albumin:creatinine ratio (spot sample)
• Lipoprotein(a) (if never measured; not reimbursed in France)if neededSuspected familial hypercholesterolaemia: Lp(a) is particularly useful in this context ^[5,15].