02 — Patient Eligibility

Table of Contents

• 1.0 Overview
• 2.0 Inclusion Criteria
  • 2.1 Primary Dyslipidemia
  • 2.2 Risk-Based Referrals
  • 2.3 Medication-Related Referrals
  • 2.4 Evaluation Referrals
• 3.0 Exclusion Criteria
• 4.0 Triage and Scheduling
  • 4.1 Referral Receipt
  • 4.2 Priority Scheduling
  • 4.3 Pre-Visit Preparation
• 5.0 Version History
• References

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1.0 Overview

The Sandusky Dyslipidemia Model clinic accepts adult patients referred for evaluation and management of dyslipidemia and associated atherosclerotic cardiovascular disease (ASCVD) risk. This document defines the criteria used to determine patient eligibility for the clinic.

2.0 Inclusion Criteria

Patients meeting any one of the following criteria are eligible for referral:

2.1 Primary Dyslipidemia

Criterion	Details
2.1.1 Elevated LDL-C despite therapy	LDL-C above goal per 2026 ACC/AHA guidelines [1] after adequate trial of first-line therapy
2.1.2 Severe hypercholesterolemia	LDL-C ≥ 190 mg/dL (any age ≥ 18)
2.1.3 Suspected familial hypercholesterolemia	Clinical features, family history, or Dutch Lipid Clinic Network Score ≥ 6 [2]
2.1.4 Severe hypertriglyceridemia	Fasting triglycerides ≥ 500 mg/dL (pancreatitis risk management)
2.1.5 Mixed dyslipidemia	Combined hyperlipidemia requiring multi-agent therapy

2.2 Risk-Based Referrals

Criterion	Details
2.2.1 High or very high ASCVD risk	10-year ASCVD risk ≥ 20% by AHA PREVENT equations [3], or established ASCVD
2.2.2 Risk-enhancing factors with borderline/intermediate risk	Patients with 10-year risk 5–19.9% and one or more risk enhancers per 2026 guidelines [1]
2.2.3 Elevated coronary artery calcium	CAC score ≥ 100 Agatston units, or ≥ 75th percentile for age and sex
2.2.4 Elevated lipoprotein(a)	Lp(a) ≥ 125 nmol/L, particularly with family history of premature ASCVD
2.2.5 Post-ASCVD event optimization	Patients after MI, stroke, or revascularization requiring lipid therapy intensification

2.3 Medication-Related Referrals

Criterion	Details
2.3.1 Statin intolerance	Documented intolerance to ≥ 1 statin requiring alternative therapy evaluation
2.3.2 Need for advanced therapies	Patients who may require PCSK9 inhibitors, inclisiran, or other advanced agents
2.3.3 Complex drug interactions	Dyslipidemia management complicated by concomitant medications

2.4 Evaluation Referrals

Criterion	Details
2.4.1 Secondary dyslipidemia workup	Suspected secondary cause requiring systematic evaluation
2.4.2 Discordant lipid parameters	Discordance between LDL-C, non-HDL-C, and/or ApoB requiring advanced lipid characterization

3.0 Exclusion Criteria

The following patients are not appropriate for this clinic:

Criterion	Rationale	Alternative
3.1 Age < 18 years	Clinic serves adults only	Refer to pediatric lipid specialist
3.2 Isolated low HDL-C without other lipid abnormality	No evidence-based pharmacotherapy to raise HDL-C reduces ASCVD events [4]	Manage via primary care with lifestyle counseling
3.3 Dietary counseling as primary need	No dietitian or nutrition services on-site	Refer to registered dietitian
3.4 Acute coronary syndrome or hemodynamic instability	Requires inpatient management	Emergency department / inpatient cardiology
3.5 Request for nutraceutical management only	Nutraceuticals are not part of the clinic’s therapeutic plan	Discuss with referring provider

4.0 Triage and Scheduling

4.1 Referral Receipt

Upon receipt of a referral, clinic staff verify that the patient meets at least one inclusion criterion (Section 2.0) and does not meet an exclusion criterion (Section 3.0). Referrals that do not meet criteria are returned to the referring provider with an explanation.

4.2 Priority Scheduling

Priority	Criteria	Target Scheduling
Urgent	LDL-C ≥ 190 mg/dL, post-ACS event < 3 months, TG ≥ 500 mg/dL	Within 2 weeks
Standard	All other eligible patients	Within 4–6 weeks

4.3 Pre-Visit Preparation

Patients scheduled for a new visit are instructed to:

1. Bring a current medication list or medication bottles
2. Bring any prior lipid panel results, imaging reports, or relevant records
3. Complete labs ordered by the referring provider (if applicable)
4. Arrive 15 minutes early for nursing intake

5.0 Version History

Version	Date	Description
1.0.0	2026-03-30	Initial release

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References

1. 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia. J Am Coll Cardiol. 2026.
2. Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease. Eur Heart J. 2013;34(45):3478–3490a.
3. Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):e430–e449.
4. AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365(24):2255–2267.