From the Guidelines
For a patient with high cholesterol on initial medication, it is recommended to follow up in 4-12 weeks to assess the effectiveness of the treatment and potential side effects. At the follow-up visit, order a fasting lipid profile test to evaluate the patient's response to the medication, which should include total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides 1. Additionally, consider ordering liver function tests (such as alanine transaminase and aspartate transaminase) and a complete blood count to monitor for potential side effects of statin medications, which are commonly used to treat high cholesterol 1. If the patient is taking a statin, such as atorvastatin or simvastatin, also consider ordering a creatine kinase test to assess for muscle damage 1.
- The follow-up visit should be scheduled 4-12 weeks after initiation of statin therapy or a change in dose to monitor the response to therapy and inform medication adherence 1.
- Annual monitoring of lipid profiles is also recommended to assess the ongoing effectiveness of the treatment and potential side effects 1.
- Clinical judgment is recommended to determine the need for and timing of lipid panels in cases where patients are adherent but the LDL cholesterol level is not responding 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Follow-up Tests for Hypercholesterolemia
To monitor the effectiveness of lipid-lowering medication in patients with hypercholesterolemia, the following tests should be ordered at follow-up:
- Total cholesterol levels
- Triglycerides
- Low-density lipoprotein cholesterol (LDL-C) levels
- High-density lipoprotein cholesterol (HDL-C) levels
Frequency of Follow-up Tests
The frequency of follow-up tests may vary depending on the patient's risk factors and response to treatment. Studies have shown that more frequent monitoring of lipid levels can lead to better outcomes 2. Specifically, the study found that:
- Total cholesterol, triglycerides, and LDL-C concentrations decreased progressively with increased physician monitoring
- 6.9%, 9.9%, and 11.8% of men, and 5.7%, 9.7%, and 11.5% of women, went from having an LDL-C ≥160 to <160 mg/dL for their 1st, 2nd, and 3rd follow-up measurements, respectively
Treatment Goals
The goal of treatment for hypercholesterolemia is to reduce LDL-C levels to <100 mg/dL for high-risk patients 3. Studies have shown that achieving lower LDL-C levels can lead to greater risk reduction 3. The use of statins, either alone or in combination with other lipid-lowering agents, is effective in reducing LDL-C levels and improving outcomes 4, 5, 3.
Additional Considerations
It is also important to screen patients for heterozygous familial hypercholesterolemia, a common genetic disease of lipid metabolism responsible for particularly severe and early coronary disease 6. Additionally, the identification and aggressive treatment of high-risk patients should be a high priority for clinicians 3.