Lab Test Request — Statin Decision Review.xlsx

	B	C	D	E	F	G	H	I	J	K
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2	Lab Test Request — Statin Decision Review
3	Patient: Jacqueline McGrath Date prepared: July 28, 2026
4	Purpose: tests to discuss before starting statin therapy. Reference-guideline based; not medical advice.
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6	#	Test	Priority	Why I'm requesting it	Guideline basis	Requested (Y/N)	Result	Units / Target	Date	Notes

7	1	ApoB (apolipoprotein B)	Core	Directly counts atherogenic particles; better predictor of events than LDL-C. Preferred over LDL-C when triglycerides are above 1.5 mmol/L.	CCS 2021 — optional addition to initial screening; strong recommendation to use instead of LDL-C if TG >1.5 mmol/L			g/L — CCS target <0.8
8	2	Lipoprotein(a) / Lp(a)	Core	Largely genetic and does not respond to diet or exercise. A level of 50 mg/dL or higher is a risk modifier that can change an intermediate-risk decision.	CCS 2021 — measure once in a lifetime as part of initial lipid screening			mg/dL or nmol/L — risk modifier at >=50 mg/dL
9	3	Full lipid panel: TC, LDL-C, HDL-C, non-HDL-C, triglycerides	Core	Baseline before any therapy. Non-HDL-C is valid non-fasting and is a preferred parameter alongside apoB.	CCS 2021 — non-fasting acceptable for most adults; fast only if TG history >4.5 mmol/L			mmol/L
10	4	A1c or fasting plasma glucose	Core	Part of the standard workup, and a relevant baseline given the small new-onset diabetes signal associated with statins.	CCS 2021 — listed in the standard screening panel for all patients			% (A1c) or mmol/L (FPG)
11	5	eGFR (kidney function)	Core	Standard baseline; kidney disease is itself a statin indication and affects dosing.	CCS 2021 — listed in the standard screening panel for all patients			mL/min/1.73m2
12	6	hs-CRP (high-sensitivity C-reactive protein)	Helpful	Inflammatory marker used as a risk modifier; a level above 2 counts toward treating in the Canadian framework.	CCS 2021 — listed among additional risk modifiers			mg/L — modifier at >2
13	7	Coronary artery calcium (CAC) score	Tiebreaker	The decider if I am intermediate risk and undecided. Score of 0 supports withholding a statin and rescanning; 1-99 leans toward treating; over 100 means treat regardless of risk score.	CCS — indicated for asymptomatic adults over 40 at intermediate risk when treatment choice is unclear			Agatston units + age/sex percentile		Often not publicly funded in BC — ask about cost
14	8	TSH (thyroid)	Rule-out	Underactive thyroid can raise cholesterol. Worth excluding a reversible cause before committing to long-term therapy.	Standard secondary-cause screening for dyslipidemia			mIU/L
15	9	10-year Framingham Risk Score (calculated, not a lab)	Core	I want the actual percentage on paper, not just the label, since a statin is automatic at high risk but a judgment call at intermediate risk.	CCS 2021 — FRS is the recommended Canadian risk tool (<10% low, 10-19.9% intermediate, >=20% high)			% 10-year risk
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17		Priority key: Core = ask for these. Helpful = adds context. Tiebreaker = only if the statin decision is genuinely uncertain. Rule-out = excludes a reversible cause.
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19		Sources
20		2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia			https://onlinecjc.ca/article/S0828-282X(21)00165-3/fulltext
21		CCS 2021 Lipid Guidelines — Introduction (Lp(a) once in a lifetime)			https://ccs.ca/guideline/2021-lipids/chapter-1-introduction/
22		CCS 2022 Dyslipidemia Pocket Guide (PDF)			https://ccs.ca/wp-content/uploads/2022/07/2022-Lipids-Gui-PG-EN.pdf
23		Diabetes Canada Clinical Practice Guidelines — Dyslipidemia (apoB target <0.8 g/L)			https://guidelines.diabetes.ca/cpg/chapter25
24		Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice — Circulation			https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.068885
25		Major Global Coronary Artery Calcium Guidelines: Key Points — American College of Cardiology			https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2022/10/04/19/19/major-global-coronary-artery
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27		Prepared as a discussion aid using published Canadian and international lipid guidelines. Not a diagnosis or medical advice.
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