CVD prevention: CVD risk assessment and treatment
How NICE resources can support local priorities
Making the case for action
High cholesterol is one of the most significant risk factors for cardiovascular disease (CVD). It's characterised by the build-up of fatty deposits in arteries, so tends to increase as we age. A third of ischaemic heart disease is attributable to high cholesterol.
Raised cholesterol can also be caused by genetic conditions such as familial hypercholesterolaemia, which affects about 130,000 to 260,000 people in the UK, including children. Lipid-lowering therapy, such as statins, is highly effective but most people with familial hypercholesterolaemia are undetected.
The NHS Long Term Plan includes an ambition to prevent 150,000 strokes, heart attacks and dementia cases over the next 10 years by improving the detection and treatment of atrial fibrillation, hypertension and high cholesterol. To support this, a coalition led by Public Health England (PHE) has agreed specific ambitions for detecting and managing these high-risk conditions (see Health matters: preventing cardiovascular disease).
The ambitions for cholesterol are:
- By 2029, 75% of eligible people aged 40 to 74 without established CVD (such as a previous heart attack or stroke), have a validated CVD risk assessment and cholesterol reading recorded on a primary care data system in the last 5 years.
- By 2029, 45% of people aged 40 to 74 without established CVD who are identified as having a 20% or greater 10-year risk of developing CVD in primary care are treated with statins.
- By 2024, 25% of people with familial hypercholesterolaemia are diagnosed and treated in line with the NICE guideline on familial hypercholesterolaemia.
We've published guidance, quality standards and practical tools and resources to help improve local approaches to NHS health checks and support systematic detection and treatment of CVD risk factors.
Our guidance and quality standards can help you improve services, and are aligned to the NHS RightCare and PHE cardiovascular disease prevention pathway and will support the ambitions on cholesterol.
Use data about your area
Reviewing data on what’s happening in your area helps you compare how you're doing with other areas, and make decisions on how to improve care. These resources provide data related to CVD prevention in general, and high CVD risk and high cholesterol in particular:
- CVD Prevention Packs aim to provide information for the CVD prevention project. The CVD prevention programme set 10 year ambitions focussing on the three CVD risk factors, hypertension, atrial fibrillation and dyslipidaemia.
- PHE’s cardiovascular disease profiles for each CCG cover coronary heart disease, diabetes, kidney disease and stroke.
- GP Profiles cover a wide range of primary care indicators including cardio vascular diseases.
- RightCare's ‘where to look’ packs include headline opportunities, improvement opportunity tables and pathways on a page showing how CCGs in your area differ from their peers.
- NHS Health Checks fact sheets and CVD prevention ‘size of the prize’ impact estimates suggest the potential impact of improving Health Checks uptake and CVD prevention in each local area.
- PHE’s return on investment tool helps commissioners decide the best approach to preventing CVD in their populations, by showing predicted impacts of different interventions. Optimising use of statins and antihypertensives could bring some of the biggest cost savings.
Finding the right information
NICE guidance to help you with CVD risk assessment and treatment
NICE guidelines make evidence-based recommendations on topics ranging from preventing and managing specific conditions to planning broader services and interventions to improve the health of communities. They guide decisions about health and care by practitioners, providers, commissioners, service planners and users, and promote integrated care if appropriate.
We have guidelines on cardiovascular disease: risk assessment and reduction, including lipid modification and familial hypercholesterolaemia: identification and management.
The 2 relevant pathways here are cardiovascular disease prevention and familial hypercholesterolaemia.
Our quality standards on cardiovascular risk assessment and lipid modification and familial hypercholesterolaemia include quality statements that describe high-quality care in priority areas for improvement. See how to use quality standards for more information.
Support for improving quality
We publish a range of tools and resources to help with putting our guidance and quality standards into practice. You can find these on the ‘tools and resources’ tab for each piece of guidance or standard.
Tools and resources for CVD risk assessment include:
- baseline assessment tool
- costing report and template.
and for familial hypercholesterolaemia include:
- baseline assessment tool
- costing report and template
- familial hypercholesterolaemia: implementing a systems approach to detection and management.
Encouraging healthy changes such as improving your diet, stopping smoking or reducing your weight can help to lower cholesterol levels and reduce the risk of CVD and should be considered before initiating treatment with a statin. However, some people with high cholesterol will need to go straight onto a statin and NICE has published a patient decision aid on taking a statin to reduce the risk of coronary heart disease and stroke.
The summary of national guidance for lipid management for Primary and Secondary Prevention of CVD is a 2-pagealgorithm and pathway to provide a consistent approach to lipid management and modification across NHS organisations in England. It covers primary and secondary prevention, diagnosis, risk assessment, prescribing and monitoring.
The Statin Intolerance Pathway is a 2-page algorithm and pathway supporting a consistent approach to managing statin intolerance across NHS organisations in England. It is for people at high risk of cardiovascular disease, who report potential intolerance to high intensity statin treatment.
Our key therapeutic topic advice on lipid-modifying drugs summarises the evidence to support medicines optimisation.
Shared learning case studies
The shared learning collection contains over 500 case studies showing how organisations around the UK have used NICE guidance and standards to improve the quality of health and social care services. Examples are given below, but it is easy to search the collection for other topics.
Implementation of a telephone appointment service: improving access to familial hypercholesterolaemia cascade screening
NICE guidance recommends that first, second and third-degree biological relatives of people with a genetic diagnosis of familial hypercholesterolaemia should be offered cascade testing, but there is limited availability of genetic testing centres across the UK. A telephone appointment system provides a convenient and cost-effective method of genetically screening relatives wherever they live.
Improving awareness of familial hypercholesterolaemia in primary care
The All Wales Familial Hypercholesterolaemia Cascade Testing Service aims to improve the diagnosis of familial hypercholesterolaemia by offering genetic testing and implementing family cascade testing for families with an identified genetic mutation. They realised that improving awareness in primary care was an important success factor, so produced information packs and web-based training. This was particularly important for GPs in rural areas who would find it hard to attend training sessions.
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