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:

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.

NICE Pathways are interactive flowcharts that show how everything we've published fits together. The following video explains how to use NICE Pathways.

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.

Our key therapeutic topic advice on lipid-modifying drugs summarises the evidence to support medicines optimisation. 

Diagram of cogs

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.

Image of a doctor talking on a mobile phone.

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.

An image of a Doctor talking to a woman and a child.