Key points

Key points

  • The NICE guideline on cardiovascular disease: risk assessment and reduction, including lipid modification makes recommendations on the care and treatment of people at risk of cardiovascular disease (CVD) and people who have had previous CVD. This includes people with chronic kidney disease (CKD), type 1 diabetes and type 2 diabetes.

  • When a decision is made to prescribe a statin for primary or secondary prevention of CVD, the NICE guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, recommends using a statin of high intensity and low acquisition cost. The NICE guideline on familial hypercholesterolaemia gives recommendations for people with this condition.

  • People with primary hypercholesterolaemia should be considered for ezetimibe treatment in line with the NICE technology appraisal guidance on ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia.

  • People with primary hypercholesterolaemia or mixed dyslipidaemia should be considered for treatment with the PCSK9 inhibitors alirocumab or evolocumab in line with the NICE technology appraisal guidance on alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia and evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia.

  • The NICE guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, recommends that bile acid sequestrants, nicotinic acid, fibrates and omega‑3 fatty acid compounds should not generally be offered (see the guideline for details). It may be appropriate to use bile acid sequestrants or fibrates to treat familial hypercholesterolaemia in some circumstances (see the NICE guideline on familial hypercholesterolaemia).

  • Options for local implementation:

    • Review and, if appropriate, optimise prescribing of lipid-modifying drugs including statins, ezetimibe, bile acid sequestrants, fibrates, nicotinic acid, omega‑3 fatty acid compounds and PCSK9 inhibitors to ensure it is in line with NICE guidance.

    • Ensure that decisions relating to prescribing lipid-modifying drugs, especially statins for primary prevention, incorporate principles of shared decision making.