Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Identifying and assessing cardiovascular disease (CVD) risk

  • For the primary prevention of CVD in primary care, use a systematic strategy to identify people who are likely to be at high risk. [2008, amended 2014]

  • Prioritise people for a full formal risk assessment if their estimated 10‑year risk of CVD is 10% or more. [2008, amended 2014]

  • Use the QRISK2 risk assessment tool to assess CVD risk for the primary prevention of CVD in people up to and including age 84 years. [new 2014]

  • Do not use a risk assessment tool to assess CVD risk in people with an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 and/or albuminuria[2]. These people are at increased risk of CVD. See recommendation 1.3.27 for advice on treatment with statins for people with chronic kidney disease. [new 2014]

Lipid modification therapy for the primary and secondary prevention of CVD

  • Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. This should include measurement of total cholesterol, high‑density lipoprotein (HDL) cholesterol, non‑HDL cholesterol, and triglyceride concentrations. A fasting sample is not needed. [new 2014]

  • Offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10‑year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool. [new 2014]

  • Start statin treatment in people with CVD with atorvastatin 80 mg[3]. Use a lower dose of atorvastatin if any of the following apply:

    • potential drug interactions

    • high risk of adverse effects

    • patient preference. [new 2014]

  • Measure total cholesterol, HDL cholesterol and non‑HDL cholesterol in all people who have been started on high-intensity statin treatment (both primary and secondary prevention, including atorvastatin 20 mg for primary prevention) at 3 months of treatment and aim for a greater than 40% reduction in non‑HDL cholesterol. If a greater than 40% reduction in non‑HDL cholesterol is not achieved:

    • discuss adherence and timing of dose

    • optimise adherence to diet and lifestyle measures

    • consider increasing dose if started on less than atorvastatin 80 mg and the person is judged to be at higher risk because of comorbidities, risk score or using clinical judgement. [new 2014]

[2] People on renal replacement therapy are outside the scope of this guideline.

[3] At the time of publication (July 2014), atorvastatin did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information.

  • National Institute for Health and Care Excellence (NICE)