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. 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]

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

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. Use a lower dose of atorvastatin if any of the following apply:

  • 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]

  • National Institute for Health and Care Excellence (NICE)