Quality statement 3: Lifestyle advice for primary prevention

Quality statement

Adults with a 10‑year risk of cardiovascular disease (CVD) of 10% or more receive advice on lifestyle changes before any offer of statin therapy.

Rationale

Lifestyle changes such as stopping smoking, increasing physical activity, eating a healthy diet, managing weight and reducing alcohol consumption can reduce the risk of CVD. Lifestyle changes should be made, if possible, before statin treatment is offered, because these can reduce a person's risk of CVD without the need for drug treatment. It is important that the benefits of lifestyle changes for primary prevention are discussed with adults at risk of CVD, to encourage uptake of lifestyle interventions before any offer of statin therapy.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with a 10‑year risk of CVD of 10% or more receive advice on lifestyle changes before any offer of statin therapy.

Data source: Local data collection.

Process

Proportion of adults with a 10‑year risk of CVD of 10% or more who receive advice on lifestyle changes before any offer of statin therapy.

Numerator – the number in the denominator who receive advice on lifestyle changes before any offer of statin therapy.

Denominator – the number of adults with a 10‑year risk of 10% or more.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (primary care) ensure that processes are in place for adults with a 10‑year risk of CVD of 10% or more to be given advice on lifestyle changes before any offer of statin therapy.

Healthcare professionals give advice on lifestyle changes to adults with a 10‑year risk of CVD of 10% or more before they offer statin therapy.

Commissioners (NHS England area teams and clinical commissioning groups) ensure that GPs are aware that adults with a 10‑year risk of CVD of 10% or more should be given lifestyle advice before offering statin therapy. Commissioners may wish to consider incorporating this discussion into NHS Health Checks and local enhanced service specifications. Collaboration with local authorities (as the commissioner of NHS Health Checks) may be necessary to achieve this.

What the quality statement means for patients, service users and carers

Adults with a 1 in 10 or more chance of developing CVD in the next 10 years (a 10‑year risk of 10% or more) are given advice on lifestyle changes, such as stopping smoking, losing weight, eating a healthy diet and exercising, before being offered statin therapy. These changes may help to reduce their chances of having a heart attack or stroke in the future.

Source guidance

  • Lipid modification (2014) NICE guideline CG181, recommendations 1.3.14, 1.3.15 and 1.1.27

Definitions of terms used in this quality statement

Lifestyle changes

Lifestyle changes include:

  • stopping smoking

  • eating a healthy diet

  • reaching and maintaining a healthy weight

  • increasing physical activity

  • reducing alcohol consumption.

[Lipid modification (NICE guideline CG181) recommendations 1.2.1–1.2.17]

Equality and diversity considerations

The statement includes adults with a 10‑year risk of CVD of 10% or more, as determined by their QRISK2 score if they are under 85 years. Adults aged 85 years and older should be considered to be at high risk based on age alone, particularly those who smoke or have high blood pressure. Because QRISK2 calculates a person's CVD risk over the next 10 years, its risk scores may underestimate risk in younger people or women who have additional risk because of underlying medical conditions, such as serious mental health problems or severe obesity (body mass index greater than 40 kg/m2). When using a QRISK2 risk score to inform drug treatment decisions, particularly if it is near the threshold for treatment, take into account other factors that may predispose the person to premature CVD that may not be included in calculated risk scores.

The lifestyle advice given should be sensitive to people's culture and faith, and tailored to their needs. An interpreter should be consulted if needed for people whose first language is not English.