Outcomes and learning

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Implementing lipid optimisation through prescribing strategies to reduce cardiovascular risk

Outcomes

Impact on patients

From reviewing the scheme data, in total between 2022 to 2025:

12,206 patient reviews were carried out by 368 GP practices
4,506 patients (37%) had lipid therapy optimised
consistent results were seen across all 3 BOB sub-ICB places.

Primary care prescribing data shows that the prescribing of low- and medium-intensity statins across BOB significantly reduced during the scheme period, which continues to be sustained. See OpenPrescribing data on low- and medium-intensity statins.

The national CVDPREVENT primary care data (CVDPREVENT regional and ICS insights) shows improvement on lipid-lowering therapy for:

Patients with no GP-recorded CVD and a GP-recorded QRISK score of 20% or more, who are currently treated with lipid-lowering therapy.
Patients with GP-recorded CVD (narrow definition), who are currently treated with lipid-lowering therapy.
Patients with GP-recorded chronic kidney disease (G3a to G5), who are currently treated with lipid-lowering therapy. The prescribing scheme only covered those with CKD stage 3.

Financial impact

Evidence shows that every 1 mmol/L reduction in LDL cholesterol delivers a 22% reduction in major vascular events after 1 year. Clinical modelling shows substantial potential impact on reducing future cardiovascular events and therefore also a potential financial saving of £1.3 million to £2.5 million over 3 years.

The UCLPartners Size of the Prize is an evidence-based initiative demonstrating that optimising the management of high blood pressure and cholesterol can prevent thousands of heart attacks and strokes in England, saving millions in NHS costs. CVDPREVENT is the data source for the Size of the Prize resource.

Baseline data for people with recorded CVD currently treated with lipid-lowering therapy for BOB ICB (March 2022) showed achievement at 80.2%. By June 2025, this had increased to 84% achievement. If the ICB continues to improve on this trajectory and achieves 86%, this could prevent 73 cardiovascular events and 9 deaths over a 3‑year period. The associated potential savings to the NHS would range between £1,100,300 to £1,767,403.

Learning

The coordinated work on CVD, with a lipid focus, has helped positively influence prescribing behaviour and confidence, which should reduce the number of cardiovascular events.

Analysis of the prescribing schemes have identified the following key themes.

Operational barriers

Difficulty contacting patients.
Movement between care settings disrupting follow up.
Missing or delayed blood tests.

Patient-related factors

Declining optimisation due to preference for current medication, fear of or previous side effects, or preference for lifestyle changes first.
Limited understanding of cholesterol and CVD risk and uncertainty about therapy.
Complexity in frail or multimorbid patients influencing appropriateness of changes.
Non-engagement or requests for repeated monitoring before making decisions.

Clinical factors

Variation in familiarity with national guidance, including updated statin intolerance pathways.
Significant drug interactions not managed.
Need for clearer awareness that CKD confers high CVD risk regardless of QRISK score.
Complex cases requiring specialist review or affected by other health conditions.

Optimisation patterns

Shift from 'fire and forget' approach with atorvastatin 20 mg; rosuvastatin used more for intolerance.
Growing prescribing of ezetimibe or bempedoic acid and referrals to lipid clinics.
Variation in statin dose titration, especially in secondary prevention.
Shift from total cholesterol to non-HDL/LDL cholesterol target-based optimisation.

The learnings from the prescribing schemes have been fed back to the system cardiac network to inform and align with the joint forward plan for CVD.

This page was last updated: 16 April 2026