Using our recommendations: cardiovascular disease
How to use NICE guidance to reduce health inequalities in people experiencing cardiovascular disease (CVD).
The challenge
Cardiovascular disease (CVD) is a major burden for society. It is responsible for the largest gap in health life expectancy in the UK. People are almost twice as likely to die because of CVD in the most deprived 10% of the population than in the least deprived 10%.
Not all people at risk of CVD are being identified (primary prevention) or having treatment to prevent further events (secondary prevention):
Risk factors for CVD are more common in the most deprived socioeconomic groups. So, lipid modification is a particular focus in the Core20PLUS5 initiative to reduce health inequalities.
The NHS 10-year plan outlines a focus to reduce preventable CVD mortality by 25% by the development of a CVD Modern Service Framework due in spring 2026.
In primary care, health inequalities in CVD are visible every day: in who gets identified, who gets optimised, and who falls through the gaps. NICE guidance, indicators and implementation tools give clinicians a shared framework to tackle this systematically, rather than relying on individual clinician effort alone.
Farah FarzanaGP trainee and NICE fellow
There are many specific examples of health inequalities in CVD.
To show you how you can use our guidance and resources when addressing these in commissioning services etc, we will focus on the secondary prevention of CVD lipid target for people taking lipid-lowering (LDL) treatments.
We will refer to this to provide examples of the support we can offer you.
CVD lipid target for people taking lipid-lowering treatments
Our guideline on cardiovascular disease recommends the lipid target for secondary prevention of CVD to aim for is:
LDL cholesterol levels of 2.0 mmol per litre or less, or
non-HDL cholesterol levels of 2.6 mmol per litre or less.
Lowering LDL cholesterol is a widely accepted and evidence-based strategy for lowering CVD risk. This is in tandem with tackling other causal risk factors such as reducing blood pressure and promoting a healthy lifestyle.
The guideline development committee agreed that, as a general principle, LDL cholesterol and non-HDL cholesterol levels should be reduced as much as possible in people with CVD.
A key aim of agreeing targets for LDL cholesterol, and adapting the Quality and Outcomes Framework indicators in line with these, is to increase implementation across primary and secondary care. We want prevention that reaches everyone.
This is the first time we have set a cholesterol target for secondary prevention. We want to help prioritise those most likely to benefit from lipid-lowering treatments, dose increases, and additional non-statin treatments. All while providing the best value for money.
Guidance
Our CVD guidance gives you a clear structure to help you deliver care that is as equitable and accessible as possible.
See our topic page on cardiovascular conditions to find guidance for a specific cardiovascular condition.
However, it is also important for you to consider the wider influencing factors that contribute to health inequalities, so may also want to consider reviewing guidance we have in other topic areas such as:
Equality and Health Inequalities Impact Assessments and health inequality briefings: make your health and care decisions fair and inclusive
We consider health inequalities at every stage of guidance development.
This starts with an Equality and Health Inequalities Impact Assessment (EHIA). This helps ensure recommendations promote equity, address disparities and do not adversely affect any groups. These can be found on the History tab of guidance.
The equality impact assessment (old name for the EHIA) for our guideline on cardiovascular disease gives information on older people and disabled people. It explains the inequality considerations and NICE's recommendations for lipid-lowering treatment.
Implementing our recommendations: more tools and resources
Using our tailored tools and resources can help you implement our guidance and overcome barriers to uptake and adoption. This will also support you to reduce unneeded variation and health inequalities.
We have included below information and examples of the most common type of tools and resources.
However, there are many more bespoke resources you can access if needed. You can find all of these on the tools and resources tab of all guidance.
You can use our indicators in a number of different ways to address health inequalities, including:
identifying where improvements are needed
setting priorities for quality improvement and support
creating local performance dashboards
benchmarking performance against national data
supporting local quality improvement schemes
showing progress that local health systems are making on outcomes.
Our indicators include:
Cholesterol treatment target (secondary prevention) (IND278)
This covers people with cardiovascular disease in whom the last recorded cholesterol level was at target or less.
Cardiovascular disease prevention: lipid lowering therapy for people newly diagnosed with hypertension or T2DM (IND287)
This covers people with a new diagnosis and a risk assessment score of 10% or more who are having a lipid-lowering treatment.
Find out more about how you can use our indicators and how we develop them.
You can use these to evaluate whether practice in your locality is in line with the recommendations in our guidance. They can also help you plan future activity to meet recommendations relating to health inequalities. You will find them under the audit and service improvement heading.
See the recommendations relating to lipid-lowering treatment for secondary prevention of CVD in the baseline assessment tools for NICE's guideline on cardiovascular disease.
These tools help you plan and implement guidance effectively. By using them, you can identify where resources need to be allocated to improve access and outcomes including those for underserved populations where relevant.
They support equitable planning by highlighting local variations and cost drivers, enabling you to target interventions where they will have the greatest impact on reducing health inequalities.
See the resource impact tools for NICE's guideline on cardiovascular disease.
These can provide you with further information and support on challenging implementation issues and unwarranted variation that may be associated with the guidance.
There are many different types of these resources including:
educational resources
clinical and patient decision aids
summary documents
implementation toolkits
commissioning guides.
Examples of available resources include:
The NHS England summary of national guidance for lipid management for primary and secondary prevention of CVD.
An FAQ to provide answers to some commonly asked questions about NICE’s guideline on cardiovascular disease.
Articles supporting implementation of NICE's guidelines, produced in collaboration with Medscape UK.
A patient decision aid to support people conversations between a person and their healthcare professional supporting them to make an informed decision about taking a statin.
Bespoke quality improvement packs for ICBs produced by CVDPREVENT.
Real world case study: how our resources made an impact
Hear from real people who delivered real outcomes by using NICE guidance and other tools.
Our case study provides valuable insights into how you can use our guidance across various healthcare settings too.
It highlights:
innovative approaches
challenges faced
the impact of implementing evidence-based recommendations on patient outcomes and service delivery.
Read our a news story based on examples from practice for CVD and statins:
More people are benefitting from NICE-recommended statins to reduce heart attacks and strokes
Further reading
NICE's manual for technology appraisal and highly specialised technologies guidance explains how we consider the effects of health technologies on health inequalities.