Overview
This guideline covers identifying and assessing risk of cardiovascular disease (CVD) in adults without established CVD. It covers lifestyle changes and lipid-lowering treatment (including statins) for primary and secondary prevention of CVD, and includes guidance for people who also have diabetes or chronic kidney disease.
For people with familial hypercholesterolaemia, see the NICE guideline on familial hypercholesterolaemia.
Last reviewed: 2 September 2025
We added links to relevant technology appraisal guidance in the sections on lipid-lowering treatment for primary prevention of CVD, lipid-lowering treatment for secondary prevention of CVD, treatment if statins are contraindicated or not tolerated and lipid-lowering treatments that should not be used or not used routinely. This is to provide easy access to relevant guidance at the right point in the guideline only and is not a change in practice.
Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.
How we prioritise updating our guidance
Decisions about updating our guidance are made by NICE’s prioritisation board. For more information on the principles and process, see NICE-wide topic prioritisation: the manual.
For information about individual topics, including any decisions affecting this guideline, see the summary table of prioritisation board decisions.
This guideline updates and replaces NICE guideline CG181 (July 2014).
Recommendations
This guideline includes recommendations on:
- identifying and assessing CVD risk for people without established CVD
- aspirin for primary prevention of CVD
- lifestyle changes for the primary and secondary prevention of CVD
- initial lipid measurement and referral for specialist review
- discussions and assessment before starting statins
- lipid-lowering treatment for primary prevention of CVD
- lipid-lowering treatment for secondary prevention of CVD
- statins for primary or secondary prevention of CVD in people with chronic kidney disease
- optimising statin treatment
- treatment if statins are contraindicated or not tolerated
- assessing response to treatment
- lipid-lowering treatments that should not be used or not used routinely
Who is it for?
- Healthcare professionals
- Adults who are at risk of CVD or who have CVD
Guideline development process
How we develop NICE guidelines
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.