Quality statement 3: Lipid-lowering treatment for primary prevention

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Quality statement

Adults with a 10-year risk of cardiovascular disease of 10% or more are prescribed a high-intensity statin or other lipid-lowering treatment if a high-intensity statin is contraindicated or not tolerated. [2015, updated 2025]

Rationale

High-intensity statins are the most clinically effective treatment option for the primary prevention of cardiovascular disease (CVD). After a full formal risk assessment that estimates an adult without CVD has a 10-year risk of CVD of 10% or more and following a discussion with a healthcare professional about the risks and benefits of starting statin treatment, an adult may choose statin treatment to reduce their risk of CVD. Atorvastatin 20 mg is recommended as the preferred high-intensity statin, but other lipid-lowering treatment could be used if atorvastatin 20 mg is contraindicated or not tolerated.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults with a 10-year risk of CVD of 10% or more who are prescribed a lipid-lowering treatment.

Numerator – the number in the denominator who are prescribed a lipid-lowering treatment.

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

Data source: CVDPREVENT indicator CVDP006CHOL reports the proportion of patients with no GP recorded CVD and a GP-recorded QRISK score of 10% or more, who are currently treated with lipid-lowering therapy. The indicator also reports data for inequality markers including sex, age, ethnicity, deprivation level and presence of a learning disability.

What the quality statement means for different audiences

Service providers (primary care services) ensure that systems are in place for adults with a 10-year risk of CVD of 10% or more to be offered a high-intensity statin or other lipid-lowering treatment, if required, to achieve their individual lipid target of a greater than 40% reduction in non-high density (HDL) cholesterol.

Healthcare professionals (such as GPs, nurses and pharmacists) offer a high-intensity statin to adults with a 10-year risk of CVD of 10% or more, or other lipid-lowering treatment if required, to achieve their individual lipid target of a greater than 40% reduction in non-high density (HDL) cholesterol. They are aware of strategies to address adverse effects of high-intensity statins when reported by an adult on a high-intensity statin. They could use the NHS England statin intolerance pathway to address statin intolerance.

Commissioners ensure that lipid-lowering treatment is available for adults with a 10-year risk of CVD of 10% or more.

Adults with a 1 in 10 chance or more of developing CVD in the next 10 years (a 10-year risk of 10% or more) are offered medicine to lower their cholesterol. They can use the NICE patient decision aid on should I take a statin? to talk about options with their doctor, nurse or pharmacist.

Source guidance

Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE guideline NG238 (2023), recommendations 1.6.1, 1.6.2, 1.6.7, 1.9.1 and 1.9.3
Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia. NICE technology appraisal guidance 694 (2021)
Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia. NICE technology appraisal guidance 385 (2016).

Definitions of terms used in this quality statement

High-intensity statin or other lipid-lowering treatment

See NHS England's summary of national guidance for lipid management.

Equality and diversity considerations

Clinical judgement should inform interpretation of results from CVD risk tools because tools may underestimate the risk in certain groups of people , including, but not limited to:

people treated for HIV
people already taking medicines to treat CVD risk factors
people who have recently stopped smoking
people taking medicines that can cause dyslipidaemia, such as immunosuppressant drugs
people with severe mental illness
people with autoimmune disorders, and other systemic inflammatory disorders.

When using a QRISK3 risk score to inform treatment decisions in these populations, 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. [Adapted from NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, recommendation 1.1.10]

A person's sex will affect their CVD risk assessment score, and this should be considered when estimating risk for trans people. [Adapted from NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, rationale and impact section on full formal risk assessment].

For adults aged 85 and older, treatment with atorvastatin 20 mg should be considered with awareness of factors that may make treatment inappropriate, such as the person's preference, presence of comorbidities, whether they are on multiple medications, whether they are frail, their cognitive status, and their life expectancy. [NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, recommendations 1.5.2 and 1.6.9 and expert opinion]