Cardiovascular risk assessment and lipid modification

  • Quality standard
  • QS100
  • Published: 
  • Last updated: 
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Quality statement 4: Assessing response to lipid-lowering treatment

Quality statement

Adults starting or changing lipid-lowering treatment have a full lipid profile and their liver transaminases measured at 2 to 3 months. [2015, updated 2025]

Rationale

Repeating lipid profiles and measuring liver transaminases after starting or changing lipid-lowering treatment (and after a baseline blood sample has been taken), is important for patient safety and to ensure the effectiveness of the treatment. A repeat lipid profile can be used to determine whether the expected lipid levels have been met and can indicate the need for escalation of treatment. Measurement of liver transaminase is important to detect any increased levels of these enzymes, which may indicate problems with liver function.

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 starting or changing lipid-lowering treatment who had a full lipid profile and their liver transaminases measured at 2 to 3 months.

Numerator – the number in the denominator who had a full lipid profile and their liver transaminases measured at 2 to 3 months.

Denominator – the number of adults starting or changing lipid-lowering treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from electronic patient records.

What the quality statement means for different audiences

Service providers (such as primary care services or secondary care services) ensure that adults on lipid-lowering treatment have a full lipid profile and their liver transaminases measured 2 to 3 months after starting or changing treatment.

Healthcare professionals (such as GPs, doctors, nurses and pharmacists) measure a full lipid profile and liver transaminases 2 to 3 months after adults start or change lipid-lowering treatment.

Commissioners ensure that adults on lipid-lowering treatment have a full lipid profile and liver transaminases measured 2 to 3 months after starting or changing treatment.

Adults taking medicine to reduce their chance of a heart attack or stroke have a blood test 2 to 3 months after starting or changing medicine to check that it is reducing their cholesterol levels and not affecting their liver.

Definitions of terms used in this quality statement

Full lipid profile

This involves taking a blood sample to measure total cholesterol, HDL cholesterol and triglyceride levels and then calculating non-HDL cholesterol and LDL cholesterol (a fasting sample is not mandated). LDL cholesterol results may not be reported in participants with triglyceride levels more than 4.5 mmol per litre or 9 mmol per litre depending on the formula used by local laboratories. [NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, terms used in this guideline]