Cardiovascular risk assessment and lipid modification

  • Quality standard
  • QS100
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Quality statement 2: Diet and lifestyle advice for primary prevention

Quality statement

Adults with a 10-year risk of cardiovascular disease of 10% or more receive tailored advice on diet and lifestyle changes within 3 months of their cardiovascular disease risk assessment score being recorded. [2015, updated 2025]

Rationale

Making improvements to diet, stopping smoking, increasing physical activity, managing weight and reducing alcohol consumption can reduce the risk of cardiovascular disease (CVD). Healthcare professionals should offer advice to adults with a 10-year CVD risk score of 10% or more after a full formal risk assessment, based on their individual needs, preferences and circumstances.

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 receive advice on diet and lifestyle changes within 3 months of their CVD risk assessment score being recorded.

Numerator – the number in the denominator who receive advice on diet and lifestyle changes within 3 months of their CVD risk assessment score being recorded.

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

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) ensure that systems are in place for adults with a 10-year risk of CVD of 10% or more to be given advice on diet and lifestyle changes within 3 months of their cardiovascular risk assessment score being recorded.

Healthcare professionals (such as GPs, nurses, healthcare support workers, and pharmacists) give advice on diet and lifestyle changes for the primary prevention of CVD to adults with a 10-year risk of CVD of 10% or more within 3 months of their cardiovascular risk assessment score being recorded. They take the person's individual needs, preferences and circumstances into account when giving advice.

Commissioners ensure that they commission services that can deliver diet and lifestyle advice to adults with a 10-year risk of CVD of 10% or more within 3 months of their cardiovascular risk assessment score being recorded.

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 given advice on diet and lifestyle changes, such as stopping smoking, losing weight, eating a healthy diet and exercising when they are found to be at risk. These changes may help to reduce their chances of having a heart attack or stroke in the future. The advice reflects their needs, preferences and circumstances.

Source guidance

Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE guideline NG238 (2023), recommendations 1.3.1 to 1.3.11, 1.6.2 and 1.6.3

The 3-month timeframe is based on expert opinion. The 3-month timeframe is not derived from NICE guideline on cardiovascular disease: risk assessment and reduction, including lipid modification. It is considered a practical timeframe to enable stakeholders to measure performance. The timeframe is used in NICE's indicator on cardiovascular disease prevention: primary prevention with lifestyle changes.

Definitions of terms used in this quality statement

Diet and lifestyle changes

Diet and lifestyle changes include:

  • stopping smoking

  • healthy eating

  • reaching and maintaining a healthy weight

  • increasing physical activity

  • reducing alcohol consumption.

[NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification, recommendations 1.3.1 to 1.3.11]

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].