Commentary: Controversies in NICE guidance on lipid modification for the prevention of cardiovascular disease

doi:10.1136/bmj.39580.424352.AD

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Francesco P Cappuccio, Cephalon chair of cardiovascular medicine and epidemiology1

¹Clinical Sciences Research Institute, University of Warwick Medical School, Coventry CV2 2DX

f.p.cappuccio{at}warwick.ac.uk

The new guidelines from the National Institute for Health and Clinical Excellence (NICE) on lipid modification for the prevention of cardiovascular disease will guide the way we assess cardiovascular risk and treat lipids, both in primary and in secondary care. What are the new aspects, and what is it that might spark controversy in this new publication?

Risk assessment

To identify those requiring primary prevention of cardiovascular disease, the guideline reaffirms the threshold of a 10 year cardiovascular disease risk >20% in people aged over 40 years. Its recommendation of a systematic, rather than opportunistic, risk assessment is welcome, particularly in primary care. The new guidelines wisely reaffirm the 1991 Framingham risk score as the score of choice for guiding primary prevention.

However, they also retain subjective, non evidence-based adjustments. They advise increasing the risk estimate by …