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Practice Guidelines

Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance

BMJ 2008; 336 doi: (Published 29 May 2008) Cite this as: BMJ 2008;336:1246
  1. Angela Cooper, senior health services research fellow,
  2. Norma O’Flynn, clinical director
  3. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Primary Care, Royal College of General Practitioners, London SW7 1PU
  1. Correspondence to: N O’Flynn noflynn{at}

    Why read this summary?

    Cardiovascular disease remains a leading cause of morbidity and mortality in the United Kingdom. Randomised controlled trials have shown benefit from modifying risk factors in people at risk of developing cardiovascular disease and in those who have evidence of established disease. Currently patients are often assessed opportunistically and treated on the basis of individual clinical or laboratory results rather than on their overall level of risk of developing cardiovascular disease. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the effective identification and assessment of people at risk of cardiovascular disease, and on the modification of lipids in primary and secondary prevention. The detailed consideration of the evidence is available in the full guideline ( CG67).1


    NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Identifying those at risk of cardiovascular disease for primary prevention

    • Use a systematic strategy rather than opportunistic assessment to identify people at high risk of the disease.

    • Exclude patients known to have established cardiovascular disease or who are already considered at high risk, such as patients with diabetes or lipid disorders.

    • Estimate risk of cardiovascular disease using risk factors already recorded in primary care records, such as age, sex, and blood pressure.

    • Use the estimated risk value to prioritise patients, and arrange a full formal risk assessment for patients whose estimated 10 year risk is ≥20%.[These first four recommendations are based on results from health economic modelling]

    • Assess risk (both estimate and formally) using the 1991 Framingham 10 year risk equations, with the following variables: age (30-74 years), sex, systolic blood pressure (mean of previous two systolic readings), total cholesterol …

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