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Practice Guidelines

Lipid modification and cardiovascular risk assessment for the primary and secondary prevention of cardiovascular disease: summary of updated NICE guidance

BMJ 2014; 349 doi: (Published 17 July 2014) Cite this as: BMJ 2014;349:g4356
  1. Silvia Rabar, senior research fellow and project manager1,
  2. Martin Harker, senior health economist1,
  3. Norma O’Flynn, clinical director and guideline lead1,
  4. Anthony S Wierzbicki, professor of cardiometabolic disease 2
  5. On behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Guy’s and St Thomas’ Hospitals, London, UK
  1. Corresponding author: S Rabar silvia.rabar{at}

Cardiovascular disease (CVD) is the leading cause of death in England and Wales, accounting for almost a third of deaths. An update of existing National Institute for Health and Care Excellence (NICE) guidance (published in 2008)1 was necessary in light of new evidence on the efficacy and safety of statin therapy,2 on the effects of combining statins with non-statin drugs,3 4 5 and on novel risk assessment tools for predicting risk of CVD.6 Since the previous guideline, more statins have become available as generic drugs, and this has changed the cost effectiveness of statin treatment. The scope of the update included risk assessment for CVD and the use of lipid modification in people with type 1 diabetes, type 2 diabetes, and chronic kidney disease.

This article summarises the most recent recommendations from NICE on lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease.7


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

Assessing the risk of CVD

Full formal risk assessment

  • Use the QRISK2 risk assessment tool6 to assess CVD risk for the primary prevention of CVD in the general population, including people with type 2 diabetes. QRISK2 cannot be used in people over 84 years of age.

  • The available risk tools do not adequately assess risk in certain people. Do not use a risk assessment tool to assess the risk of CVD in people with:

    • -Type 1 diabetes

    • -Evidence of estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 or albuminuria (or both)

    • -Pre-existing CVD

    • -Familial hypercholesterolaemia or …

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