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

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