Cardiovascular disease: risk assessment and reduction, including lipid modification

Context

Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for almost 18 million deaths each year (over 30% of all global deaths). Around 7 million people in the UK have CVD.

Over 70 million prescriptions for statins are dispensed in England each year, costing the NHS around £100 million. The total healthcare cost of CVD in England is estimated to be £7.4 billion.

Despite the weight of conclusive research and consistent national and international guidelines, many people at significant risk of CVD do not receive lipid-lowering treatment, or they receive inadequate treatment. Anxieties about the safety of statins may mean healthcare professionals are reticent about offering them, and people are reluctant to start or continue statin treatment. Depending on statin intensity, 30% to 50% of people stop taking statins within 6 years.

Over the past 5 years, more evidence has become available on the benefits and adverse effects of statins.

Ways to estimate and explain CVD risk have also improved, and healthcare professionals now have more varied and accurate approaches available for individualised risk assessment. This can empower patients and professionals to discuss interventions to reduce short-term and long-term CVD risk.

Increasing awareness of elevated lipids (including cholesterol) as a risk factor for CVD, so that appropriate intervention can be provided, is critical to the delivery of the NHS Long Term Plan. By 2029, the ambition in England is for at least 45% of people aged 40 to 74 with a 20% or greater risk of developing CVD in the next 10 years to be on appropriate lipid-lowering treatment. Local achievement of this ambition can be monitored using the CVDPREVENT audit.