Guidance
This guideline covers identifying and assessing risk of cardiovascular disease (CVD) in adults without established CVD. It covers lifestyle changes and lipid-lowering treatment (including statins) for primary and secondary prevention of CVD, and includes guidance for people who also have diabetes or chronic kidney disease.
In December 2023, we reviewed the evidence and made a new recommendation on the target lipid level for secondary prevention of CVD for adults on lipid-lowering treatment. For more details, see the update information.
Recommendations
This guideline includes new and updated recommendations on:
- initial lipid measurement and referral for specialist review
- discussions and assessment before starting statins
- statins for primary prevention of cardiovascular disease
- lipid-lowering treatment for secondary prevention of cardiovascular disease
- statins for primary or secondary prevention of cardiovascular disease in people with chronic kidney disease
- optimising treatment for people on statins
- statins are contraindicated or not tolerated
- assessing response to treatment
- lipid-lowering treatments that should not be used or not used routinely
These supplement the existing recommendations on:
- identifying and assessing cardiovascular disease risk for people without established cardiovascular disease
- aspirin for primary prevention of cardiovascular disease
- lifestyle changes for the primary and secondary prevention of cardiovascular disease
Who is it for?
- Healthcare professionals
- Adults who are at risk of CVD or who have CVD
Guideline development process
How we develop NICE guidelines
This guideline updates and replaces NICE guideline CG181 (July 2014).
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.