Cardiovascular risk assessment and lipid modification

Quality statement

Adults with a 10‑year risk of cardiovascular disease (CVD) of 10% or more receive advice on lifestyle changes before any offer of statin treatment.

Rationale

Lifestyle changes such as stopping smoking, increasing physical activity, eating a healthy diet, managing weight and reducing alcohol consumption can reduce the risk of CVD. Lifestyle changes should be made, if possible, before statin treatment is offered, because these can reduce a person's risk of CVD without the need for drug treatment. It is important that the benefits of lifestyle changes for primary prevention are discussed with adults at risk of CVD, to encourage uptake of lifestyle interventions before any offer of statin treatment.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

What the quality statement means for different audiences

Service providers (primary care services) ensure that processes are in place for adults with a 10‑year risk of CVD of 10% or more to be given advice on lifestyle changes before any offer of statin treatment.

Healthcare professionals (such as GPs, nurses and pharmacists) give advice on lifestyle changes to adults with a 10‑year risk of CVD of 10% or more before they offer statin treatment.

Commissioners ensure that GPs are aware that adults with a 10‑year risk of CVD of 10% or more should be given lifestyle advice before offering statin treatment. Commissioners may wish to consider incorporating this discussion into NHS Health Checks and local enhanced service specifications.

Adults with a 1 in 10 or more chance of developing CVD in the next 10 years (a 10‑year risk of 10% or more) are given advice on lifestyle changes, such as stopping smoking, losing weight, eating a healthy diet and exercising, before being offered statin treatment. These changes may help to reduce their chances of having a heart attack or stroke in the future.

Source guidance

Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE guideline NG238 (2023), recommendations 1.1.17, 1.6.2 and 1.6.3

Definitions of terms used in this quality statement

Equality and diversity considerations

The statement includes adults with a 10‑year risk of CVD of 10% or more, as determined by their QRISK3 score if they are between 25 and 84 years. Adults aged 85 years and older should be considered to be at high risk based on age alone, particularly those who smoke or have high blood pressure. People aged under 25 are not at high risk for CVD unless they have a specific condition that increases risk.

Clinical judgement should inform interpretation of results from CVD risk tools when used in certain groups of people because tools may underestimate the risk (see NICE's guideline on cardiovascular disease, recommendation 1.1.10). When using a QRISK3 risk score to inform drug treatment decisions, particularly if it is near the threshold for treatment, take into account other factors that may predispose the person to premature CVD that may not be included in calculated risk scores.

The lifestyle advice given should be sensitive to people's culture and faith, and tailored to their needs. An interpreter should be consulted if needed for people whose first language is not English. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.