National Institute for Health and Clinical Excellence (NICE)
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Millions of people with cardiovascular disease could benefit from a new cholesterol treatment target recommendation

Up to 2.1 million people with cardiovascular disease (CVD) could benefit from a new cholesterol target outlined in NICE guidance for the first time

Updated final guidance published today (Thursday 14 December 2023) introduces a new target for cholesterol levels for people who have had a heart attack or stroke to reduce the risk of them having another.

CVD is the cause of 1 in 4 deaths in England. Secondary prevention is treatment for people who have already had an adverse health incident because of CVD, such as a heart attack or stroke.

The guidance recommends that if statins alone are not sufficient to reach the blood cholesterol target in an individual, then clinicians can consider additional treatments, following a conversation on the risks and benefits with the patient.  

The guidance recommends that for secondary prevention of CVD clinicians aim to keep patients’ low-density lipoprotein (LDL) cholesterol levels at 2.0 mmol per litre or less, or non-HDL cholesterol levels of 2.6 mmol per litre or less.

It is estimated that 2.6 million people in England have CVD with around 2.1 million prescribed cholesterol lowering therapies to help treat and manage elevated cholesterol associated with the condition.

It is estimated that by increasing the number of people reaching the 2.0 mmol per litre or less LDL target, many more health incidents can be avoided, including strokes, heart attacks, and premature deaths.

The potential benefits of implementing these recommendations will vary according to how many people with uncontrolled CVD take additional treatments to reduce their cholesterol. NICE estimates there could be between 50,000 and 145,000 fewer CVD events over 10 years.

Professor Jonathan Benger, NICE chief medical officer said: “Improving the control of cholesterol in a larger number of people will further reduce deaths from heart attacks and strokes. This guideline will help clinicians talk through the options with their patients to achieve the best outcomes.

“We are focussed on providing useful and useable guidance for healthcare practitioners to help them and their patients make informed choices about their long-term healthcare.”

Monitoring of cholesterol levels usually takes place in primary care and the decision to prescribe an additional treatment will be taken by a GP and other primary care clinicians in discussion with the patient.

Cholesterol management pathways will be updated to ensure they are aligned with the updated guidance in discussion with NHSE and the Health Innovation Network.

Read the full final guidance on cardiovascular disease: risk assessment and reduction, including lipid modification on the NICE website.

Read the NICE guideline on Cardiovascular disease: risk assessment and reduction, including lipid modification

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