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.
ENDS
Note to editors
- NICE consulted on a draft treatment target that was
potentially suitable for local and national general practice
measurement frameworks in 2022. Stakeholders supported using an
absolute target to guide treatment decisions and support quality
improvement. However, there was not a consensus as to what the
target figure should be.
- Putting recommendations into practice can take time. How long
will vary from guideline to guideline, and will depend on how
much change in practice or services is needed. Implementing
change is most effective when aligned with local
priorities. 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.
- A link to the final guidance can be found here: NG238 Guidance 20231214
CONFIDENTIAL.docx
