TY - JOUR T1 - Cardiovascular risk assessment and lipid modification: NICE guideline JF - British Journal of General Practice JO - Br J Gen Pract SP - 378 LP - 380 DO - 10.3399/bjgp15X685933 VL - 65 IS - 636 AU - Martin Duerden AU - Norma O’Flynn AU - Nadeem Qureshi Y1 - 2015/07/01 UR - http://bjgp.org/content/65/636/378.abstract N2 - The National Institute for Health and Care Excellence (NICE) has updated its guidance on cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease (CVD).1 This article discusses the main recommendations and the implications of the update for general practice. New evidence on risk assessment tools and on statins and reduction in the cost of statins has resulted in significant changes to the level of risk at which treatment is recommended, and on the choice and dose of statins. The new guideline also incorporates guidance on lipid modification for people with type 1 and type 2 diabetes and with chronic kidney disease (CKD). See Box 1 for a summary of the main points of the revised lipid-modification guideline.Box 1. Summary of the updated NICE lipid-modification guidelineIdentifying high risk systematically Prioritise those people for formal risk assessment based on an estimate of risk from information already known and recorded in the electronic medical record.In those with an estimated 10-year risk of a CVD event >10% prioritise for full formal risk assessment. This is a change from the previous 20% risk threshold and will involve considerably more people.Use the QRISK2 risk assessment tool for formal risk assessment for people age <84 years. This is a change from the choice between QRISK2 and Framingham-based assessment, previously recommended. QRISK2 is available on primary care computer systems.Also use QRISK2 for those people with type 2 diabetes. This is a change from previous guidance which recommended UKPDS.Do not use QRISK2 for people with type 1 diabetes. Because of high CVD risk, all adults with type 1 diabetes should be considered for statin therapy.Do not use a risk assessment tool to assess CVD risk in people with an estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or albuminuria. It … ER -