NICE introduces new cholesterol target for people with cardiovascular disease

NICE has laid out guidance today which introduces a new target for cholesterol levels for people who have had a heart attack or stroke.

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

New cholesterol target expected to save thousands of lives

It is estimated that 2.6 million people in England have cardiovascular disease (CVD) with around 2.1 million prescribed cholesterol lowering therapies.

NICE estimates that keeping cholesterol below the above levels could reduce thousands of strokes, heart attacks and premature deaths, with up to 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 focused on providing useful and useable guidance for healthcare practitioners to help them and their patients make informed choices about their long-term healthcare.”

Additional treatments should be considered if cholesterol target is not reached with statins alone

If the person is taking the maximum tolerated dose and intensity of statin but the lipid target for secondary prevention of CVD is not met, NICE says GPs (or another primary care professional) should consider additional lipid-lowering treatments.

Even if the lipid target for secondary prevention of CVD is met, NICE also recommends considering ezetimibe in addition to the maximum tolerated intensity and dose of statin to reduce CVD risk further.

In all cases, NICE says an informed discussion should take place between the clinician and the patient about the risks and benefits of additional lipid-lowering treatments.

All cholesterol management pathways to be updated

Now, NICE says it will update cholesterol management pathways to ensure they are up to date with this latest guidance.

To read the full guidance on cardiovascular disease: risk assessment and reduction, including lipid modification, click here.