This is a summary of the somewhat controversial updated guideline from NICE on lipids. You could probably only have failed to notice the uproar surrounding this is you’d been living on Mars for the last few months. I am just summarising the guideline here, but please comment if you feel strongly about it!
I have listed eight key ‘take-home messages’, then a more comprehensive summary below.
Eight key take-home messages
- Measure lipids on a non-fasting sample. Take note of the ‘Total Cholesterol’ (TC) and the ‘Non-HDL’ levels (ie TC – HDL).
- Use QRISK2 as the standard risk scoring tool UNLESS the patient has:
- CKD with GFR < 60 and/or albuminuria.
- Type 1 diabetes (NB you can use QRISK2 for T2DM and manage people as you otherwise would).
- Age 85 or over (assume they are high risk).
- Familial Hypercholesterolaemia (beware TC > 7.5 AND a FHx of premature CVD.
- If the risk is 10% per 10 years or more, offer lifestyle advice initially, then atorvastatin 20mg
- Consider using atorvastatin at any age in t1 diabetics, but especially if over 40 or other risk factors (see the full summary below).
- Use atorvastatin 20mg for patients with CKD.
- For secondary prevention use atorvastatin 80mg (unless they have CKD in which case use 20mg).
- When it comes to non-statin drugs, only ezetimibe should be routinely used.
- Target cholesterol. Aim for a 40% reduction in non-HDL cholesterol after 3m
What tests should we be doing?
Non-fasting sample (which is why they aren’t bothering with LDL which requires a fasting sample).