The National Institute for Health and Clinical Excellence (NICE) guideline, Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease1 is a significant advance over earlier more fragmented approaches to cardiovascular risk. The guideline provides strategies for identification of patients at risk, suggests lipid modification in primary and secondary prevention and unifies treatment approaches to coronary heart disease, stroke and peripheral vascular disease. This guideline does not give recommendations for patients with underlying disorders that increase cardiovascular disease risk, but NICE guidance on diabetes, which includes lipid modification, has also just been published2 and NICE guidance on familial hypercholesterolaemia is due shortly.

A 20% cardiovascular disease (CVD) 10-year risk threshold for statin treatment was established by the technology appraisal on statins.3 This is considerably lower than the previously recommended National Service Framework threshold, which is equivalent to a 40% CVD risk. The new 20% CVD risk threshold increases the numbers of people targeted for further clinical assessment and possible statin treatment for primary prevention in England and Wales from around one million to over three million.4 The guideline endorses this threshold and sets out a strategy for the identification of people at high CVD risk and clarifies their management and treatment.

The guidance recommends a systematic strategy to identify people …