Quality Prescribing Guidance for Cardiovascular Risk Reduction 2026-2029
Hyperlipidaemia
- Non-fasting sampling of lipid parameters is recommended for general risk screening
- Measure both total blood cholesterol and high-density lipoprotein (HDL) cholesterol to achieve the best estimate of CVD risk
- Primary prevention using a statin is recommended in individuals with:
- ASSIGN v2.0 score ≥10%
- CKD eGFR <60 or ACR >3mg/mmol (approx. equal to 30 mg/g)
- Familial hypercholesterolaemia (FH)
- Type 1 diabetes who are over 40 years old, or disease duration >10 years, or nephropathy or other CVD risk factors
- Atorvastatin 20mg daily is the statin of choice in primary prevention
- Consider ezetimibe
- where initial statin therapy is contraindicated or individuals cannot tolerate statin therapy
- co‑administered with initial statin therapy when Serum total or Low-density Lipoprotein (LDL) cholesterol concentration is not appropriately controlled or a change from initial statin therapy to an alternative statin is being considered
- If treatment is initiated, its effect must be evaluated, and subsequent treatment intensification to reach ultimate risk factor goals must be considered in all patients, taking into account additional benefit, comorbidities, and frailty, all of which converge with patient preferences in a shared decision-making process
- The absolute benefit of lowering Low-Density Lipoprotein Cholesterol (LDL-C) depends on the absolute risk of Atherosclerotic Cardiovascular Disease (ASCVD) and the absolute reduction in LDL-C, so even a small absolute reduction in LDL-C may be beneficial in a high- or very-high-risk patient