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High Cholesterol

Reduce CVD risk for all

Treat to target

Think Familial Hyperlipidaemia

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1.      The NHS lipid pathway on a page is a simple and easy summary of all aspects of managing lipids from primary to secondary prevention as well as diagnosing and treating familial hyperlipidaemia.
2.      Statin reluctance or intolerance can be challenging to manage, the Statin Intolerance Pathway, simplifies this into easy steps for success. 
3.     1 in 250 people have familial hyperlipidaemia yet we diagnose <5%; ALWAYS think FH when reviewing cholesterol results. Many remained undiagnosed and undertreated, risking not only the patient’s health but failing to cascade test their family. Offer a cholesterol test to ALL adults at least once under 40 years to avoid missing FH.
4.      Use high intensity statins (atorvastatin and rosuvastatin) when prescribing for secondary and primary prevention.
5.      Always record CVD risk for primary prevention using QRISK3 for patients who may need primary prevention.
6.      Treatment target recommendations vary a between guidelines, but the consensus is always to treat as low as possible to provide maximal CVD risk reduction.
7.      Ezetimibe is recommended for all patients not to target as an add on therapy or alternative if statins are not tolerated.
8.     Bempedoic acid is a new drug treatment, working like a statin, to add to Ezetimbe or use as monotherapy when other treatments are not tolerated
9.      PCSK9i remain underutilised and are available from specialist lipid services (see NHS lipid pathway for details).
10.  UCLP lipid stratification tool is easy to run on GP systems and allows a practice to quickly identify patients who are undertreated requiring review.


Improving detection and management of high cholesterol

Too many people are still living with undetected and poorly managed high cholesterol across Cheshire and Merseyside. Public Health England (PHE) and NHS England have agreed national ambitions for the detection and management of high cholesterol and Familial Hypercholesterolaemia over the next 10 years. C&M Health and Care Partnership has committed to acheiving these ambitions through a whole-system approach. 

The cholesterol ambitions are:

By 2029: 75% of eligible people aged 40 to 74 without established CVD, such as a previous heart attack or stroke, have received a formal validated CVD risk assessment and cholesterol reading recorded on a primary care data system in the last 5 years 

By 2029: 45% of people aged 40 to 74 without established CVD, such as a previous heart attack or stroke, identified as having a 20% or greater 10-year risk of developing CVD in primary care are treated with statins

By 2024: 25% of people with Familial Hypercholesterolaemia (FH) are diagnosed and treated optimally according to the NICE FH Guideline

The infographic to the right reflects national levels as at 2019. 

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Includes guidelines, pathways, websites and other resources. 

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View on demand national and local condition-specific webinars. 

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Includes leaflets, websites, decision aids and more. 

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The evidence base driving local strategy. 

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