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CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Lipid modification - primary and secondary CVD prevention - How up-to-date is this topic?
Changes

Version 1.5, revision planned in 2012.

Last revised in December 2008

June 2010 — minor update. Following a review of the data from the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) trial [Clinical Trial Service Unit, 2008], the Medicines and Healthcare products Regulatory Agency (MHRA) has advised that simvastatin 80 mg should be considered only in patients with severe hypercholesterolaemia and high risk of cardiovascular complications who have not achieved their treatment goals on lower doses, when the benefits are expected to outweigh the potential risks [MHRA, 2010]. Issued in June 2010.

November 2009 — minor update. Advice from the Medicines and Healthcare products Regulatory Agency (MHRA) [MHRA, 2009b] that treatment with any statin may be associated with depression, sleep disturbances, memory loss, sexual dysfunction or, very rarely, interstitial lung disease has been added. Issued in November 2009.

October 2009 — minor update. A reminder from the Medicines and Healthcare products Regulatory Agency (MHRA) [MHRA, 2009a] that aspirin is not licensed for use in primary prevention of vascular events has been added. Issued in October 2009.

April 2009 — updated to include indicators related to lipid modification in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the Goals and outcome measures section. Issued in May 2009.

June to December 2008 — converted from PRODIGY guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

The recommendations have been updated in line with guidance issued by the National Institute for Health and Clinical Excellence on lipid modification [NICE, 2008a]. Significant changes to the recommendations include:

  • For primary prevention of cardiovascular disease (CVD):
    • Repeat lipid measurement is unnecessary. A target for total or low-density lipoprotein (LDL) cholesterol is not recommended.
  • For secondary prevention of CVD:
    • The use of higher intensity lipid-modifying treatment (simvastatin 80 mg) is recommended if a target total cholesterol of less than 4 mmol/L or a low-density lipoprotein (LDL) cholesterol of less than 2 mmol/L has not been achieved.
    • Other higher intensity statin therapy (other than simvastatin 80 mg) is not recommended except for people with acute coronary syndrome (where the use of atorvastatin 80 mg is cost effective).

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