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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Cardiovascular risk assessment and primary prevention

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Synopsis

Apply NICE cardiovascular-risk assessment and lipid-modification recommendations in UK adults without established cardiovascular disease.

  • Use QRISK3 for formal 10-year risk estimation in eligible adults aged 25 to 84 years.
  • Do not use a risk calculator when risk is already high because of established CVD, type 1 diabetes, CKD with eGFR below 60 mL/min/1.73 m² or albuminuria, familial hypercholesterolaemia, or another inherited lipid disorder.
  • Offer atorvastatin 20 mg daily for primary prevention when QRISK3 is 10% or more after an informed discussion.
  • A score below 10% does not exclude atorvastatin when the person prefers treatment or risk may be underestimated.
  • For people aged 85 years or older, consider atorvastatin 20 mg without relying on a 10-year calculator; frailty, comorbidity, polypharmacy and life expectancy matter.
  • Aim for a reduction in non-HDL cholesterol greater than 40% from baseline in primary prevention.
  • Do not routinely offer aspirin for primary prevention of CVD.

Key red flags

Immediate clinical disease

Exertional chest pain, focal neurological symptoms, acute limb ischaemia or heart-failure features require diagnostic assessment, not a primary-prevention calculator.

Investigation priorities

01
Non-fasting full lipid profileFirst step

Establish total, HDL, non-HDL, LDL cholesterol and triglycerides.

Management branches

FirstStructured primary-prevention assessment

Adult without known CVD attends for prevention review or NHS Health Check.

  1. Confirm that this is primary prevention and identify conditions in which QRISK3 should not be used.
  2. Measure smoking status, blood pressure, BMI, full lipids, glycaemic status and renal function; review family history, comorbidity and medicines.
  3. Calculate QRISK3 when eligible and discuss absolute risk, uncertainty and modifiable contributors.
  4. Address lifestyle and condition-specific treatment; arrange timely review rather than waiting indefinitely before treating high risk.

Key medicines

Atorvastatin20 mg orally once daily for primary prevention.Check interactions, pregnancy status and liver disease; investigate unexplained muscle symptoms and use a lower dose or alternative strategy if intolerance is confirmed.
Ezetimibe10 mg orally once daily.Check hepatic impairment and interactions; when combined with a statin, retain statin safety monitoring.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG238: Cardiovascular disease risk assessment and reductionCurrent UK risk assessment, statin initiation, targets and monitoring.
  • NICE CKS: CVD risk assessmentPrimary-care implementation and NHS Health Check context.
  • NICE CG71: Familial hypercholesterolaemiaFH identification and cascade testing.
  • Atorvastatin 20 mg SmPCUK product dosing and cautions.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom