Cardiovascular risk assessment and primary prevention — Rapid

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.

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

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.

Confirm that this is primary prevention and identify conditions in which QRISK3 should not be used.
Measure smoking status, blood pressure, BMI, full lipids, glycaemic status and renal function; review family history, comorbidity and medicines.

Key medicines

Atorvastatin20 mg orally once daily for primary prevention.

Ezetimibe10 mg orally once daily.

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