Synopsis
Translate lipid results into UK primary- and secondary-prevention treatment, recognise familial hypercholesterolaemia and intensify therapy safely to national targets.
- Offer atorvastatin 20 mg for primary prevention when QRISK3 10-year CVD risk is at least 10%; do not deny treatment solely because risk is below 10% when informed preference or underestimated risk supports it.
- For established CVD, offer atorvastatin 80 mg unless interactions, adverse-effect risk or patient preference justify a lower dose.
- Aim for more than a 40% reduction in non-HDL cholesterol in primary prevention and LDL cholesterol 2.0 mmol/L or less or non-HDL cholesterol 2.6 mmol/L or less in secondary prevention.
Key red flags
Triglycerides above 20 mmol/L, or 10–20 mmol/L persisting on a fasting repeat, may reflect uncontrolled diabetes, alcohol, medicines or a genetic disorder and carries pancreatitis risk.
Investigation priorities
Quantify total, HDL, non-HDL and triglycerides and calculate LDL where valid.
Management branches
A lipid profile and cardiovascular risk review identify a prevention opportunity.
- First: optimise smoking, diet, activity, weight, alcohol and blood pressure, and correct major secondary causes; do not make lifestyle change a prerequisite for statin discussion.
- Next: calculate QRISK3 where appropriate and offer atorvastatin 20 mg when risk is at least 10%, also considering treatment below 10% when risk may be underestimated or the informed patient prefers it.
Key medicines
AtorvastatinPrimary prevention: 20 mg orally once daily. Secondary prevention: 80 mg orally once daily; use a lower dose when interactions, high adverse-effect risk or patient preference require it.
Ezetimibe10 mg orally once daily, with or without food.