Synopsis
Interpret lipid patterns in cardiovascular context, identify secondary and familial disease, and use statins and add-on therapy to evidence-based UK targets with safe monitoring.
- Use a non-fasting profile for routine assessment: total cholesterol, HDL cholesterol, non-HDL cholesterol and triglycerides, calculating LDL when analytically appropriate.
- For primary prevention, NICE recommends offering atorvastatin 20 mg when QRISK3 is 10% or more and considering it below 10% when risk may be underestimated or the person prefers treatment.
- For established cardiovascular disease, offer atorvastatin 80 mg unless interaction, adverse-effect risk or preference justifies a lower dose; do not recalculate QRISK.
Key red flags
Severe muscle pain or weakness, dark urine, marked CK rise, hyperkalaemia or acute kidney injury demands immediate statin cessation, hospital assessment and interaction review.
Investigation priorities
Characterise atherogenic cholesterol and screen triglyceride severity conveniently.
Management branches
An adult without established cardiovascular disease is being considered for lipid lowering.
- Obtain a lipid profile, blood pressure, smoking, diabetes, renal and family history, exclude major secondary causes and calculate QRISK3 when the tool is appropriate.
- Optimise lifestyle and offer atorvastatin 20 mg when ten-year risk is at least 10%, also discussing treatment below threshold when risk may be underestimated.
Key medicines
Atorvastatin for primary preventionTake 20 mg orally once daily when NICE primary-prevention criteria and shared decision-making support treatment; increase intensity if the non-HDL response remains below target after adherence review.
Atorvastatin for secondary preventionTake 80 mg orally once daily for established cardiovascular disease unless interactions, adverse-effect risk or patient preference support a lower dose, then maximise the tolerated intensity.