At-a-glance
• Use QRISK3 for most adults 25–84 without established CVD.
• Primary prevention: offer atorvastatin 20 mg when QRISK3 ≥10% (after shared decision-making).
• Secondary prevention: offer atorvastatin 80 mg for established CVD unless lower dose is indicated.
• Targets: primary prevention aims >40% reduction in non-HDL; secondary prevention targets LDL ≤2.0 mmol/L or non-HDL ≤2.6 mmol/L.
Primary prevention (NICE NG238)
- Risk estimation: use QRISK3 for people aged 25–84 without established CVD (and recognise where risk may be underestimated).
- Offer statin: atorvastatin 20 mg for primary prevention when 10-year QRISK3 risk is ≥10%, after an informed discussion of benefits/harms and patient preferences.
- Lipid target: aim for a >40% reduction in non-HDL cholesterol once on statin therapy.
Secondary prevention (established CVD) (NICE NG238)
- Initial treatment: offer atorvastatin 80 mg to people with established CVD, whatever their baseline cholesterol, unless drug interactions, high adverse-effect risk, or patient preference indicates a lower dose.
- Lipid targets: for secondary prevention, aim for LDL ≤2.0 mmol/L or non-HDL ≤2.6 mmol/L.
- If not at target: optimise adherence, address secondary causes, up-titrate where tolerated; consider add-on therapies in line with NICE technology appraisals (e.g., ezetimibe) and local lipid pathways.
Before starting and monitoring (practical checklist)
- Baseline: full lipid profile, assess secondary causes (e.g., hypothyroidism, nephrotic syndrome), medication review, lifestyle discussion.
- Safety: counsel on muscle symptoms and interactions; consider baseline LFTs per local policy.
- Follow-up: re-check lipids to confirm expected response and adjust intensity/adjuncts to meet targets.
Frequently asked questions
What statin dose is recommended for primary prevention at QRISK3 ≥10%?
NICE NG238 recommends offering atorvastatin 20 mg for primary prevention when 10-year QRISK3 risk is 10% or more (after shared decision-making).
What statin dose is recommended for established CVD?
NICE NG238 recommends atorvastatin 80 mg for secondary prevention unless lower dose is needed due to interactions, adverse-effect risk, or patient preference.
What lipid targets should I use?
Primary prevention: aim for >40% reduction in non-HDL cholesterol. Secondary prevention: aim for LDL ≤2.0 mmol/L or non-HDL ≤2.6 mmol/L.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.