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Improve management of raised cholesterol (and other CVD risk factors)

  • The NHS Wales cardiovascular atlas of variation (NHS Wales, 2019) notes modifiable behavioural risk factors for coronary heart disease include tobacco use/ smoking (BRF-001), unhealthy diet (BRF-002) and alcohol misuse (BRF-004).
  • Insufficient physical activity (BRF-003) and psycho-social stress/ poor mental well-being (MHW-001) are additional potentially modifiable behavioural risk factors (NICE, 2010).
  • The NHS Wales cardiovascular atlas of variation (NHS Wales, 2019) notes high blood cholesterol is a modifiable clinical (metabolic) risk factor for coronary heart disease; other clinical risk factors include hypertension (CRF-001) and obesity (CFR-003), as well as diabetes (LTC-004).
  • Lifestyle modifications for the primary and secondary prevention of CVD should include advice on cardio-protective diet, physical activity, weight management, alcohol consumption and smoking cessation, and lipid modification therapy (CG181).
  • When managing familial hypercholesterolaemia, clinicians are advised by NICE to regard “lifestyle advice” as a component of medical management, and not as a substitute for lipid-modifying drug therapy; this involves advice on diet, physical activity, weight management, alcohol consumption, and smoking (CG71).
  • A 10% reduction in serum cholesterol in 40 year old men has been reported to result in a 50% reduction in heart disease within five years (WHO, 2011).
  • For signposting to relevant NICE guidelines/ quality standards relating to lipid management as a source of potential improvement actions, see below.