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.