• Cardiovascular disease is a major financial burden to the NHS and a leading cause of disability and death in the UK1

    The NHS Long Term Plan aims to prevent up to 150,000 cases of heart attack, stroke and dementia over the next 10 years.2,3

    The plan of action to tackle CVD includes3

    National statements

    The NICE clinical guideline for ‘Cardiovascular disease: risk assessment and reduction, including lipid modification’ was last updated in September 20164

    NICE published a surveillance report of CG181 in 2018, which highlighted that, since publication of the guideline, NICE have recommended PCSK9 inhibitors for specific groups of patients with inadequate control of LDL-C on maximum tolerated statin therapy (NICE TA393)5

    The report advised that PCSK9 inhibitors should be incorporated into the guideline recommendations as part of an update5. The planned update will also include identification and assessment of CVD risk, and lipid modification therapy for the primary and secondary prevention of CVD6

    An estimated seven million people in the UK are living with cardiovascular disease and every three minutes someone dies as a result7

    Premature death rate from CVD (before the age of 75) are the most common in the North West, closely followed by the North East and the lowest in the South East of England8

    The total annual healthcare cost of heart and circulatory diseases in England is estimated at £7.4billion8

    NHS England: Our Ambition to Reduce Premature Mortality

    Premature CVD death rate

    Data from 2015 to 2017
    Adapted from: BHF Statistics Factsheet – England8

    There are clear recommendations in the UK regarding optimal cholesterol levels9, 10

    People with high levels of LDL-C should pay particular attention to keeping their cholesterol levels within a recommended range9, 10

    For people with existing CVD and uncontrolled LDL-C

    View detailed recommendations

    In an observational study, only 2 in 5 UK patients at very high cardiovascular risk achieved the ESC/EAS recommended goal of <1.8 mmol/L despite treatment with statins11

    Despite recommendations regarding optimal cholesterol levels, an observational study found that half of all high-risk cardiovascular disease patients still have LDL-C levels that are too high11

    In an observational study, when hospitalized for ACS, only 1 in 4 people with high CV risk and treated with lipid-lowering therapy were at the ESC/EAS recommended goal of <1.8mmol/L12

    An audit (MINAP)* in 2016, identified that diagnosed hyperlipidaemia (elevation of LDL-C levels requiring treatment) was more prevalent in people experiencing a second heart attack than in those experiencing their first13

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    *MINAP: Myocardial Ischaemia National Audit Project
    †The term ‘baseline’ referes to the LDL-C level in a person not taking any LDL-C lowering medication. In people who are taking LDL-C-lowering medication(s), the projected baseline (untreated) LDL-C levels should be estimated, based on the average LDL-C-lowering efficacy of the given medication or combination of medications.14

    1. Public Health England Press Release, September 2018. ‘Prevention must be at the heart of the NHS long-term plan’. Available at: https://www.gov.uk/government/news/prevention-must-be-the-heart-of-the-nhs-long-term-plan/ Last accessed: July 2020
    2. The NHS Long Term Plan, January 2019. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf Last accessed: July 2020
    3. Public Health England. Health matters: preventing cardiovascular disease, February 2019. Available at: https://www.gov.uk/government/publications/health-matters-preventing-cardiovascular-disease/health-matters-preventing-cardiovascular-disease Last accessed: July 2020
    4. NICE Clinica Guideline CG181. Available at: https://www.nice.org.uk/guidance/cg181/ Last accessed: July 2020
    5. NICE Surveillance report 2018 Appendix A – NICE guideline CG181. Available at: https://www.nice.org.uk/guidance/cg181/evidence/appendix-a-evidence-summaries-pdf-4724759774 Last accessed: July 2020
    6. NICE Surveillance report 2018 – NICE guideline CG181. Available at: https://www.nice.org.uk/guidance/cg181/resources/surveillance-report-2018-cardiovascular-disease-risk-assessment-and-reduction-including-lipid-modification-2014-nice-guideline-cg181-pdf-6123288665797 Last accessed: July 2020
    7. British Heart Foundation, CHF Statistics Factsheet – UK, January 2020. Available at: https://www.bhf.org.uk/-/media/files/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf?la=en Last accessed: July 2020
    8. British Heart Foundation, BHF Statistics Factsheet – England, December 2019. Available at: https://www.bhf.org.uk/-/media/files/research/heart-statistics/bhf-cvd-statistics-england-factsheet.pdf?la=en Last accessed: July 2020
    9. National Institute for Health and Care Excellence. CG71. Published 2008, last updated November 2017. Available at: https://www.nice.org.uk/guidance/cg71 Last accessed: July 2020
    10. Piepoli MF et al. Eur Heart J. 2016; 37:2315-81
    11. Gitt AK et al. Data in brief. 2016; 9:616-20
    12. Gitt AK et al. Atherosclerosis. 2017; 266:158-22
    13. Myocardial Ischaemia National Audit Project (MINAP) Annual Public Report April 2015 – March 2016
    14. Mach F et al. Eur Heart J. 2019; doi:10.1093/eurheartj/ehz455. [Epub ahead of print]