History?

Alcohol units/week?

Smoking?

- Never smoked?

- Stopped smoking (date)?

- Number of cigarettes per day?

Examination:

Height?

Weight?

BMI?

BP?

Investigations:

Checked if required lab test results were available and requested outstanding parameters?

Lipid profile?

CK (if persistent generalised unexplained muscle pain (whether associated with previous lipid-lowering therapy or not)?

ALT/AST?

Renal function?

HbA1c?

TSH (if symptoms of underactive or overactive thyroid)?

QRISK3?

Management:

Primary prevention?

QRISK3 < 10%?

Advised that although the risk is low, further reductions in risk can often still be achieved? Offer advice on any relevant lifestyle factors that can be improved?

Considered reviewing any relevant comorbidities that may not be optimally treated? 

Advise that a further risk assessment should be considered in 5 years?

Considered using a lifetime risk tool such as QRISK3-lifetime to inform discussions on CVD risk and to motivate lifestyle changes?

(Note: Do not rule out treatment with atorvastatin 20 mg just because the QRISK3 is < 10% if the patient has an informed preference for taking a statin or there is concern that risk may be underestimated.)

Aged 25 to 84 years and QRISK3 ≥ 10%?

Diabetes type 1 and aged > 40, diabetes for > 10 years, established CKD or other CVD risk factors)?

CKD?

Familial hypercholesterolaemia?

- If yes to any of the above and no CI offered Atorvastatin 20 mg?

Diabetes type 1?

≥ 85 years (particularly if smoker or raised BP)?

- If yes to any of the above and no CI considered Atorvastatin 20 mg (without the need of a formal risk assessment)?

Secondary prevention?

Atorvastatin 80 mg if no CI offered?

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Advised that the adverse effects of statins are generally mild, reversible, and not medically serious, although some people may find them distressing?

Advised that myopathy and rhabdomyolysis are the most serious adverse effects of statins, but rare with an estimated incidences of 5 cases per 100,000 person years and 1.6 cases per 100,000 person years, respectively?

Advised to seek medical advice if adverse effects are experienced such as unexplained muscle symptoms (pain, tenderness, or weakness)?

Lidid modification - General Patient Information explained and provided?

Advised review after lipid profile and liver function test control in 3 months?

Reference(s):

NICE CKS: Lipid modification - CVD prevention. May 2023

NICE CKS: CVD risk assessment and management. May 2023