Excerpt

This guideline updates for primary prevention, the NICE technology appraisal, ‘Statins for the prevention of cardiovascular events’ (TA94, 2007) and reviews and updates the recommendations made in the NICE guideline Lipid Modification (CG67, 2008) for primary and secondary prevention of cardiovascular disease (CVD). The scope for this guideline was limited to the identification and assessment of CVD risk and to the assessment and modification of lipids in people at risk of CVD, or people with known CVD. The guideline development group wishes to make clear that lipid modification should take place as part of a programme of risk reduction which also include attention to the management of all other known CVD risk factors.

Contents

• Guideline update
• Guideline Development Group
• 1. Introduction
  • 1.1. Background
  • 1.2. Management of CVD risk
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
• 3. Methods
  • 3.1. Developing the review questions and outcomes
  • 3.2. Searching for evidence
  • 3.3. Evidence of effectiveness
  • 3.4. Evidence of cost effectiveness
  • 3.5. Developing recommendations
• 4. Guideline summary
  • 4.1. Key priorities for implementation
  • 4.2. Full list of recommendations
  • 4.3. Key research recommendations
  • 4.4. How this clinical guideline was updated
• 5. Identification of people requiring assessment of CVD risk [2008]
  • 5.1. Evidence statements for the identification of people at high risk of developing CVD
  • 5.2. Clinical effectiveness of identification of people requiring assessment of CVD risk
  • 5.3. Cost-effectiveness identification of people requiring assessment of CVD risk [2008]
  • 5.4. Conclusions
  • 5.5. Recommendations [2008]
• 6. Full formal risk assessment of CVD risk
  • 6.1. Introduction
  • 6.2. Clinical evidence
  • 6.3. Economic evidence
  • 6.4. Evidence statements
  • 6.5. Recommendations and link to evidence
  • 6.6. Recommendations [2008]
  • 6.7. Research recommendation
• 7. Communication about risk assessment and treatment [2008]
  • 7.1. Introduction
  • 7.2. Clinical effectiveness of methods of communicating risk assessment to individuals at high risk of cardiovascular disease (CVD)
  • 7.3. Evidence statements – communication of risk assessment and information
  • 7.4. Evidence to Recommendations
  • 7.5. Recommendations
• 8. Cardioprotective diet
  • 8.1. Introduction
  • 8.2. Review question: What is the clinical and cost effectiveness of dietary intervention strategies versus usual diet for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6. Recommendations and link to evidence
• 9. Lifestyle modifications for the primary and secondary prevention of CVD [2008]
  • 9.1. Introduction – lifestyle modification for the primary and secondary prevention of CVD
  • 9.2. Regular physical activity
  • 9.3. Combined cardioprotective dietary advice and regular physical activity (primary prevention of CVD)
  • 9.4. Alcohol
  • 9.5. Weight management
  • 9.6. Smoking cessation
  • 9.7. Recommendations
• 10. Plant stanols and sterols
  • 10.1. Introduction
  • 10.2. Review question: What is the clinical and cost effectiveness of foods enriched with phytosterols (plant stanols and sterols) or phytosterol supplements versus placebo for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 10.3. Clinical evidence
  • 10.4. Economic evidence
  • 10.5. Evidence statements
  • 10.6. Recommendations and link to evidence
• 11. Statins for the primary and secondary prevention of CVD
  • 11.1. Introduction
  • 11.2. Review question: What is the clinical and cost effectiveness of statin therapy for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 11.3. Clinical evidence (statins versus placebo and head-to-head comparisons of statins)
  • 11.4. Clinical evidence review for reduction in LDL cholesterol
  • 11.5. Number needed to treat
  • 11.6. Economic evidence
  • 11.7. Evidence statements
  • 11.8. Recommendations and link to evidence
  • 11.9. Research recommendations
  • 11.10. Adherence to statin therapy
  • 11.11. Advice and monitoring for adverse effects
• 12. Fibrates for the prevention of CVD
  • 12.1. Introduction
  • 12.2. Review question: What is the clinical and cost effectiveness of fibrates versus placebo or statins for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 12.3. Clinical evidence
  • 12.4. Economic evidence
  • 12.5. Evidence statements
  • 12.6. Recommendations and link to evidence
  • 12.7. Research recommendation
• 13. Nicotinic acid for the prevention of CVD
  • 13.1. Introduction
  • 13.2. Review question: What is the clinical and cost effectiveness of nicotinic acids versus placebo or statins for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 13.3. Clinical evidence
  • 13.4. Economic evidence
  • 13.5. Evidence statements
  • 13.6. Recommendations and link to evidence
• 14. Bile acid sequestrants (anion exchange resins) for the prevention of CVD
  • 14.1. Review question: What is the clinical and cost effectiveness of bile acid sequestrants (anion exchange resins) versus placebo or statins for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 14.2. Clinical evidence
  • 14.3. Economic evidence
  • 14.4. Evidence statements
  • 14.5. Recommendations and link to evidence
• 15. Omega-3 fatty acid compounds for the prevention of CVD
  • 15.1. Introduction
  • 15.2. Review question: What is the clinical and cost effectiveness of omega-3 fatty acids versus placebo or statins for adults without established CVD (primary prevention) and with established CVD (secondary prevention)?
  • 15.3. Clinical evidence
  • 15.4. Economic evidence
  • 15.5. Evidence statements
  • 15.6. Recommendations and link to evidence
• 16. Ezetimibe [2008]
  • 16.1. Ezetimibe (for primary prevention)
  • 16.2. Ezetimibe (for secondary prevention)
• 17. Reference list
• 18. Acronyms and abbreviations
• 19. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • Appendix G. Clinical evidence tables
  • Appendix H. Economic evidence tables
  • Appendix I. Forest plots
  • Appendix J. Excluded clinical studies
  • Appendix K. Excluded economic studies
  • Appendix L. Cost-effectiveness analysis: low-intensity, medium-intensity and high-intensity statin treatment for the primary and secondary prevention of CVD
  • Appendix M. Unit costs
  • Appendix N. Research recommendations
  • Appendix O. How this clinical guideline was updated
  • Appendix P. NICE Technical Team
  • Appendix Q. Deleted parts from CG67 (2008)
  • Appendix R. References

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.