Closing in on cholesterol: delivering cardiovascular prevention across the NHS
For National Cholesterol Month, Helen Williams, National Clinical Director for Cardiovascular Disease Prevention, and Rani Khatib, National Speciality Advisor for Cardiovascular Disease Prevention, outline how managing cholesterol and improving lipid management is key to preventing cardiovascular disease.
Cardiovascular disease (CVD) remains the leading cause of premature death in the UK.
The government and NHS have set a mission to reduce premature deaths from heart disease and strokes by 25% within the next decade.
Achieving this will require a system-wide shift towards prevention, with cholesterol management as a top priority.
Why cholesterol matters
High cholesterol is one of the most significant modifiable risk factors for CVD. Lifestyle factors such as poor diet, lack of exercise, being overweight, smoking and drinking alcohol drive this risk factor.
Supporting sustainable lifestyle change reduces risk of CVD and can help people to lower their cholesterol, but many will still need lipid lowering therapies.
Yet, as of March 2025, only 86% of adults with CVD are receiving lipid lowering therapy (CVDPREVENT Audit).
Modelling from UCL Partners Size of the Prize in England shows that if we increased treatment rates to 90%, almost 14,000 heart attacks, strokes and deaths could be prevented in 3 years. At 95%, this number rises to 22,000.
Strategic shift towards prevention
The NHS 10 Year Health Plan calls for a strategic shift to support people to live longer healthier and more independent lives through prevention interventions and bringing care close to home and in the community. Cholesterol management is one example of where this shift can deliver real impact.
Early detection is key. We need to raise awareness of the risks associated with high cholesterol and particularly to those at high risk, including those over 50 years old, are male, are women who have been through menopause, or those of South Asian or sub-Saharan African origin.
Familial hypercholesterolaemia (FH) is a genetic condition, in which cholesterol levels can be significantly elevated and is evident through the whole life course from early childhood and can lead to very early cardiovascular events. Early diagnosis of this is needed to enable optimal management of the condition.
Routine lipid profiling and CVD risk assessment should be embedded into everyday clinical pathways.
NICE guidance encourages use of cardiovascular risk assessment tools like QRISK, which takes into consideration wider risk factors like smoking, weight, ethnicity and family history and calculates an individual’s CVD risk over the next 10 years for those aged 25 to 84 years.
The NHS Health Check offers a scalable way to identify risk and intervene early. The NHS Health Check in England comprehensively assesses cardiovascular risk in eligible patients aged 40-74 every 5 years, including checking a lipid profile.
People with established conditions, such type II diabetes and hypertension should also have their CVD risk calculated using QRISK as part of their care plan as they are not eligible for an NHS Health Check.
The guidance also recommends assessing HbA1c (marker to assess for diabetes) and kidney function through a blood test for those at increased risk of diabetes or chronic kidney disease – who are also a high-risk population for developing CVD.
We should make every contact count and encourage all patients to attend their NHS Health Check when invited.
Empowering communities
Local innovations are already showing the way forward. Community pharmacies, participating in the national Independent Prescriber Pathfinder Programme, are checking cholesterol, assessing cardiovascular risk and initiating treatment where necessary, often in combination with the management of high blood pressure.
Community pharmacies are ideally placed, accessible and within walking distance for around 80% of the population.
Optimising treatment to target
For people with established CVD, lipid lowering treatments including statins, ezetimibe and other lipid lowering therapies are essential to reduce risk of further heart attacks, strokes or progression of peripheral arterial disease.
The NHS England 2025/26 priorities and operational planning guidance reinforces the importance of treatment to target. To do this, we need to make better use of the range of lipid lowering therapies available.
The National Lipid Pathway supports health care professionals in delivering a person-centred approach to both primary and secondary prevention and outlines the place in therapy of the various lipid lowering therapies now available.
Statins remain the first line option for most patients, but additional lipid lowering therapies are likely to be needed to achieve lipid targets, particularly in secondary prevention.
In March 2025, a new NHS contract for inclisiran ensures continued access to the drug for NHS patients in England.
Alongside this, from April 2025, the reimbursement model for GP practices and community pharmacies was increased. This marks a key step in strengthening the lipid management strategy across the NHS.
However, medicines alone are not enough.
Lifestyle advice, education and shared management plans are essential to empower patients to understand their cardiovascular risk, reach their lipid targets and build confidence to sustain the benefits in the long-term.
Driving improvement
To meet NICE recommended lipid targets, the Quality and Outcomes Framework (QOF) continues to incentivise lipid optimisation in primary care practices to support people with established CVD or chronic kidney disease, encouraging timely initiation of appropriate therapy.
In 25/26 additional funding was made available for the CVD prevention indicators to further drive improvements in delivery.
The CVDPREVENT Audit, updated quarterly, provides rich data across CVD and the key risk factors to benchmark progress against national, regional and lCB performance to guide local improvement.
ICB quality improvement packs offer tailored data to support ICBs and their CVD Leads to drive evidence-based change.
Now is the time for action. Better understanding of cholesterol and improving lipid management will be critical to CVD prevention and achieving our national ambition.
These 4 core interventions for cholesterol management will drive this forward:
- Detecting earlier by encouraging healthcare professionals to embed full lipid profiling and building CVD risk assessment into routine care.
- Empowering patients through shared decision making. Offer personalised care conversations about their cardiovascular risk, lifestyle advice and support informed decision making.
- Treating based on risk. Initiate and optimise high intensity statins, addressing adverse events and supporting patients to adhere to medication.
- Intensify to treat to NICE targets by using the full range of lipid lowering therapies, oral and injectables in line with eligibility criteria.
Together we can raise awareness about lipid management, close treatment gaps and support communities to reduce their risk of CVD.
Further information
Learn more about HEART UK’s National Cholesterol Month and explore their patient resources on the Heart UK website.
Check our NHS Futures Collaboration page for more resources and webinar recordings on lipid management.
Helen Williams
Helen is National Clinical Director for Cardiovascular Disease Prevention at NHS England, and Clinical Care Professional Lead for Long-Term Conditions for the South East London Integrated Care System.
Helen has worked as a CVD specialist for more than 25 years across secondary, community and primary care settings. She was clinical adviser to the AHSN national atrial fibrillation (AF) programme and developed the pharmacist-led virtual clinic model to optimise uptake of anticoagulation in AF, which has now been spread nationally.
Most recently, as the National Specialty Adviser for CVD Prevention at NHS England, she worked on the delivery of the national CVD ambitions for AF, blood pressure and cholesterol in the NHS Long Term Plan.
Helen also works at UCL Partners on the implementation of Proactive Care Frameworks and CVDACTION to support primary care with the tools and resources to optimise patient outcomes, particularly for AF, blood pressure, lipids, heart failure, diabetes and chronic kidney disease.
Dr Rani Khatib
Dr Rani Khatib FRPharmS, FESC is National Specialty Advisor for Cardiovascular Disease Prevention at NHS England; Senior Consultant Pharmacist in Cardiology and Cardiovascular research at Leeds Teaching Hospitals NHS Trust; and an Associate Professor at the Leeds Institute of Cardiometabolic Medicine (LICAMM), University of Leeds.
He is also a National Clinical Champion for Lipids Management and member of the Heart Failure Expert group at NHS England, and lead author of the national lipid management and statin intolerance pathways.
Dr Khatib served as a specialist committee member on the NICE Heart Failure Guidelines and Quality Standards and is a Fellow of the European Society of Cardiology (ESC), and the Royal Pharmaceutical Society.
Rani leads on the delivery of several innovative cardiorenal metabolic risks and medicines optimisation clinics and services across West Yorkshire. He heads the Cardiology Innovative Medicines Optimisation Service and is the senior CVD consultant at Health Innovation Yorkshire & Humber; co-chairs the UK Clinical Pharmacy Association Cardiovascular Group; and is a core member of the international Cardiology Allied Professionals Task Force at ESC.
Dr Khatib is a well-published, senior academic grants holder, with multiple recognitions and awards for innovation and excellence in patient care.