GPAtlas🧭 When to offer assessment
Cardiovascular prevention rests on a single idea: find the asymptomatic person whose 10-year risk is high enough to benefit from treatment, before the first heart attack or stroke. NICE NG238 (published December 2023, replacing the long-standing CG181) frames this work. The recommendation is to identify people systematically rather than relying on opportunistic checks alone, supported by the NHS Health Check, which invites everyone aged 40–74 without established CVD, diabetes, or CKD every five years.
The risk tool itself is QRISK3, validated for adults aged 25–84 (a common pitfall is to conflate this with the 40–74 Health Check window). The clinical skill is twofold: stratify by 10-year risk, and recognise the groups who bypass the calculator entirely – they are high-risk by definition and proceed straight to treatment.
| 10-year CVD risk (QRISK3) | Interpretation | Action |
|---|---|---|
| < 10% | Lower risk | Lifestyle advice for all; do not rule out atorvastatin 20 mg if there is an informed preference or risk may be underestimated |
| ≥ 10% | Threshold for offering a statin | Offer atorvastatin 20 mg plus lifestyle, after shared decision-making |
| Type 1 diabetes · CKD (eGFR < 60 and/or albuminuria) · familial hypercholesterolaemia | High risk by definition | Do not use QRISK3 – offer a statin directly (per the relevant pathway) |
| Age ≥ 85 | High risk through age alone | Consider atorvastatin 20 mg, weighing frailty and comorbidity |
Prioritise assessment in those with a family history of premature CVD (first-degree relative < 60), a smoking history, hypertension, obesity or central adiposity, South Asian family origin, a chronic inflammatory condition (rheumatoid arthritis, SLE), or severe mental illness. Lifestyle advice is offered to everyone, irrespective of the score.
Source: NICE NG238 · NHS Health Check programme
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