New UK (NICE) guidelines for CVD

Executive summary

* The National Institute for Clinical Excellence (NICE) is the organisation in the UK that sets medical guidelines for every drug, every intervention, and every procedure.

* NICE published guidelines (CG181) for cardiovascular disease (CVD) in July 2014.

* These were consulted upon for a few days in September/October 2023 and a revised version has been issued (NG238).

* The revised guidelines have six key changes:

- Specific cholesterol targets have been set;

- A previously off-label use of a high dose statin is now to be offered unless contraindicated;

- Other cholesterol lowering drugs are recommended in addition to statins (e.g., PCSK9s);

- Ezetimibe particularly should be used more widely;

- Statin doses should be as high as people can tolerate;

- Alternative treatments for CVD (e.g. niacin, omega-3) must not be used.

* The 'cardioprotective diet' changed little between CG181 and NG238. The diet section got shorter. The key goals remained – consume less than 30% of one's diet in the form of total fat and less than 7% in the form of saturated fat. Consume rapeseed oil and spreads etc.

* There were 49 pages of declarations of interest among the panel members.

* The takeaway message from the guidelines was lower cholesterol as much as possible. The panel comprised many people who have an interest in lowering cholesterol.