NHS England lipid management guidelines

Eddy Edson

Eddy Edson

Well-Known Member
Relationship to Diabetes
Type 2
Up to date and summarised in a helpful chart:

https://www.england.nhs.uk/aac/publication/summary-of-national-guidance-for-lipid-management/

Some random things which catch my eye:

- It really brings things much more into line with Euro and US guidance than I had noticed for the UK previously.

- No "HDL ratio" stuff here: it's all non-HDL and LDL cholesterol.

- PAD is recognised as a condition which puts you in the secondary prevention category, in line with international guidance. Previously, I hadn't seen that explicitly stated in UK guidance. (It does say "symptomatic PAD" which makes me wonder a bit, given that asymtomatic PAD seems to be recognised as carrying significant risks, often.)

- The main primary prevention target is non-HDL reduction of > 40% from baseline, and the lower the better. There isn't an absolute target number, no magic level separating the quick from the dead etc etc etc.

- Ditto for secondary prevention, except if a baseline non-HDL level isn't available, target a non-HDL level of < 2.5 which should correspond more or less to LDL-C < 1.8.

"Target" here means: "intensify treatment if you don't achieve this", not "below this level everything is peachy". It's a subtelty which gets missed.

- For primary prevention, where risk is identifed, lifestyle changes are the first thing to try where appropriate (but there is no very detailed guidance beyond the normal broad categories of things for lifestyle - a bit jarring when compared to the detailed guidance of meds for when lifestyle changes don't work or are inappropriate.)

- Similar guidance from NHS Scotland, or no?

- Anyway, I'd suggest that moderators on this site make sure that any commentary on lipids and statins they offer is consistent with this guidance, and that messages from other posters which are inconsistent with it be flagged with a health warning. This stuff is important, but individual posters' opinions are not.
 
I wanted to read the bit at the end about statin intolerance, but the link takes me to a '404 error' unfortunately.
 
Aaah - I now understand exactly why my old GP wanted me to try Pravastatin. He even prescribed it and I got it filled, and then burst into tears when opening the packet because I couldn't bear the thought of having to suffer that much effect on my brain and memory again.
 
Eddy Edson said:
Up to date and summarised in a helpful chart: https://www.england.nhs.uk/aac/wp-c...2020/04/lipid-management-pathway-guidance.pdf

Some random things which catch my eye:

- It really brings things much more into line with Euro and US guidance than I had noticed for the UK previously.

- No "HDL ratio" stuff here: it's all non-HDL and LDL cholesterol.

- PAD is recognised as a condition which puts you in the secondary prevention category, in line with international guidance. Previously, I hadn't seen that explicitly stated in UK guidance. (It does say "symptomatic PAD" which makes me wonder a bit, given that asymtomatic PAD seems to be recognised as carrying significant risks, often.)

- The main primary prevention target is non-HDL reduction of > 40% from baseline, and the lower the better. There isn't an absolute target number, no magic level separating the quick from the dead etc etc etc.

- Ditto for secondary prevention, except if a baseline non-HDL level isn't available, target a non-HDL level of < 2.5 which should correspond more or less to LDL-C < 1.8.

"Target" here means: "intensify treatment if you don't achieve this", not "below this level everything is peachy". It's a subtelty which gets missed.

- For primary prevention, where risk is identifed, lifestyle changes are the first thing to try where appropriate (but there is no very detailed guidance beyond the normal broad categories of things for lifestyle - a bit jarring when compared to the detailed guidance of meds for when lifestyle changes don't work or are inappropriate.)

- Similar guidance from NHS Scotland, or no?

- Anyway, I'd suggest that moderators on this site make sure that any commentary on lipids and statins they offer is consistent with this guidance, and that messages from other posters which are inconsistent with it be flagged with a health warning. This stuff is important, but individual posters' opinions are not.
Click to expand...
Thanks for this but how does this general advice compare with specific NIHCE
guidelines on Type 2 Diabetes regarding cholesterol.
 
Burylancs said:
Thanks for this but how does this general advice compare with specific NIHCE
guidelines on Type 2 Diabetes regarding cholesterol.
Click to expand...
Don't know? I guess T2D features in this mainly as an input to the QRISK3 calculation.

The doc references the general NICE 2016-vintage CVD risk/lipids guidance https://www.nice.org.uk/guidance/cg181/chapter/1-recommendations

But it also appears to incorporate recommendations from the last NICE surveillance report from 2018 https://www.nice.org.uk/guidance/cg...g181-4724759773/chapter/Surveillance-decision which for some reason haven't made it into the actual NICE guidance,

FWIW, NHS England seems to me to be ahead of NICE on lipid management in some respects.

(On the other hand, the NICE surveillance recommends using QRISK3 for T1D's, whereas NHS England says no.)
 
That last bit is poss because so very many T1's diabetes is now so much better controlled than the NHS had got around to taking into account in 2016? I dunno really - think mine was better controlled then than it is now .....
 
trophywench said:
Aaah - I now understand exactly why my old GP wanted me to try Pravastatin. He even prescribed it and I got it filled, and then burst into tears when opening the packet because I couldn't bear the thought of having to suffer that much effect on my brain and memory again.
Click to expand...
If you wanted to try again, maybe try rosuvastatin, now available in generic form in the UK. It's a hydrophilic statin like Pravastatin, so maybe you'd have fewer probs than with Ator or Sim, but much more effective => can look at lower dosages.
 
You can get Prav in a lower dose than Rosu though, hence I think? why they say to try a smaller dose of Prav first for anyone having had or being scared of, mental side effects.

They wanted OH to start a statin cos his total chol is 5.5 ish and he has an AAA - and he said no - so today he had a text saying they'd prescribed him ezetimibe instead and please pick it up from the pharmacy. Over a month ago I told the same GP surgery why I'd refused statins and that all along I'd been more than willing and still was, to take another drug or drugs instead. I have heard nob all since - and it's the same GP surgery.
 
trophywench said:
You can get Prav in a lower dose than Rosu though, hence I think? why they say to try a smaller dose of Prav first for anyone having had or being scared of, mental side effects.

They wanted OH to start a statin cos his total chol is 5.5 ish and he has an AAA - and he said no - so today he had a text saying they'd prescribed him ezetimibe instead and please pick it up from the pharmacy. Over a month ago I told the same GP surgery why I'd refused statins and that all along I'd been more than willing and still was, to take another drug or drugs instead. I have heard nob all since - and it's the same GP surgery.
Click to expand...
Seems pathetic on their part. Bang the table!
 
There have been reports of cognitive impairment with Ezitemibe, though they are rare @trophywench. i took it for a short while, but stopped.
 
According to the PIL it can cause practically every side effect known to medical science. Doesn't mean you'll get any of em though !

Incidentally it was so long ago it was 'a fibrate' that my D clinic asked my GP to 'consider', I have always assumed my GP did not wish to consider it since he never mentioned it. He's retired now so who knows?
 
trophywench said:
According to the PIL it can cause practically every side effect known to medical science. Doesn't mean you'll get any of em though !

Incidentally it was so long ago it was 'a fibrate' that my D clinic asked my GP to 'consider', I have always assumed my GP did not wish to consider it since he never mentioned it. He's retired now so who knows?
Click to expand...
I believe they are much more expensive as I had a friend whose husband was on one but was initiated by a Cardiologist.
 
No they aren't - though Fenofibrate tablets are nearly £3 a month as opposed to £1.50 for pravastatin, unless you have to have capsules at over £23.
 
Thanks for sharing this @Eddy Edson

Feels like a useful source of reference, so I’ve moved it to the Links section.
 
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