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Prescribing Information and Adverse Event Reporting (links to external website):

Guidance

Setting and achieving LDL-C lowering treatment

Guidelines provide evidence-based treatment targets, proven to be both clinically-effective and cost-effective.1,2

Concomitant use of NUSTENDI®/NILEMDO® with simvastatin >40 mg daily is contraindicated; please refer to the relevant SmPC for more information.3,4

The NICE NG238 and AAC guidance covers lipid management and treatment targets for primary and secondary prevention of CVD.1,2

Treatment targets and Treatment escalation

Concomitant use of NUSTENDI®/NILEMDO® with simvastatin >40 mg daily is contraindicated; please refer to the relevant SmPC for more information.3,4

To support ambitions to reduce premature mortality from heart disease or stroke by 25% within a decade, the QOF 2025/26 has introduced significant changes focused on CVD prevention. This comprises the reallocation of 141 QOF points (worth £198 million) across nine CVD prevention indicators, including its two CHOL indicators.5

Concomitant use of NUSTENDI®/NILEMDO® with simvastatin >40 mg daily is contraindicated; please refer to the relevant SmPC for more information.3,4

The CVD prevention scheme focuses on identifying patients at risk of developing CVD, thereby helping to reduce the risk of its onset.7

Eligible patients
The Health Improvement Scotland Right Decision Service

The Health Improvement Scotland Right Decision Service has a ‘Treat to Target’ of <1.8 mmol/L LDL-C or equivalent of <2.5 mmol/L non-HDL for secondary prevention.8

*ASSIGN is a CV risk score (0-100) which estimates the 10-year percentage risk of developing CVD for individuals in Scotland who do not currently have a diagnosis of CVD. ‘High-risk’ score ≥10 should be offered targeted risk reduction advice and treatments in line with current SIGN guidelines.9

References

  1. National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification [NG238]. December 2023. Available at: https://www.nice.org.uk/guidance/ng238/chapter/Recommendations Accessed: September 2025.
  2. NHS England. Summary of national guidance for lipid management. April 2024. Available at: https://www.england.nhs.uk/aac/publication/summary-of-national-guidance-for-lipid-management/ Accessed: September 2025.
  3. NILEMDO® Summary of Product Characteristics.
  4. NUSTENDI® Summary of Product Characteristics.
  5. NHS England. Changes to the GP contract in 2025/26. Available at: https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2025-26/ Accessed: September 2025.
  6. NHS England. Quality and Outcomes Framework Guidance for 2025/26. Available at: https://www.england.nhs.uk/wp-content/uploads/2025/03/quality-outcomes-framework-guidance-for-2025-26.pdf Accessed: September 2025.
  7. NHS Scotland. Cardiovascular Disease Prevention Scheme – Directed Enhanced Service. NHS Circular: PCA(M)(2025)02. April 2025. Available at: https://www.publications.scot.nhs.uk/files/pca-2025-m-02.pdf Accessed: September 2025.
  8. Health Improvement Scotland Right Decision Service. Available at: https://rightdecisions.scot.nhs.uk/national-cardiovascular-disease-cvd-prevention-and-risk-factors-toolkit/ Accessed: September 2025.
  9. Healthcare Improvement Scotland. ASSIGN (v2.0). Available at: https://rightdecisions.scot.nhs.uk/assign-v20/assign-cardiovascular-risk-score-calculator/ Accessed: September 2025.

Abbreviations

AAC, Accelerated Access Collaborative; BMI, body mass index; BP, blood pressure; CHOL, cholesterol; CV, cardiovascular; CVD, cardiovascular disease; DM, diabetes mellitus; HbA1c, haemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL, low-density lipoprotein; LDL-C, low-density lipoprotein cholesterol; LLT, lipid-lowering therapy; NICE, National Institute for Health and Care Excellence; QOF, Quality and Outcomes Framework; SmPC, Summary of Product Characteristics; T2DM, type 2 diabetes mellitus; TC, total cholesterol; TIA, transient ischaemic attack.

Job code: UK/BIL/08/25/0003|Date of preparation: September 2025

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