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Guidance
Setting and achieving LDL-C lowering treatment targets
Guidelines provide evidence-based treatment targets, proven to be both clinically-effective and cost-effective.1,2
Concomitant use of NILEMDO®/NUSTENDI® with simvastatin >40 mg daily is contraindicated; please refer to the relevant SmPC for more information.3,4
ESC/EAS 2019 dyslipidaemia management guidance
Concomitant use of NILEMDO®/NUSTENDI® with simvastatin >40 mg daily is contraindicated; please refer to the relevant SmPC for more information.3,4
*Very high risk: defined as people with any of the following: documented ASCVD, either clinical or unequivocal on imaging; documented ASCVD includes previous ACS (MI or unstable angina), stable angina, coronary revascularisation (PCI, CABG, and other arterial revascularisation procedures), stroke and TIA, and peripheral arterial disease; unequivocally documented ASCVD on imaging includes those findings that are known to be predictive of clinical events, such as significant plaque on coronary angiography or CT scan (multivessel coronary disease with two major epicardial arteries having >50% stenosis), or on carotid ultrasound; DM with target organ damage,† or at least three major risk factors, or early onset of T1DM of long duration (>20 years); Severe CKD (eGFR <30 mL/min/1.73m2); a calculated SCORE ≥10% for 10-year risk of fatal CVD; FH with ASCVD or with another major risk factor. High risk: defined as people with: Markedly elevated single risk factors, in particular TC >8 mmol/L (>310 mg/dL), LDL-C >4.9 mmol/L (>190 mg/dL), or BP ≥180/110 mmHg; patients with FH without other major risk factors; patients with DM without target organ damage,† with DM duration ≥10 years or another additional risk factor; moderate CKD (eGFR 30–59 mL/min/1.73 m2 ). A calculated SCORE ≥5% and <10% for 10-year risk of fatal CVD. Moderate risk: defined as young patients (T1DM <35 years; T2DM <50 years) with DM duration <10 years, without other risk-factors; calculated SCORE ≥1% and <5% for 10-year risk of fatal CVD. Low risk: defined as Calculated SCORE <1% for 10-year risk of fatal CVD.2
†Target organ damage is defined as microalbuminuria, retinopathy or neuropathy.2
LDL-C levels of <1.8 mmol/L have been associated with plaque regression and stabilisation7,8
References
- 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: April 2025.
- Mach F, et al. Eur Heart J. 2020;41:111–188.
- NILEMDO® Summary of Product Characteristics.
- NUSTENDI® Summary of Product Characteristics.
- NHS England. Quality and Outcomes Framework guidance for 2025/26. April 2025. Available at:
https://www.england.nhs.uk/publication/quality-and-outcomes-framework-guidance-for-2025-26/
Accessed: April 2025. - 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: April 2025.
- Masana L, et al. Pharmacol Res. 2023;190:106738.
- Nicholls SJ, et al. JAMA. 2016;316(22):2373–2384.
Abbreviations
AAC, Accelerated Access Collaborative; ACS, acute coronary syndrome; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CABG, coronary artery bypass graft; CHOL, cholesterol; CKD, chronic kidney disease; CT, computed tomography; CV, cardiovascular; CVD, cardiovascular disease; DM, diabetes mellitus; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; eGFR, estimated glomerular filtration rate; FH, familial hypercholesterolaemia; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; NICE, National Institute for Health and Care Excellence; PCI, percutaneous coronary intervention; QOF, Quality and Outcomes Framework; SmPC, Summary of Product Characteristics; TIA, transient ischaemic attack; TC, total cholesterol; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.
Job code: UK/BEM/03/25/0039|Date of preparation: April 2025