Previous changes

May 2025 — minor update. QOF indicators updated in line with the NHS England Quality and Outcomes Framework guidance for 2025/26.

March 2025 — minor update. Added information about the use of aspirin for people in higher at risk groups as an off-license indication. 

September 2024 — minor update. Recommendations on physical activity have been clarified.  

May 2024 — reviewed.  A literature search was conducted in March 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor structural changes have been applied to the topic, with the basis for recommendation sections updated to align with current guidance from the National Institute for Health and Care Excellence (NICE) on Cardiovascular disease: risk assessment and reduction, including lipid modification and the European Society of Cardiology (ESC) guidelines on Cardiovascular disease prevention in clinical practice.

May 2023 — minor update. Recommendations aligned with updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification.

February 2023 — minor update. The information that aspirin is not recommended for the primary prevention of cardiovascular disease (CVD) has been reworded to align with the updated NICE guideline Cardiovascular disease: risk assessment and reduction, including lipid modification, which recommends that it should not be routinely offered for primary prevention of CVD.

August 2020 — minor update. Broken URL link updated.

February to March 2019 — reviewed. A literature search was conducted in February 2019 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated to take into account the National Institute for Health and Care Excellence (NICE) Surveillance report 2018 – Cardiovascular disease: risk assessment and reduction, including lipid modification (2014) NICE guideline CG181, and a prospective cohort study which updated and validated a new version of the QRISK tool: QRISK3. 

June to September 2014 — reviewed and re-written with a new topic structure. A literature search was conducted in June 2014 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The main significant changes made to this topic reflect the recommendations from the National Institute for Health and Care Excellence (NICE) in the guideline Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease  and includes the following:

• A 10 year cardiovascular disease (CVD) risk should be assessed using the QRISK2 assessment tool (and not the Framingham tool).
• Statin treatment is an option for the primary prevention of CVD for people with an estimated 10 year CVD risk of 10% or more.
• Atorvastatin 20 mg a day is the recommended statin if the person decides to take drug treatment after an informed discussion about benefits and harms, and if there are no contraindications.

December 2013 — minor update. Text has been removed from the section on antiplatelet treatment and links added to the updated CKS topic on antiplatelet treatment.

June 2013 — minor update. The 2013 QOF options for local implementation have been added to this topic.

April 2012 — minor update. The 2012/2013 QOF indicators have been added to this topic. Minor text change to recommendations on how to interpret cardiovascular risk in people with diabetes. Updated to include the recommendation from the House of Commons Science and Technology Committee that people should have at least two alcohol-free days per week. 

September 2011 — minor update. Rewording of unclear recommendation in the CVD risk assessment scenario. 

July 2011 — minor update. Formatting change to section on CVD risk calculators.

June 2011 — minor update. The 2011/2012 QOF indicators have been added to this topic. 

February 2011 — topic structure revised to ensure consistency across CKS topics — no changes to clinical recommendations have been made.

December 2010 — minor update. The Basis for recommendation section on CVD risk calculators has been updated to include new supporting evidence for ASSIGN cardiovascular risk calculator and the QRISK cardiovascular lifetime risk calculator. 

July 2010 — minor update. Polycythaemia vera added to the list of indications for low-dose aspirin.

April 2010 — updated to include advice about the QRISK2 and the ASSIGN cardiovascular risk calculators. Advice from SIGN that aspirin is no longer recommended for primary prevention of cardiovascular disease in people with diabetes has also been included. 

December 2009 — minor update. The recommendations on when to consider for primary prevention of cardiovascular disease have been updated. 

October 2009 — minor update. A reminder from the Medicines and Healthcare products Regulatory Agency (MHRA) that aspirin is not licensed for use in primary prevention of vascular events has been added.

May 2009 — updated to include indicators related to primary and secondary prevention of coronary heart disease in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the Goals and outcome measures section. 

February 2009 — minor typographical correction. 

July to December 2008 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

This topic has been updated to reflect the NICE guideline Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. Changes to the recommendations on risk assessment include:

• Using a systematic method to prioritize people for formal risk assessment (rather than opportunistic screening).
• Adjusting calculated risk to take into account risk factors not included in risk calculators:
  • Ethnic background. Previously it was recommended that the calculated risk be multiplied by 1.4 for people originating from the Indian subcontinent. Now it is recommended that the risk be adjusted for men (but not for women).
  • Premature cardiovascular disease in a first-degree relative. Previously it was recommended that the calculated risk be multiplied by 1.3 when there is a family history of premature cardiovascular disease. Now it is recommended that the calculated risk be multiplied by 1.5 when one family member is affected, and by up to 2 when more than one first-degree relative has had premature cardiovascular disease.
  • Adiposity. More emphasis (for routine primary care) is now placed on taking account of severe obesity (body mass index > 40 kg/m²), and less emphasis on central obesity and the measurement of waist circumference.
  • Comorbidity and treatments. Some comorbidities (such as diabetes, rheumatoid arthritis, and chronic kidney disease) and treatments (e.g. for HIV or with antipsychotics) can increase the risk of cardiovascular disease. Optimal management of these conditions is now specifically recommended to reduce this risk.
  • Age 75 years or older. It is now recommended that people be regarded as at high risk of cardiovascular disease once they reach the age of 75 years, and that formal risk calculation is not necessary.
• Using a risk calculator and not using risk charts to estimate 10-year risk of cardiovascular disease. Previously it was recommended that risk charts or a risk calculator could be used.

There are no substantive changes to recommendations on lifestyle interventions to reduce cardiovascular risk. There are no substantive changes to recommendations on antiplatelet treatment or antihypertensive treatment. Changes to the recommendations for lipid modification include:

• For primary prevention: to offer to treat with simvastatin 40 mg/day (or a suitable alternative). No targets for treatment are recommended.
• For secondary prevention: to offer to start treatment with simvastatin 40 mg/day (or a suitable alternative). If serum total cholesterol remains above 4 mmol/L or low density lipoprotein cholesterol remains above 2.0 mmol/L, consider increasing to simvastatin 80 mg (or a suitable alternative).

November 2008 — minor correction to hyperlinks to the cardiovascular risk charts and calculators provided by the British Hypertension Society.

April to June 2006 — reviewed. This guidance has been rewritten following a full literature review and to take account of JBS 2, the second Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. The guidance title has changed from Coronary heart disease — identification and management to Cardiovascular risk — assessment and management to reflect the wider aims of current prevention guidelines. Risk assessment is now based on 10-year cardiovascular disease risk using the JBS 2 charts or calculator — previously, risk calculation was based on coronary heart disease risk. Indications for professionally supported lifestyle interventions and drug treatments and suggested targets for treatment have been updated. There is new information about lifestyle interventions and new sections with suggestions on how to help people change to healthier lifestyles, and how to communicate risk and uncertainty. Validated in September 2006 and issued in October 2006. 

November 2005 — minor update. Reference made to the CKS topic on Antiplatelet treatment, which outlines gastrointestinal issues that need to be considered in the prescribing of low-dose aspirin for the prevention of cardiovascular events.

September 2004 — updated to include the circumstances where simvastatin can be purchased over the counter from a pharmacy. 

March 2003 — written. Validated in June 2003 and issued in July 2003.

New evidence

Evidence-based guidelines

• De Backer, J., Haugaa, K.H., Eide Hasselberg, N., (2025) ESC Guidelines for the management of cardiovascular disease and pregnancy: Developed by the task force on the management of cardiovascular disease and pregnancy of the European Society of Cardiology (ESC). European Heart Journal https://academic.oup.com [Free Full-text]
• Damman K, Ter Maaten JM, Mayne KJ, et al (2026) 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease, in collaboration with the European Renal Association (ERA). European Heart Journal. https://academic.oup.com/eurheartj [Free Full-text]

HTAs (Health Technology Assessments)

• NICE (2026) Semaglutide for reducing the risk of major adverse cardiovascular events in people with cardiovascular disease and overweight or obesity. National Institute for Health and Care Excellence. [Free Full-text]

Economic appraisals

No new economic appraisals since 1 May 2024.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 May 2024.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 May 2024.

New policies

No new policies since 1 May 2024.

New safety alerts

No new safety alerts since 1 May 2024.

Changes in product availability

No changes in product availability since 1 May 2024.

How should I identify people who may benefit from a CVD risk assessment?

• Do not use opportunistic assessment as the main strategy in primary care to identify cardiovascular disease (CVD) risk in unselected people.
• For the primary prevention of CVD in primary care: 
  • Use a systematic strategy to identify people who are likely to be at high risk.
  • Prioritise people on the basis of an estimate of their CVD risk before a full formal risk assessment — estimate their CVD risk using CVD risk factors already recorded in primary care electronic medical records.
    • Prioritise people for a full formal risk assessment if their estimated 10-year risk of CVD is 10% or more.
  • People aged over 40 years should have their estimate of CVD risk reviewed on an ongoing basis.
    • In England all people aged 40–74 years are offered an NHS Health Check every 5 years, which includes an assessment of CVD risk.
• Encourage the participation of people who have been identified for CVD risk assessment by:
  • Discussing what they know about their CVD risk. 
  • Exploring their attitudes and confidence towards altering aspects of their lifestyle to benefit future health.
  • Informing them about potential future management options and how this will involve developing a shared management plan.

How should I perform a CVD risk assessment?

• Discuss the process of risk assessment with the person, including the option of declining a formal assessment.
• Use the QRISK3 assessment tool to calculate the estimated cardiovascular disease (CVD) risk within the next 10 years for people aged 25 to 84 years (including people with type 2 diabetes) if the person is in agreement with the assessment. 
• Do not use QRISK assessment tool in people: 
  • Who already have CVD — for more information, see the CKS topics on Angina, MI - secondary prevention, Peripheral arterial disease, and Stroke and TIA.
  • Who are at high risk of developing CVD, including people with: 
    • Type 1 diabetes.
    • An estimated glomerular filtration rate of less than 60 ml/min/1.73m², or albuminuria.
    • Familial hypercholesterolaemia, or other inherited disorders of lipid metabolism — for more information, see the CKS topic on Hypercholesterolaemia - familial.
  • Aged 85 years or over — consider these people to be at high risk of developing CVD because of age alone, especially smokers and people with high blood pressure.
• To fill in the QRISK assessment tool, complete as many fields as possible, including:
  • Personal details — age, sex, ethnicity, postcode.
  • Clinical information — smoking status, selected medical and family history, systolic blood pressure and standard deviation of at least two most recent systolic blood pressure readings, height and weight, and the total cholesterol/high-density lipoprotein (HDL)-cholesterol ratio from a non-fasting blood sample.
• Consider also taking blood to assess HbA1c and kidney function. This is not needed for CVD risk assessment but is offered to people at increased risk of developing diabetes or chronic kidney disease as part of a general health check.
• Repeat the assessment every five years, but earlier if any significant changes occur in the family history or knowledge of the family history.

How should I interpret and communicate the estimated CVD risk score?

• QRISK calculates a 10-year estimated risk and not a lifetime risk as estimated by another risk calculator, QRISK3-lifetime.
  • Consider using a lifetime risk tool such as QRISK3-lifetime to inform discussions on CVD risk and to motivate lifestyle changes, particularly for people with a 10-year QRISK3 score less than 10%, and people under 40 who have CVD risk factors.
• The QRISK risk score is expressed as a percentage. For example, if a person has a 20% estimated risk, the following kind of phrases may be useful:
  • This means that you have a 20 in 100 chance (2 in 10 chance) of developing a cardiovascular disease CVD (CVD) within 10 years (angina, myocardial infarction, transient ischaemic attack, stroke or peripheral arterial disease.) 
  • In other words, in this example, 2 in 10 people with the same risk factors will develop CVD within the next 10 years.
  • The score is calculated based on outcomes in groups of people with risk factors for CVD and is therefore not designed to predict individual outcomes.
• Be aware that the risk score is an estimate — standard CVD risk scores underestimate risks in people who have additional risk because of underlying medical conditions or treatments. This can include people:
  • Treated for HIV.
  • Taking medicines that can cause dyslipidaemia (for example, immunosuppressants). 
  • With hypertriglyceridaemia (>4.5 mmol/L).
  • Already taking antihypertensive or have recently given up smoking — use clinical judgement to decide on further treatment of risk factors in people who are below the CVD risk threshold for treatment.
  • With severe mental illness.
  • With autoimmune disorders and other systemic inflammatory disorders.
• Offer information about the person's absolute risk of cardiovascular disease (CVD) and about the benefits and harms of an intervention over a 10-year period — use jargon-free language to communicate information on risk. If technical terms are used, explain them clearly. This information should present: 
  • Individualised risk and benefit scenarios. 
  • The absolute risk of events numerically and use appropriate diagrams and text. For example, the QRISK website provides a 'smiley face' graphical image on completion of the assessment.
• When discussing CVD risk, also consider that:
  • Many risk factors have a continuous relationship to the risk of developing CVD rather than a yes/no outcome. Therefore, consider using terms such as 'risk assessment' and 'risk reduction' rather than terms such as 'screening' or 'positive or negative for a risk,' which suggest an all-or-nothing effect.
  • People's values, preferences, and attitudes to risk vary widely and may need to be explored when discussing lifestyle and treatment decisions.
  • Everyone is at risk. Just because a person has a low risk does not mean they have no risk.
  • Most people, if not all, can reduce their risk by changes in lifestyle and, where relevant, with drug treatment.

How should I manage people with a CVD risk of less than 10%?

• For people with an estimated cardiovascular disease (CVD) risk score of less than 10% using the QRISK assessment tool:
  • Advise that although the risk is low, further reductions can often still be achieved. 
  • Offer advice on any relevant lifestyle factors that can be improved. 
  • Consider reviewing any relevant comorbidities that may not be optimally treated. 
  • Advise that a further risk assessment should be considered in 5 years. 
  • Consider using a lifetime risk tool such as QRISK3-lifetime to inform discussions on CVD risk and to motivate lifestyle changes. 
• Consider principles that may help a person to adopt a healthy lifestyle:
  • Find out what they know or have already been told about their risk of developing CVD and how they feel about it. 
  • Exploring their beliefs about what determines future health.
  • Assess their readiness, concerns, and confidence to make any changes to their lifestyle.
  • Acknowledge that changing lifelong habits can be difficult and that a gradual, sustained change is often more permanent than a rapid change. 
  • Be supportive of every improvement in lifestyle.
  • Where relevant, engage support from their family.
  • Accept that some people need support for a long time and that repeated efforts to encourage and maintain lifestyle change may be necessary. 
• Consider treatment with atorvastatin 20 mg for the primary prevention of CVD even if the person's 10-year QRISK3 score is less than 10%, where:
  • The person has an informed preference for taking a statin.
  • There is concern that CVD risk may have been underestimated by the QRISK3 calculation.
    • For more information on commencing statin treatment, see the CKS topic on Lipid modification - CVD prevention.

What lifestyle advice should I give to help reduce the risk of CVD?

• Give lifestyle advice to all people who have had a cardiovascular disease (CVD) risk assessment, regardless of their risk score. 
• Advise that most people, if not all, will be able to reduce whatever risk they have of developing CVD by relevant changes to lifestyle — the three most important modifiable and causal CVD risk factors are smoking, hypertension and abnormal lipids.
• Advise smokers to stop and non-smokers to avoid passive smoking. 
  • Offer support for people who want to stop smoking and include referral to an NHS Stop Smoking Service. For more information, see the CKS topic on Smoking cessation.
• Advise weight loss if the person is overweight or obese: 
  • Offer appropriate advice and support to help them work towards a healthy weight (for example, achieving and maintaining a weight loss target of 3 kg).
  • If obese, also assess for symptoms of sleep apnoea, and treat if appropriate — for more information, see the CKS topics on Obesity and Obstructive sleep apnoea syndrome.
• Advise the person to adopt a diet that helps to reduce CVD risk, including:
  • Eating: 
    • Unsalted nuts, seeds and legumes — at least 4 to 5 portions per week (one portion is about a handful or about 30 g).
    • Fish — at least two portions per week, including a portion of oily fish (pregnant women should limit their oily fish intake to no more than two portions per week and avoid marlin, shark, and swordfish).
    • Fruit and vegetables — at least 5 portions per day.
    • Fibre — 30-45 g per day (choose wholegrain varieties of starchy foods).
  • Reducing:  
    • Sugar and food products containing refined sugars, including fructose.
    • Saturated fat — total fat intake should be 30% or less of total energy intake, and saturated fat should be 7% or less of total energy, and where possible saturated fats are replaced by mono-unsaturated and polyunsaturated fats.
    • Salt — it should be less than 6 g per day (it should not be added at the table, and processed foods should be kept to a minimum).
  • Increasing mono-unsaturated fat intake with olive oil or rapeseed oil or spreads based on these oils, and to use them in food preparation.
    • Note: Dietary supplements, including omega-3 capsules, plant sterols (sitosterol or sitostanol) or supplemented foods, are not recommended as there is no good evidence that they reduce CVD risk. People with chronic kidney disease, type 1 or type 2 diabetes should avoid plant sterols and stenols.
• Advise the person to keep alcohol consumption within the recommended limits: 
  • For men and women: no more than 14 units per week (spread over 3 days or more).
    • For more information, see the section on Unit of alcohol in the CKS topic on Alcohol - problem drinking.  
  • Having at least two alcohol-free days per week.
  • Avoiding binge drinking and intoxication.
  • If alcohol use seems to be a problem, it should be specifically addressed — for more information, see the CKS topic on Alcohol - problem drinking.
• Advise the person to be physically active and to avoid prolonged sedentary behaviour, including:
  • At least 150 minutes per week of moderate intensity aerobic activity (to the point of slight breathlessness), or at least 75 minutes per week of vigorous intensity aerobic activity, or a mix of moderate and vigorous aerobic activity. 
    • Encourage people who cannot manage moderate intensity physical activity because of comorbidity, medical conditions or personal circumstances to exercise to their maximum safe capacity. 
    • Note: activity in bouts of 10 minutes or more is as effective as longer bouts so long as the total per week is achieved. Moderate intensity activities include those that can be incorporated into everyday life such as brisk walking, using stairs, and cycling. 
  • Muscle-strengthening activities on two or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).

How should I manage comorbidities which are associated with increased risk of CVD?

• Other medical conditions are associated with an increased risk of cardiovascular disease (CVD) — where possible, treatment should be optimized to reduce their effect on CVD risk, these include:
  • Atrial fibrillation — for more information, see the CKS topic on Atrial fibrillation. 
  • Chronic kidney disease — for more information, see the CKS topic on Chronic kidney disease. 
  • Diabetes mellitus — for more information, see the CKS topic on Diabetes - type 1 and Diabetes - type 2. 
  • Dyslipidaemias, such as familial hypercholesterolaemia — for more information, see the CKS topic on Hypercholesterolaemia - familial. 
  • Heart failure — for more information, see the CKS topic on Heart failure - chronic.
  • Hypertension — for more information, see the CKS topic on Hypertension. 
  • Migraine has been associated with an increased risk of ischaemic stroke and ischaemic cardiac disease — for more information, see the CKS topic on Migraine.
  • Obesity, especially if associated with obstructive sleep apnoea — for more information, see the CKS topics on Obesity and Obstructive sleep apnoea syndrome. 
  • Periodontitis — for more information, see the CKS topic on Gingivitis and periodontitis. 
  • Polycystic ovary syndrome (PCOS) — for more information, see the CKS topic on Polycystic ovary syndrome.
  • Premature menopause (<40 years old) — for more information, see the CKS topic on Menopause.
  • Rheumatoid arthritis, systemic lupus erythematosus, and other systemic inflammatory disorders — for more information, see the CKS topic on Rheumatoid arthritis. 
  • Serious mental health problems — for more information see the CKS topics on Psychosis and schizophrenia and Bipolar disorder. 

How should I manage people with a CVD risk of 10% or more?

• Before offering statin treatment for primary prevention: 
  • Use the clinical findings, lipid profile and family history to judge the likelihood of a familial lipid disorder — for more information on diagnosing or excluding familial hypercholesterolaemia as a cause of dyslipidaemia, see the CKS topic on Hypercholesterolaemia - familial. 
  • Exclude possible secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease, and nephrotic syndrome).
  • Discuss the benefit of lifestyle modifications and optimize the management of all other modifiable CVD risk factors, including any relevant comorbidities that may not be optimally treated.
    • Offer the opportunity to reassess CVD risk again after they have tried to change their lifestyle. 
    • Recognise that some people may need support to change their lifestyle — to help, refer them to programmes such as exercise referral schemes or smoking cessation services. For more information, see the CKS topic on Smoking cessation
• Offer statin treatment after risk assessment if lifestyle modification is ineffective or inappropriate.
  • Discuss the benefits and risks of taking a lipid modification therapy, taking into account additional factors such as comorbidities, potential benefits from lifestyle interventions, the person's preferences, polypharmacy, general frailty and life expectancy.
  • Offer atorvastatin 20 mg daily if the person decides to take this and there are no contraindications — for more information on starting statin treatment, see the CKS topic on Lipid modification - CVD prevention.

What lifestyle advice should I give to help reduce the risk of CVD?

• Lifestyle advice for people with a cardiovascular disease (CVD) risk of 10% or more is the same as for people with a CVD risk of less than 10%. See the section on lifestyle advice in the Scenario: Management of people with an estimated CVD risk less than 10%.

How should I manage comorbidities which are associated with increased risk of CVD?

• Similar to people with a cardiovascular disease (CVD) risk of 10% or less, treatment other medical conditions which are associated with an increased risk of CVD should be optimized where possible, to reduce their effect on CVD risk. For more information, see the section on Managing comorbidities in the Scenario: Management of people with an estimated CVD risk less than 10%. 

What drug treatments should I offer for the primary prevention of CVD?

• Decide whether to start statin therapy after an informed discussion with the person about the risks and benefits of statin treatment, taking into account additional factors such as potential benefits from lifestyle changes, informed patient preference, comorbidities, polypharmacy, general frailty and life expectancy.
• Offer atorvastatin 20 mg a day (unless contraindicated) for the primary prevention of cardiovascular disease (CVD) to people (including those with type 2 diabetes) with an estimated CVD risk of 10% or more calculated using the QRISK3 assessment tool.
  • For more information on starting statin treatment, see the CKS topic on Lipid modification - CVD prevention.
• For people: 
  • Aged 85 years or older (beyond the QRISK range for inclusion) — consider offering atorvastatin 20 mg, which may be of benefit in reducing the risk of non-fatal myocardial infarction. But, take into account factors that may make treatment inappropriate, such as comorbidities, polypharmacy, general frailty, and life expectancy.
  • With chronic kidney disease — consider offering atorvastatin 20 mg, dose adjustments may be required in people who do not achieve lipid targets for primary prevention of CVD (the use of higher doses should be discussed with a renal specialist if eGFR is less than 30 ml per minute per 1.73 m2). For information on how to estimate and manage CVD risk, see the CKS topic on Chronic kidney disease. 
  • With type 1 diabetes mellitus — consider offering statin treatment in all adults.
    • Offer atorvastatin 20 mg to adults aged over 40 years, or who have had diabetes for more than 10 years, or who have established nephropathy, or have other CVD risk factors.
    • Consider atorvastatin 20 mg for adults aged less than 40 years with type 1 diabetes, including those who have had diabetes for 10 years or less.
    • For more information on how to manage CVD risk, see the CKS topic on Diabetes - type 1.
  • With hypercholesterolaemia — for more information, see the CKS topic on Hypercholesterolaemia - familial. 
• A target reduction in non-HDL cholesterol of >40% is recommended for the primary prevention of CVD. For information on assessing response to statin treatment, including how to follow up a person after the initiation of lipid modification therapy for primary prevention, see the CKS topic on Lipid modification - CVD prevention.
• Offer antihypertensive drug treatment for the primary prevention of CVD, if appropriate:
  • For more information on when antihypertensive drug treatment is appropriate, see the CKS topics on Hypertension, and Diabetes - type 2.
• Do not routinely offer aspirin for the primary prevention of CVD:
  • Consider aspirin 75 mg in people at high risk of CVD (>20%) where there is no clear increased risk of bleeding (for example, GI bleeding, peptic ulcer disease, concurrent use of medications that increase bleeding risk).
  • People without bleeding risk factors with a 10-year risk of CVD of more than 20% should be given low-dose aspirin, and people with a risk 10–20% should be considered potentially eligible. This is an off-license use of aspirin in these higher-risk groups of people.