Cardiovascular disease (CVD) is an umbrella term for diseases of the heart and blood vessels caused by atherosclerosis – the build up of fats, cholesterol and other substances, collectively known as atheroma, in the blood vessels. 

CVD is the leading cause of death in the UK. Some risk factors such as age, sex, family history and ethnicity cannot be modified. However, other risk factors including smoking, raised blood pressure and cholesterol are all amenable to intervention to reduce cardiovascular (CV) risk.

CVD is most commonly caused by the build-up of atheroma in the walls of the blood vessels. This begins through the development of fatty streaks in the artery. Over time a cholesterol-rich atheroma is formed, covered by a plaque. The atheroma causes narrowing of the artery, which can progress to a point at which the patient may experience symptoms due to reduced blood and oxygen supply. 

By reducing cholesterol levels with lifestyle changes and pharmacological intervention, the risk of CV events such as heart attack and stroke can be reduced. The introduction of a statin has a 20 per cent relative risk reduction in major vascular events for every 1mmol/L reduction of low-density lipoprotein (LDL) cholesterol, regardless of the starting cholesterol level. Ensuring lipid modification is offered to those at highest risk was identified as a priority in the NHS Long Term Plan published in January 2019.

Measuring the lipid profile

Cholesterol levels are measured using a blood test, which can be either a venous sample or a finger-prick test using point-of-care technology. A non-fasting sample may be used, which makes this simpler for both the patient and the clinician. The results of the lipid profile will give a breakdown of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL cholesterol and triglycerides. Low-density lipoprotein cholesterol (LDL-C) is not directly measured but can be calculated from a fasting lipid profile.