Although the focus of this module has been on primary prevention, it is important to remember that other patient groups will also require lifestyle support and pharmacological intervention.

In all of these groups, statin therapy is the first choice and mainstay of treatment, and the same precautions apply as for primary prevention.

• Secondary prevention

Secondary prevention refers to the management of CV risk in patients with established CVD. These people should be offered lifestyle advice and lipid modification with a statin, regardless of their baseline cholesterol levels

• Familial hypercholesteraemia

These inherited lipid disorders can be identified from high baseline lipid levels, clinical examination for features of high cholesterol such as tendon xanthoma or corneal arcus and a personal or family history of premature CVD (before the age of 60 years). Patients should be referred to specialist lipid services, where genetic testing may be undertaken.

Reflective exercises

• How would you explain to a patient why a statin has been recommended?
• What advice would you give regarding how to take it and the potential side effects?