Primary prevention refers to people who do not have established CVD. Use of a recognised cardiovascular risk assessment tool gives an estimate of an individual person’s CV risk over the next 10 years. NICE lipid lowering guidelines (2016) recommended the use of the QRisk assessment tool in adults up to the age of 84 years. This tool was updated in 2018 and QRisk 3 is the latest version. 

People aged 85 years or older are considered at increased risk of CVD because of age alone. However, the use of statins for primary prevention in this age group is the subject of much debate and the decision to initiate or continue a statin is made on a case-by-case basis.

The risk assessment will give an estimate of the individual’s risk of a heart attack or stroke in the next 10 years. NICE now recommends considering offering lifestyle advice and a statin if the person’s 10-year CV risk is 10 per cent or more. This level of risk for offering a statin has also been reflected in the 2019 update of the NICE guideline for hypertension in adults, which had previously suggested the higher threshold of 20 per cent.

A QRisk of less than 10 per cent over the next 10 years should be seen as an opportunity to re-enforce lifestyle advice and be reviewed in line with guidance, as future risk will change over time.