National Programme —

Lipid Management & FH (familial hypercholesterolaemia)

Supporting primary care to optimise lipid management pathways.

medical doctor with stethoscope writing, filing medical form

Building on the three-year lipid management programme to improve outcomes in patients with cardiovascular disease and familial hypercholesterolaemia (FH)  

Supporting and working with health and care professionals to increase confidence, knowledge and adherence to the lipid lowering pathways as part of the lipid service re-design taking place in the region

A key element of the NHS Long Term Plan is reducing the incidence of Cardiovascular Disease (CVD), which causes a quarter of all deaths in the UK, particularly in deprived areas.   

Lipid Management

Over the next 12 months the South West AHSN is aiming to ensure that more patients ‘at risk’ of and with CVD are effectively treated for their cholesterol. Our support involves increasing awareness and knowledge of the national guidance for lipid management and it’s associated pathways  in both primary and secondary care. We are working collaboratively with our partners to deliver targeted education across the region to re-design and deliver improved lipid services and share best practice across the region.  

The AHSN Network Lipid Management and Familial Hypercholesterolaemia programme has a focus on optimising the treatment of disordered lipids to give patients the best chance of avoiding cardiac events. 

This page has been created to provide information to healthcare professionals about the treatment options for disordered lipids, as outlined in the Lipid Management Pathway. 


Why is Lipid Management a priority? 

Cardiovascular disease (CVD) is associated with brain, heart and vascular health risks and makes up the leading cause of death in England.

  • 137,000 deaths per year of which 37,000 (26%) are premature
  • 6.8 million living with CVD
  • £7.4bn in costs to the NHS, and £15.8bn with the wider economy

Preventing and managing CVD and its risk factors has the potential to improve population health and ease pressures on overstretched health and care systems by reducing demand for services. 

Lipid management in England must improve to drive better CVD outcomes  

  • Every 1mmol/L reduction in LDL-C is tied to a 22% reduction in major vascular events after one year
  • A EU-wide study revealed that 61% of high-risk ASCVD patients are unable to reach an LDL-C goal of <1.8mmol (ESC target) signposting the need for a different approach

Lipid control is a vital part of this: 43% of all adults live with LDL-C levels above national guidelines

LDL-C management for secondary prevention is a clinical priority for patients and the NHS, as recognised by incentives in the 2023/2024 QOF amounting to 30 points and ~£36 million in funds 

The 2023/2024 updates of QOF include a non-HDL target that is lower than 2.5 mmol/L or where non-HDL cholesterol is not recorded an LDL-C target of lower than 1.8 mmol/L for secondary prevention patients. 1 

The 1.8 mmol/L LDL-C target in the QOF may not be reachable for some patients with statins alone.4 

Many high-risk CVD patients could still benefit from further treatment optimisation and access to further combination therapies within the lipid management pathway 

Despite other successful lipid management initiatives  by the AAC and AHSNs in England, many high-risk CVD patients could still benefit from further treatment optimisation and access to further combination therapies. 

National Guidance 

Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease 


Clinical Pathways 

To support delivery of this part of the NHS Long-Term Plan, the Accelerated Access Collaborative (AAC) Lipid Management Rapid Uptake Product (RUP) Working Group developed a NICE-endorsed Statin intolerance pathway along with a companion document in April 2020.

The aim of these pathways is to simplify and encourage adherence to national guidance for optimal management of patients at high risk of CVD and reducing the incidence of heart attacks or strokes.  

Two pathways have also been developed – one for acute cardiovascular disease in secondary care and one for primary care clinicians –to provide clear and simple guidance for clinicians on how optimal lipid management may be achieved and provide an additional resource to support patient management 


Medication specific guidance  

There are a number of treatment options available to help lower patients’ cholesterol 

 Information about individual medications can be found here: 

 Inclisiran (Leqvio) 

The AHSN Network is the delivery partner for the deployment of Inclisiran in England, working in partnership with NHS England. As a Network, AHSNs (Academic Health Science Networks) are working closely with clinicians across the country to support the healthcare system in the introduction of Inclisiran into local lipid management pathway. Inclisiran is one of the treatment options available as part of the pathway, with a goal to better manage patient cholesterol and lead to better outcomes for our population.

Patient and health care professionals guides to Inclisiran may be downloaded via the following link:  

Inclisiran-HCPs and patient-leaflets: emc 

NHS Accelerated Access Collaborative » Summary information on the funding and supply of inclisiran (Leqvio®) (

Would you like to know more about our Lipid Optimisation Programme and/or the other South West AHSN programmes? Please complete this form. You can also find more information on Inclisiran here: Summary information on the funding and supply of Inclisiran (Leqvio®) (NHS England, April 2023) 

Bempedoic acid (Nilemdo) 

Patient and health care professionals guides to Bempedoic Acid may be downloaded via the following link:  

Bempedoic acid-HCPs and patient-leaflets: emc 

Bempedoic acid and ezetimibe (Nustendi) 

Patient and health care professionals guides to bempedoic acid and ezetimibe may be downloaded via the following link:  

Bempedoic acid and ezetimibe-HCPs and patient-leaflets: emc 

PCSK9 inhibitors ( alirocumab and evolocumab) 

A patient and HCPs guide to PCSK9i (alirocumab and evolocumab) may be downloaded via the following links:

Alirocumab (Praluent) – HCPs and patient-leaflets – emc 

Evolocumab (Repatha) – HCPs and patient-leaflets – emc  


Please find the formulary specific guidance for lipid management and familial hypercholesterolaemia and more information about the pathway medications for your county below:  



The Devon Formulary and Referral Site ( 



Somerset local formulary guidance  



Cornwall local formulary guidance 

For more information on FH and the Lipids Pathway, please contact Harriet Matthews, CVD Programme Manager for Innovation and Implementation. 
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