Learning Objectives
- Stratify cardiovascular risk using QRISK3 and other tools
- Apply the updated ESC/NICE lipid guidelines
- Understand PCSK9 inhibitors and inclisiran indications
- Manage antiplatelet therapy in ACS and elective PCI
Risk Stratification
QRISK3 is the recommended tool in England and Wales for 10-year CVD risk prediction. Assess every 5 years in adults aged 40-74 without established CVD.
Statin Therapy
NICE recommends:
- Offer high-intensity statin (atorvastatin 20mg+) to all patients with CVD or T2DM
- Offer statin to all adults with QRISK3 ≥10% — discuss benefits/risks
- Atorvastatin 80mg for established CVD unless contraindicated
Novel Lipid-Lowering Therapies
PCSK9 inhibitors (evolocumab, alirocumab): NICE approved for familial hypercholesterolaemia and for patients who have had MI on maximally-tolerated statin. Very high LDL reduction (~60%).
Inclisiran (Leqvio): Twice-yearly injection. NICE approved for same population as PCSK9 inhibitors. Administered in primary care. Significant adherence advantage.
Key Takeaways
- Review all high-risk patients on suboptimal statin — intensify or add ezetimibe first
- Inclisiran can be initiated and administered in primary care — no secondary care referral needed for eligible patients
- Annual lipid check for all patients on lipid-lowering therapy