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There are no lipid reduction targets in secondary prevention, the aim is to use the maximum tolerated dose of a statin. Prescribe Atorvastatin 80mg unless contraindicated, in Chronic Kidney Disease (CKD) the initial dose should be 20mg. A fasting sample is not needed.
All secondary prevention patients should have a full lipid profile measured on one occasion to include total cholesterol, HDL cholesterol, non-HDL cholesterol and triglycerides. A fasting sample is only required if triglycerides are ≥10mmol/l. In the majority of patient the only lipid measurement that needs repeating will be non-HDL cholesterol.
Cardiovascular disease includes angina, myocardial infarction (MI), cardiovascular event (CVE), transient ischemic attack (TIA), aortic aneurysm and peripheral vascular disease.
Liver transaminases (ALT or AST) should be measured prior to starting a statin, and again after 3 and 12 months. Long term monitoring of LFTs is not indicated.
Myocardial Infarction (MI) – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction. NICE guidelines [CG172]. Published: November 2013
Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE guideline [CG181] Published: July 2014.
This guideline has been signed off by the Pathology Optimisation Clinical Group on behalf of NEW Devon CCG.
Publication date: June 2017