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2014 NICE - controversial 

''Primary prevention'' 
 >40yr with 10yr risk of CVD >10%
use QRISK2 unless >85yr, T1DM, eGFR<60 or albuminuria, FH hyperlipid
note QRISK2 underestimates risk in those with HIV, mental health problem, on antipsychotics,steroids or immunosuppressants, with autoimmune/inflammatory disorders eg SLE
Atorvastatin 20mg - 1st line

''Measuring lipid levels''
do both //total cholesterol and HDL//
Full profile (including TG) needed pre-statin (not fasting sample) 
If total chol >7.5 with FH premature CVD - consider familial hypercholest - needs referral
If total chol >9.0 or LDL-chol (ie nonHDL) >7.5 without FH premature CVD - consider familial hyperchol - needs referral

''Interpreting QRISK2''
from 2014 use cut off of 10yr risk of 10% and offer statin
Can do lifestyle first and repeat chol pre statin

''Special situations''
''Type 1 diabetes mellitus''
consider atorvastatin 20mg in all >40yr, DM>10yr, nephropathy or other CVD risk factor
''CKD''
atorvastatin 20mg to all
increase dose if <40% reduction in non-HDL cholesterol and eGFR > 30 
If eGFR < 30 to renal specialist

''Secondary prevention''
All with CVD should be taking a statin unless CI - 1st line - Atorvastatin 80mg (?Mark - for 3/12 then reduce and give as per level - stabilizes plaque in initial 3/12 post MI) 

''Follow-up'' of all starting on statins
at 3/12 ... repeat profile and do LFTs and inc dose up to Atorva 80 if nonHDLchol hasn't dec by 40%
underline lifestyle change

''Lifestyle modifications''
''Cardio-protective diet''
total fat <30% total energy intake (sat fat <7%)
chol intake <300mg/day
replace sat fat with monunsat or polyunsat fat
replace sat and momunsat with olive or rapeseed oil (or spread from these)
wholegrain starch
reduce sugar and food containing fructose
5 F&V/day
2 fish /week - 1 oily
4-5 nuts/seeds/legumes/wk

''Physical activity''
150 mins moderate intensity or 75 mins vigorous aerobic activity / wk
muscle strengthening activity 2+ days /wk for all major muscle groups

''Weight management''
Aim for normal

''Alcohol intake''
3-4u/day men, 2-3u/d women

''Smoking cessation''
quit