High cholesterol: policy context
Most policy in the NHS in Scotland refers to diseases and services. There is no specific policy on high cholesterol as such, but there is strategy on coronary heart disease and stroke - the Better Heart Disease and Stroke Care Action Plan 2009. This recognises raised cholesterol as a risk factor and recommend its identification in the population through assessment of global cardiovascular risk among adults aged 40 years and older. The Heart Disease Improvement Plan 2014 sets out priorities to deliver care for people affected by heart disease in Scotland.
Familial hypercholesterolaemia is associated with very high levels of cholesterol and high risk of cardiovascular disease. The NHS Quality Improvement Scotland (now Health Improvement Scotland) Clinical Standards for Heart Disease 2010 recommend that all close relatives of cases should have their cholesterol levels measured so that they can start lifestyle modifications and preventive treatments if necessary. Children of people with familial hypercholesterolaemia should also be tested before the age of 10 years. NICE Clinical Guideline 71 provides recommendations about the management of familial hypercholesterolaemia.
NICE public health guidance 25 Prevention of Cardiovascular Disease and the associated Prevention of cardiovascular disease: Evidence update January 2014, notes that there is a move away from the emphasis on individual risk factor towards towards assessment of global cardiovascular risk. The fall in cholesterol levels seen in many Western populations are mainly attributable to lifestyle changes and changes in the wider determinants of health rather than to medication.
In terms of policy relating to cholesterol in particular, until recently there were targets for general practice in relation to managing raised cholesterol in people with known cardiovascular disease and diabetes or who had had a stroke or transient ischaemic attack (TIA) and also targets for recording the total cholesterol to high density lipoprotein (HDL) ratio in people over 40 who had schizophrenia, bipolar affective disorder and other psychoses. The Quality and Outcomes Framework (QOF) is now discontinued and recent data is no longer available.
Specific guidelines and policy regarding clinical intervention in high cholesterol is described in SIGN 149 guidelines on risk estimation and the prevention of cardiovascular disease. NICE Clinical guideline CG181 Cardiovascular disease: risk assessment and reduction, including lipid modification provides guidance relevant to those with high cholesterol. JBS 3: Joint British Societies’ consensus recommendations for prevention of cardiovascular disease provides recommendations for treatment of cardiovascular risk factors including cholesterol.
