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. See Better Heart Disease and Stroke Care Action Plan 2009. This recognises raised cholesterol as a risk factor and recommend its identification in the population and appropriate management and treatment. It advocates that population-wide approaches offer the biggest opportunity for health gains relative to the scale of effort but also notes that when an individual is diagnosed with familial hypercholesterolaemia, all close relatives should have their cholesterol levels measured so that they too can start lifestyle modifications and preventive treatments if necessary. This approach is supported by the NHS Quality Improvement Scotland (now Health Improvement Scotland) Clinical Standards for Heart Disease 2010. Children of people with familial hypercholesterolaemia should also be tested before 10 years old.
NICE public health guidance 25 Prevention of Cardiovascular Disease , see also its associated Prevention of cardiovascular disease: Evidence update January 2014 , notes that there is a move away from the emphasis on individual risk factor towards consideration of how these combine to create a global 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, there are targets for general practice in relation to managing raised cholesterol in people with known cardiovascular disease and diabetes or who have 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 have schizophrenia, bipolar affective disorder and other psychoses. For more detail for Scotland, see the Quality and Outcomes Framework (QOF).
In addition, policy regarding clinical intervention in high cholesterol is described in SIGN guidelines on coronary heart disease and stroke. Specific guidelines on the prevention of cardiovascular disease give further explanation on the thresholds used to define 'raised cholesterol' (See Risk estimation and the prevention of cardiovascular disease(771KB)). 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.