Hypercholesterolaemia
ASSIGN (2.0) CVD Calculator SIGN 149: Cardiovascular disease NICE NG238: Cardiovascular disease
Statin treatment indicated for estimated 10-year cardiovascular risk ≥ 10%.
Ezetimibe may be considered in combination with a statin for patients who have failed to reach target cholesterol levels despite treatment with titrated/optimised statins alone. It may also be considered as monotherapy where statins are inappropriate or poorly tolerated.
Suitable for those intolerant to atorvastatin. See prescribing notes.
Ezetimibe may be considered in combination with a statin for patients who have failed to reach target cholesterol levels despite treatment with titrated/optimised statins alone. It may also be considered as monotherapy where statins are inappropriate or poorly tolerated.
Prescribing Notes:
- See SIGN Guideline 149 and NICE Clinical Guideline 238 for guidance on risk estimation and the prevention of cardiovascular disease.
- The MHRA has produced recommendations for dose restrictions when used with some other drugs as interactions may increase the risk of adverse effects, or reduce the effectiveness of statin treatment.
- If someone reports adverse effects when taking statins discuss:
- stopping the statin and trying again when the symptoms have resolved to check if the symptoms are related to the statin;
- changing to a different statin in the same intensity group (rosuvastatin if already receiving atorvastatin);
- reducing the dose; or
- changing to a lower-intensity statin.
History Notes
27/05/2026
Regional formulary chapter launched.
Use all medicines in this pathway in line with local guidance.
PCSK9i monoclonal antibodies.
An alternative to evolocumab or alirocumab (PCSK9i monoclonal antibody therapies) where these treatments are either not tolerated or insufficiently effective.
Adenosine triphosphate citrate lyase inhibitors.
Prescribing Notes:
See SMC website for guidance and restrictions on use:
History Notes
27/05/2026
Regional formulary chapter launched.