Lipid management in Scotland: Recommendations for action
Background
Heart disease remains a major cause of death and disability in Scotland, accounting for over 17,000 deaths in 2021¹. While there has been a steady rise in life expectancy over the past four decades², progress in reducing mortality from heart disease has stalled, with too many people still living with undetected high-risk conditions including high cholesterol. Raised cholesterol is a key risk factor for cardiovascular disease, including heart attacks and strokes, and impacts 56% of men and women aged 16-64 in Scotland³. The inherited form of raised cholesterol, Familial Hypercholesterolemia (FH) is a rarer but potentially very dangerous health condition, impacting 1 in 250 of the general population.(4)
In March 2021 the Scottish Government published the Heart Disease Action Plan (5) which sets out priorities and actions to reduce the incidence of preventable heart disease and ensure equitable and timely access to diagnosis, treatment, and care for patients. While progress has been made since publication, a lack of measurable targets against timely diagnosis and treatment means high-risk patients in Scotland remain vulnerable to experiencing unnecessary - and potentially catastrophic - cardiovascular events.
Lipid Management Policy Roundtable 03.11.22
HEART UK, the Cholesterol Charity, and Amgen UK Ltd, convened a group of key stakeholders to discuss the progress made to date and what more could be done to advance the situation for patients with, or at risk of, raised cholesterol. Clinical leaders, a patient, and Members of the Scottish Parliament, as well as representatives from the Scottish Government, discussed the current opportunities and challenges for lipid management and what approaches to improving treatment and care could look like for Scotland.
The group heard from a HEART UK patient ambassador about their experience of diagnosis, treatment, and care along with clinical perspectives of identifying and treating patients and the importance of genetic testing for those at high risk of inherited forms of raised cholesterol. Potential approaches and interventions which could improve identification and treatment of high-risk patients were also
discussed with a recognition of the need to reduce hospital admissions to alleviate the burden on the NHS and avoid preventable, and potentially catastrophic, cardiovascular events for patients across Scotland.
Recommendations
The group agreed on a series of recommendations which would improve the situation for patients with raised cholesterol in Scotland:
- Awareness must be raised amongst healthcare professionals and the public that high cholesterol is a major risk factor for cardiovascular events.
- Ensure progress in the development of a community awareness, detection, and prevention programme (part of the Scottish Government Heart Disease Action Plan 2021), which will identify individuals with raised cholesterol and high cardiovascular risk.
- Update and maintain a cardiovascular risk estimation tool for Scotland to provide both patients and clinicians with the information they need to prevent cardiovascular disease.
- Ensure regular review of national lipid guidelines to provide an up-to-date, evidence-based once-for-Scotland approach for all patients with high cholesterol.
- More must be done to proactively identify and offer care to patients with Familial Hypercholesterolaemia (FH).
- Lipid clinics and lipid specialist advice must be equally available to patients and primary care clinicians irrespective of location. These services are vital in order to champion high-quality cardiovascular disease prevention in primary care and to identify more individuals with FH at a younger age.
- Specialist nurses have a successful track-record of working effectively between lipid clinics and primary care in Scotland. The introduction of a small specialist nursing team could help alleviate pressures on current lipid services, champion cardiovascular disease prevention and proactively identify and offer care to high-risk patients and their families.
- Incentives and targets should be introduced (such as Quality Performance Indicators), including a specific FH patient identification target, in order to incentivise clinicians to identify, treat and manage high-risk patients in a “Once for Scotland” approach.
- Consideration should be given to re-introduce routine cholesterol measurement in the Scottish Health Survey (removed in 2012).
- All patients with hyperlipidaemia should have better access to appropriate information, education, and support. Those diagnosed with, or at risk of, FH should have access to information about the genetic nature of their condition and support should be provided for them and their family members who may also be at risk of the condition.
Next steps – building on the recommendations for action
Roundtable attendees and a wider network of stakeholders with an interest in lipid management should reconvene in October 2023 to review progress on recommendations for action.
1 British Heart Foundation. Scotland Factsheet (August 2022) https://www.bhf.org.uk/dechox/ -/media/files/research/heart-statistics/bhfcvd-statistics---scotland-factsheet.pdf
2 National Care service – health and demographic profile (June 2022) https://www.gov.scot/publications/national -care-service-scotlandshealth-demographic-profile/pages/4/
3 High cholesterol: key points (2020) https://www.scotpho.org.uk/clinical -risk-factors/high-cholesterol/key-points/
4 Wald et al, NEJM 2016 https://www.nejm.org/doi/full/10.1056/NEJMoa1602777
5 https://www.gov.scot/publi cations/heart-disease-action-plan/
GBR-NP-0223-80010 February 2023
This non-promotional roundtable was jointly organised by Amgen UK and HEART UK and both organisations worked together to shape the scope of the roundtable. Amgen UK Ltd provided funding for the roundtable by the way of agency services to manage the meeting logistics and outputs.
