CVD: Current guidelines and treatment
CVD – Current guidelines and treatment
Cardiovascular disease remains the biggest cause of premature death in the UK with 180,000 deaths from CVD, of which 80,000 are from coronary heart disease (CHD) and 49,000 from cerebrovascular accident (CVA). Some 46,000 of these deaths occur before the age of 75. It is not only the mortality of CVD that is concerning, although this has fallen by two-thirds since 1980, but the morbidity it causes: approximately 150,000 people each year have a stroke and 103,000 have a heart attack.1 A patient with one circulatory disease is at higher risk of having others and therefore it is best practice to consider their overall cardiovascular risk and treat accordingly.2 Practice nurses are at the forefront of this work as when they see the patient for one chronic disease, they are in an ideal position to address the bigger picture.
Aims and Objectives
On completion of this resource you should have an understanding of:
- What is meant by the family of cardiovascular diseases
- The key recommendations in relation to stroke guidance
- Assessing chest pain and making a diagnosis
- The management of angina
- The guidance for lipid modification
This module, offered at intermediate level, explores the management of cardiovascular disease based on current guidelines. Complete the module, including the recommended reading and some or all of the suggested activities, to obtain a certificate of one hour’s CPD to add to your portfolio.
References
1. British Heart Foundation. Heart and circulatory diseases: Factsheet; January 2025. https://www.bhf.org.uk/what-we-do/our-research/heart-statistics
2. Department of Health, Cardiovascular disease outcomes strategy, improving outcomes for people with or at risk of cardiovascular disease, 2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214895/9387-2900853-CVD-Outcomes_web1.pdf
Practice Nurse featured articles
Haws J. QRISK4: what's on the horizon in CVD risk assessment. Pracitce Nurse 2025;55(2):22-25
Galloway M. Reducing cardiovascular risk: latest recommendations. Practice Nurse 2024;54(2):12-15
Bostock B. Lipid management for primary care. Practice Nurse 2023;53(4):16-19
Magowan J. A clinical priority: cardiovascular disease prevention. Practice Nurse 2021;51(2):16-20.
Cardiovascular disease (CVD) refers to a group of conditions that affect the heart and blood vessels. It includes heart disease, stroke and transient ischemic attacks, and dementia. CVD is the leading cause of death and disability, despite major improvements in both the detection and management over recent years, and remains a significant cause of health inequality. CVD is estimated to affect about 7 million people and is responsible for a quarter of all deaths and the main cause of premature death in the UK.1 The NHS Long Term Plan (LTP) for Health describes tackling CVD as a clinical priority and as the single clinical area with the greatest potential for saving lives over the next ten years.1 The ambition for CVD is to prevent over 150,000 heart attacks, strokes, and dementia cases over the next 10 years through prevention, early detection and treatment of CVD.1
CVD is largely preventable, and the biggest gains can be achieved through primary prevention initiatives, which target individuals without existing disease and promote healthy lifestyle choices and which identify risk factors and high-risk conditions. The LTP strategy for prevention focuses on identifying and treating the three ‘ABC’ high-risk conditions – Atrial Fibrillation (AF), Blood pressure and Cholesterol (Table 1).
2019 | 2029 | ||
A – Atrial fibrillation | Detection | 79% | 84% |
Management | 85% | 90% | |
B – Blood pressure/hypertension | Detection | 57% | 80% |
Management | 56% | 80% | |
C – Cholesterol | Detection | 49% | 75% |
Management | 35% | 45% |
IMPROVING DETECTION OF ABC CONDITIONS
A. AF is characterised by a rapid, irregular heartbeat, which can cause blood clots to form which, in turn, can result in a stroke. AF can be easily detected by checking for an irregular pulse and investigating with an electrocardiogram (ECG). There is a five-fold increased risk of stroke associated with AF, but this risk can be reduced by up to 65% through effective use of anticoagulation therapy.6 The ambition of the LTP is to improve detection rates from 79% detection in 2019 to 84% by 2029 and improve effective management from 85% to 90%.
B. Hypertension is the second largest global risk factor for disease and disability (after poor diet) and is responsible for approximately half of all strokes and ischemic heart disease events. Hypertension is estimated to effect one in four adults in the UK but prevalence is increased in areas of deprivation, with hypertension 30% more likely in the most deprived areas of England compared with the least deprived.2 Hypertension detection rates vary considerably between the best and the worst CCGs but average out nationally at just over at an estimated 57% detection. Furthermore, only an estimated 56% of people with hypertension are treated to target levels recommended by national guidelines.3 The LTP goal is to improve detection of underlying hypertension to 80% and to address suboptimal management of hypertension by treating 80% of patients to target.
C. High cholesterol is a well-established CVD risk factor and estimated to be responsible for one in three cases of ischemic heart disease, and to account for 7.1% of deaths in England.2 Testing blood lipids and using an approved CVD risk calculator such as QRISK enables the identification of increased risk. Raised cholesterol can be managed through appropriate lifestyle advice and for those with an estimate CVD risk of >10% over the next 10 years, NICE recommends offering treatment with statins.4 In addition, the LTP aims to improve the diagnosis and treatment of Familial Hypercholesterolaemia (FH) to 25% of cases.
CVD risk factors rarely occur in isolation, so when reviewing patients consider the presence of other potential high-risk conditions. Palpating and assessing a radial pulse for irregularities when reviewing a patient with hypertension and taking blood to screen for diabetes and lipids are examples of this approach. Holistic assessment of lifestyle and medications adherence is recommended, and the provision of individual patient-centred advice that considers the individual’s ideas, concerns and expectations. Reducing lifestyle risks such as smoking, poor diet, obesity, inactivity, and excessive alcohol consumption is essential to CVD prevention.
References
NHS. The NHS long term plan. 2019. https://www.longtermplan.nhs.uk/
Public Health England. Health Matters – Preventing Cardiovascular Disease; April 2018 https://www.gov.uk/government/publications/health-matters-preventing-cardiovascular-disease/health-matters-preventing-cardiovascular-disease#scale-of-the-problem
NICE NG136. Hypertension in adults: diagnosis and management; 2019 (updated 2023). https://www.nice.org.uk/guidance/ng136
NICE CKS. Lipid modification; October 2020 (updated 2025) https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/