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Ezetimibe |
| People with primary hypercholesterolaemia should be considered for exetimibe treatment in line with Ezetimibe |
for treating primary heterozygous-familial and non-familial hypercholesterolaemia as per NICE TA358 (replaces NICE
|
| TAG132) |
| GREEN Ezetimibe tablets 10mg |
| |
| Bempedoic acid (without ezetimibe) |
| Treatment of primary hypercholesterolaemia or mixed dyslipidaemia |
| GREEN Bempedoic acid (Nilemdo®) ICB commissioned |
|
GREEN Bempedoic acid with ezetimibe [Nustendi®]
|
| This recommendation does not apply to bempedoic acid when used without ezetimibe. |
| NICE TA694 Recommended as an option for treating primary hypercholesterolaemia (heterozygous familial and non-familial) |
| or mixed dyslipidaemia as an adjunct to diet in adults. It is recommended only if: |
| > statins are contraindicated or not tolerated. |
| > ezetimibe alone does not control low-density lipoprotein cholesterol well enough, and |
| > the company provides bempedoic acid and bempedoic acid with ezetimibe according to the |
commercial arrangement
|
| Bempedoic acid with ezetimibe can be used as separate tablets or a fixed-dose combination. |
| Suitable for GP prescribing following recommendation/initiation by specialist. ICB commissioned |
Alirocumab (NICE TAG393) and Evolocumab (NICE TAG394) are recommended as options for treating primary |
hypercholesterolaemia or mixed dyslipidaemia
|
| |
RED Alirocumab (Praluent®) Solution for injection 75mg/mL, 150mg/ml (CCG commissioned)
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RED Evolocumab (Repatha®)
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GREEN RESTRICTED Inclisiran - see position statement CCG commissioned |
| Supporting documents for practices: Inclisiran Prescribing information Leaflet |
| Inclisiran_Summary information on the funding and supply-NHSE_v2-april-2023 |
| Inclisiran dosing, administration, how to guide June 23 |
To be used in accordance with the:
|
| 'Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD' |
| See supporting documents for Inclisiran: |
| Summary information on the funding and supply [NHSE] |
| Prescribers Information Leaflet |
| Dosing, administration, how to guide |
| |
| NICE TA733 Inclisiran is recommended as an option for treating primary hypercholesterolaemia (heterozygous familial and |
non-familial) or mixed dyslipidaemia as an adjunct to diet in adults. It is recommended only if:
|
| > there is a history of any of the following cardiovascular events: |
| º acute coronary syndrome (such as myocardial infarction or unstable angina needing hospitalisation) |
| º coronary or other arterial revascularisation procedures |
| º coronary heart disease |
| º ischaemic stroke or |
| º peripheral arterial disease, and |
| > low-density lipoprotein cholesterol (LDL-C) concentrations are persistently 2.6 mmol/l or more, despite |
| maximum tolerated lipid-lowering therapy, that is: |
| º maximum tolerated statins with or without other lipid-lowering therapies or, |
| º other lipid-lowering therapies when statins are not tolerated or are contraindicated, and |
| > the company provides inclisiran according to the commercial arrangement. |
GREEN Icosapent ethyl [Vazkepa] |
| NICE TA805 Icosapent ethyl is recommended as an option for reducing the risk of cardiovascular events in adults. |
| It is recommended if they have a high risk of cardiovascular events and raised fasting triglycerides (1.7 mmol/litre or |
| above) and are taking statins, but only if they have: |
| > established cardiovascular disease (secondary prevention), defined as a history of any of the following: |
| - acute coronary syndrome (such as myocardial infarction or unstable angina needing hospitalisation) |
| - coronary or other arterial revascularisation procedures |
| - coronary heart disease |
| - ischaemic stroke |
| - peripheral arterial disease, and |
| > low-density lipoprotein cholesterol (LDL‑C) levels above 1.04 mmol/litre and below or equal to 2.60 mmol/litre. |
| See full NICE guidance ICB Commissioned |
Nicotinic acid group
|
Do not offer nicotinic acid (niacin) for the prevention of CVD to any of the following:
|
| |
Omega-3-acid ethyl esters
|
| BLACK Omega-3-acid ethyl esters - Post Myocardial Infarction. |
| NHS England has identified this product as an item that should not be routinely prescribed in primary care. Available to |
| purchase over the counter. Click herefor the Position Statement for Omega-3-acid ethyl ester prescribing in CVD |
| BLACK Omega-3 fatty acid compounds for preventing CVD |
| NHS England has identified this product as an item that should not be routinely prescribed in primary care. Available to |
| purchase over the counter. |
| |
| Recommendations in this section update and replace recommendations 1.10.4.1 and 1.10.4.2 from Type 2 diabetes |
| NICE guideline NG28 (updates and replaces NICE clinical guideline 87). |
| Do not offer omega‑3 fatty acid compounds for the prevention of CVD to any of the following: |
| > people who are being treated for primary prevention | > people who are being treated for secondary prevention
|
| > people with CKD |
| > people with type 1 diabetes |
| > people with type 2 diabetes |
| There is no evidence that omega‑3 fatty acid compounds help to prevent CVD |
| |
| Omega-3-acid ethyl esters - Hypertriglyceridaemia |
NHS England has identified this product as an item that should not be routinely prescribed in primary care. Available to
|
purchase over the counter.
|
BLACK Omega-3-acid ethyl ester capsules 1g.
|
| |
Anion-exchange resins
|
Do not offer a bile acid sequestrant (anion exchange resin) for the prevention of CVD to any of the following:
|
> people who are being treated for primary prevention
|
| > people who are being treated for secondary prevention |
| > people with CKD |
| > people with type 1 diabetes |
| > people with type 2 diabetes |
| |
Combination therapy for preventing CVD
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Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid
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compound with a statin for the primary or secondary prevention of CVD.
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