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Health condition · Clinically reviewed

Coronary disease prevention, the modern UK playbook - risk scoring, lifestyle and the right medicines.

The UK's leading cause of death is largely preventable. A structured plan - QRISK3, blood pressure, lipids, smoking, diabetes, activity and cardiac rehabilitation - changes outcomes for a lifetime.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, JBS3, ESC and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK prevention guidance including NG238 lipid targets, SGLT2 and GLP-1 cardiovascular data, and Lp(a) screening.

Key facts

Prevention at a glance.

The essentials, in plain English - what CV prevention covers, how risk is scored, and how the modern medicine cabinet has changed.

  • What it is

    Coronary heart disease is the UK's leading cause of death and is largely preventable through modifying risk factors across a lifetime.

  • Two arms

    Primary prevention targets people with no known cardiovascular disease. Secondary prevention follows a heart attack, PCI, CABG, stroke or peripheral arterial disease.

  • Risk assessment

    QRISK3 is the UK primary care tool. Low is under 10 percent, moderate 10 to 19 percent, high 20 percent or more over 10 years. JBS3, SCORE2 and ASCVD add lifetime context.

  • Biggest lever

    Stopping smoking is the single most important intervention at any age and cuts cardiovascular risk faster than any drug.

  • Lipid targets

    NICE NG238 recommends high-intensity statin for QRISK3 of 10 percent or more. Secondary prevention targets LDL under 1.4 mmol/L or a 50 percent reduction.

  • Aspirin caveat

    Aspirin 75 mg is standard for secondary prevention. It is no longer used for primary prevention because ASPREE, ARRIVE and ASCEND showed harm outweighs benefit.

Why this guide matters

Prevention beats rescue, every time.

Coronary heart disease is largely preventable and increasingly treatable. Three ideas shape everything else on this page.

  • Two arms, one strategy

    Primary prevention keeps well people well. Secondary prevention protects those who have already had an event. The tools overlap but intensity differs.

  • Score first, then treat

    QRISK3, backed by lipid panels, blood pressure profiles and sometimes a CT calcium score, decides who benefits most from statins and other therapies.

  • Lifestyle and drugs together

    Smoking cessation, activity and diet still matter enormously - but modern lipid, blood pressure and diabetes medicines now change survival in their own right.

How risk is assessed

From a first check to a personalised plan.

The steps a UK GP, practice nurse or cardiologist will usually follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    NHS Health Check or opportunistic review

    Free between 40 and 74 in England. Covers blood pressure, cholesterol, BMI, smoking, alcohol, family history and QRISK3.

  2. 02

    Assessing

    QRISK3 calculation

    A 10-year cardiovascular risk score using age, sex, ethnicity, blood pressure, lipids, smoking, diabetes, kidney function and postcode-linked deprivation.

  3. 03

    Assessing

    Bloods and BP profile

    Non-fasting lipid panel including non-HDL and ApoB where available, HbA1c, U and E, LFTs, TFTs, and home or ambulatory BP monitoring.

  4. 04

    Confirming

    Advanced risk markers

    Lipoprotein(a) once in a lifetime, hsCRP for inflammatory risk, and a family history review for premature coronary disease or familial hypercholesterolaemia.

  5. 05

    Confirming

    Imaging for intermediate risk

    CT coronary calcium score can reclassify borderline QRISK3 patients. CT coronary angiography is used for symptomatic assessment and risk stratification.

  6. 06

    Preparing

    Shared decision on treatment

    Lifestyle first for everyone. Add high-intensity statin, antihypertensives, SGLT2 or GLP-1 agents where indicated, guided by absolute risk and patient priorities.

  7. 07

    Preparing

    Cardiac rehabilitation after events

    Post-MI, PCI, CABG or stable angina, structured rehabilitation reduces recurrence, mortality and readmission and starts the secondary prevention plan.

Typical timeline: from a first check to a personalised plan in a matter of weeks.

Modifiable risk factors

What actually drives coronary risk.

Smoking, blood pressure, cholesterol, diabetes, weight, activity and diet - the levers that reduce lifetime cardiovascular events when pulled together.

  • Smoking

    The single most important modifiable risk factor. NRT, varenicline, bupropion and specialist stop-smoking services double or triple quit rates.

  • Raised blood pressure

    Target under 130/80 in most adults, individualised with age and frailty. ACE inhibitors or ARBs, amlodipine, indapamide and spironolactone are the mainstays.

  • Raised cholesterol

    High-intensity statin (atorvastatin 20 to 80 mg or rosuvastatin 5 to 40 mg) with ezetimibe, PCSK9 inhibitors, inclisiran or bempedoic acid where targets are missed.

  • Type 2 diabetes

    HbA1c control matters, but SGLT2 inhibitors and GLP-1 agonists cut cardiovascular events and mortality in their own right.

  • Obesity and central adiposity

    BMI 18.5 to 24.9 and waist under 94 cm in men or 80 cm in women (lower thresholds for South Asian, Chinese and other high-risk groups).

  • Sedentary lifestyle

    150 minutes of moderate or 75 minutes of vigorous aerobic activity a week, strength training twice a week, and breaking up prolonged sitting.

  • Poor diet

    A Mediterranean or DASH pattern with less ultra-processed food, less added sugar and salt, more fibre, wholegrains, oily fish, nuts and olive oil.

  • Red flag - chest pain or breathlessness

    New exertional chest tightness, breathlessness, or symptoms at rest need urgent assessment. Prevention is for the well, not for the actively symptomatic.

Treatment

How prevention is delivered in the UK.

Lifestyle first for everyone, then blood pressure, lipid and diabetes drugs matched to absolute risk. Cardiac rehabilitation and antiplatelets for those with established disease.

  • Smoking cessation

    The highest-yield intervention. Combine behavioural support with NRT, varenicline or bupropion. Any quit at any age improves outcomes within months.

  • Blood pressure control

    Lifestyle first, then ACE inhibitor or ARB, amlodipine, indapamide and spironolactone as a fourth agent. Target usually under 130/80.

  • High-intensity statin

    Atorvastatin 20 to 80 mg or rosuvastatin 5 to 40 mg for QRISK3 of 10 percent or more, and for all secondary prevention.

  • Add-on lipid therapy

    Ezetimibe, PCSK9 inhibitors (alirocumab, evolocumab), inclisiran, bempedoic acid, and icosapent ethyl (Vazkepa) for high triglycerides at high risk.

  • SGLT2 and GLP-1 agents

    Dapagliflozin, empagliflozin, canagliflozin, semaglutide, liraglutide and tirzepatide reduce cardiovascular events in type 2 diabetes and, for some, in obesity or heart failure.

  • Antiplatelet therapy

    Aspirin 75 mg lifelong after MI, PCI, CABG, stroke or PAD. Not recommended for primary prevention in most adults.

  • Post-MI medications

    ACE inhibitor, beta-blocker and dual antiplatelet for the first year following an event, with mineralocorticoid antagonists for LV dysfunction.

  • Cardiac rehabilitation

    A structured programme of supervised exercise, education, dietary support and psychological care after cardiac events. See /treatments/cardiac-rehabilitation-programme/.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or cardiologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE NG238. Cardiovascular disease: risk assessment and reduction, including lipid modification.

  • NICE NG136. Hypertension in adults: diagnosis and management.

  • JBS3. Joint British Societies' consensus recommendations for the prevention of cardiovascular disease.

  • ESC 2021. Guidelines on cardiovascular disease prevention in clinical practice.

  • British Heart Foundation. Patient information on prevention and cardiac rehabilitation.

  • MHRA. Safety updates on statins, PCSK9 inhibitors and SGLT2 inhibitors.

Red flags

When prevention becomes urgent care.

Most cardiovascular prevention is managed in primary care. These are the situations that need urgent same-day, specialist or emergency assessment.

  • New chest pain on exertion

    Central chest tightness, breathlessness or arm and jaw discomfort with activity needs urgent GP or same-day cardiology review to exclude angina or ACS.

  • Sudden severe chest pain

    Crushing chest pain lasting more than 15 minutes, especially with sweating, nausea or breathlessness, is a 999 call. Do not drive yourself.

  • Familial hypercholesterolaemia

    LDL above 5 mmol/L, tendon xanthomata or premature coronary disease in a first-degree relative warrants FH screening and cascade testing.

  • Very high Lp(a)

    Lp(a) above 90 nmol/L (roughly 50 mg/dL) is an independent, genetic risk factor. Escalate other modifiable risks and consider specialist input.

  • Uncontrolled hypertension

    Persistent BP above 180/120, or over 160/100 with end-organ damage, needs urgent same-day assessment.

  • Diabetes with poor control

    HbA1c persistently above target, particularly with albuminuria or eGFR decline, warrants SGLT2 or GLP-1 escalation and specialist review.

  • Post-event mood change

    Depression and anxiety after MI, PCI or CABG worsen prognosis. Screen at rehabilitation and treat actively.

  • Sleep apnoea signs

    Loud snoring, witnessed apnoeas and daytime sleepiness. Treating OSA improves BP and cardiovascular risk.

  • Suspected stroke

    Face droop, arm weakness or speech disturbance is a 999 call. Time-critical stroke care starts prevention afresh.

Living with it

A lifetime plan, not a crash diet.

Four everyday commitments make the biggest difference - daily movement, a heart-healthy plate, smoke-free living and looking after sleep, mood and stress.

A quiet reminder

Small, steady changes beat heroic weeks.

Consistency across years is what changes lifetime risk. Habits kept quietly for months are worth more than a fortnight of perfect discipline.

  1. 01 Daily

    Move most days

    150 minutes a week of brisk walking, cycling or swimming, plus two sessions of resistance training. Break up long spells of sitting.

  2. 02 Plate

    Eat a heart-healthy pattern

    Mediterranean or DASH: vegetables, wholegrains, pulses, oily fish twice a week, nuts, olive oil, less ultra-processed food and less salt.

  3. 03 Habits

    Stop smoking, moderate alcohol

    Any quit at any age helps. Keep alcohol under 14 units a week, spread across the week, and avoid binge drinking.

  4. 04 Mind

    Sleep, stress and mood

    Aim for 7 to 9 hours, treat sleep apnoea, and take low mood and chronic stress as seriously as blood pressure - they change outcomes.

Frequently asked

Everything we get asked about coronary prevention.

Quick answers on QRISK3, aspirin, lipid targets, SGLT2 and cardiac rehabilitation.

  • What is the difference between primary and secondary prevention?

    Primary prevention aims to stop a first cardiovascular event in people without known disease, guided by tools like QRISK3. Secondary prevention follows a heart attack, PCI, CABG, stroke or peripheral arterial disease and uses a more intensive combination of lifestyle change and drug therapy.

  • Should I take aspirin to prevent a heart attack?

    Not for primary prevention. Trials including ASPREE, ARRIVE and ASCEND showed the bleeding risk outweighs the benefit in most people without established disease. Aspirin 75 mg is standard lifelong therapy for secondary prevention after a cardiovascular event.

  • What cholesterol target should I aim for?

    For primary prevention with QRISK3 of 10 percent or more, NICE NG238 recommends a high-intensity statin aiming for LDL under 2.6 mmol/L or non-HDL under 3.4 mmol/L. For secondary prevention, the target is LDL under 1.4 mmol/L or at least a 50 percent reduction from baseline.

  • Do SGLT2 inhibitors and GLP-1 agonists really cut heart attacks?

    Yes. Dapagliflozin, empagliflozin and canagliflozin reduce cardiovascular events and mortality in type 2 diabetes, chronic kidney disease and heart failure. Semaglutide, liraglutide and tirzepatide reduce cardiovascular events in type 2 diabetes, and semaglutide has shown benefit in people with obesity and established cardiovascular disease.

  • What is Lp(a) and should I have it checked?

    Lipoprotein(a) is a genetically determined lipid particle that independently raises cardiovascular risk. UK guidance now supports a one-off measurement in adults, particularly those with a family history of premature coronary disease. Values above 90 nmol/L push you towards more aggressive management of every other modifiable risk factor.

  • Is cardiac rehabilitation worth the time?

    Yes. Structured cardiac rehabilitation after a heart attack, PCI, CABG or stable angina reduces cardiovascular mortality, hospital readmission and future events. It combines supervised exercise, education, dietary and psychological support and is a cornerstone of secondary prevention in the UK.

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