Lipid integrated service: linking deprived primary care areas that are not achieving lipid targets with specialist support

Introduction Lipids optimisation and targeting health inequalities reduces cardiovascular disease (CVD) burden. We established an integrated lipids optimisation service between an Integrated Care Board and a Teaching Hospital. Delivered over two phases, phase 2 expands regionally, prioritising support for more deprived Primary Care Networks (PCNs) identified using local ICB CVDPREVENT data. CVDPREVENT is a national audit programme in England that uses primary care data to monitor CVD management and identify care gaps. Purpose To empower and upskill clinicians within regional PCNs to enhance lipid management for patients with, or at risk of, CVD, focusing on PCNs with higher deprivation. Methods Phase 1 ran from Jun 2023 to Jul 2024 and Phase 2 ran from Oct 2024 to Mar 2025. Practices across 57 PCNs were invited to participate, 71 practices from 32 PCNs actively engaged. Priority was given to PCNs in more deprived areas and those with poorer CVD prevention indicators. Support included: electronic access to lipid specialist advice and guidance (A&G), tailored lipids training (virtual and in-person), and fortnightly Multidisciplinary Team (MDT) meetings and virtual peer-learning sessions. Results 102 A&G cases (comprising 196 clinical queries) were submitted from 32 practices across 27 PCNs. Of these, 43 cases were for primary prevention, 49 for secondary prevention, and 10 suspected familial hypercholesterolemia. Lipid-lowering therapy (LLT) changes were recommended in 86% of cases, including LLT intensification (67%), statin rechallenge (71%) and cessation (11%). Clinicians demonstrated a substantial improvement in knowledge, progressing from needing basic education to feeling confident or expert in lipid management. The project potentially avoided referrals to secondary care in 79% of cases, enhancing service efficiency and optimising specialist resources. Between Jun 2023 and Mar 2025, CVDPREVENT data showed: QRISK ≥20% on LLT: +2.35% (17,420 patients), CVD patients on LLT: +1.82% (16,757 patients) and CVD patients meeting cholesterol targets: +9.55% (19,712 patients). The later overall rise reflects changes in targets: a 6.63% increase under the old target and a further 0.82% increase after the new target was introduced in phase 1 (Table 1). Notably, NHS WYICB reported the smallest inequality gap, with the Slope Index of Inequality (SII) decreasing from 4.63% in Jul 2024 to 2.76% in Jan 2025, indicating meaningful progress in narrowing deprivation-related disparities (Figure 1). Conclusion An integrated lipid management service linking primary care and lipid specialists has improved support, strengthened primary care confidence, and driven ongoing training demand. CVDPREVENT data show more consistent and equitable cardiovascular prevention, yet with 62,515 WYICB patients with CVD still not meeting targets, system-wide innovation and support remain essential to further reduce cardiovascular risk.