Plant stanols and sterols 1.3.17 Do not advise any of the following to take plant stanols or sterols for the prevention of CVD: 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. [2014] 1.4 Lipid modification therapy for the primary and secondary prevention of CVD 1.4.1 Be aware that when deciding on lipid modification therapy for the prevention of CVD, drugs are preferred for which there is evidence in clinical trials of a beneficial effect on CVD morbidity and mortality. 1.4.2 When a decision is made to prescribe a statin use a statin of high intensity and low acquisition cost. [2014] See appendix A for statin classification. Initial lipid measurement and referral for specialist review 1.4.3 Measure both total and high-density lipoprotein (HDL) cholesterol to achieve the best estimate of CVD risk. [2008] 1.4.4 Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. This should include measurement of total cholesterol, HDL cholesterol, non-HDL cholesterol and triglyceride concentrations. A fasting sample is not For information about implementing this recommendation, see the implementation: getting started section. 1.4.5 Use the clinical findings, lipid profile and family history to judge the likelihood of a familial lipid disorder rather than the use of strict lipid cut-off values alone. [2014] 1.4.6 Exclude possible common secondary causes of dyslipidaemia (such as excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome) before referring for specialist review. 