There is a NICE patient decision aid to support discussions about statin therapy to reduce the risk of coronary heart disease and stroke. 1.4.12 The decision whether to start statin therapy should be made after an informed discussion between the clinician and the person about the risks and benefits of statin treatment, taking into account additional factors such as potential benefits from lifestyle modifications, informed patient preference, comorbidities, polypharmacy, general frailty and life 1.4.13 Before starting statin treatment perform baseline blood tests and clinical assessment, and treat comorbidities and secondary causes of dyslipidaemia. Include all of the following in the assessment: smoking status alcohol consumption blood pressure (see NICE's guideline on hypertension) BMI or other measure of obesity (see NICE's guideline on obesity: identification, assessment and management) total cholesterol, non-HDL cholesterol, HDL cholesterol and triglycerides renal function and eGFR transaminase level (alanine aminotransferase or aspartate aminotransferase) thyroid-stimulating hormone. [2014] Primary prevention 1.4.14 Before offering statin treatment for primary prevention, discuss the benefits of lifestyle modification and optimise the management of all other modifiable CVD risk factors if possible. [2014] 1.4.15 Recognise that people may need support to change their lifestyle. To help them do this, refer them to programmes such as exercise referral schemes. (See NICE's guidelines on behaviour change: individual approaches and physical activity: exercise referral schemes.) [2014] 1.4.16 Offer people the opportunity to have their risk of CVD assessed again after they have tried to change their lifestyle. [2014] 1.4.17 If lifestyle modification is ineffective or inappropriate offer statin treatment after risk assessment. [2014] 1.4.18 Offer atorvastatin 20 mg for the primary prevention of CVD to people who have a 10% or greater 10-year risk of developing CVD. Estimate the level of risk using the QRISK2 assessment tool. 