It describes the lifestyle changes people can make and how statins can be used to reduce their risk. Who is it for? Healthcare professionals People who are at risk of CVD or who have had CVD Introduction This guideline updates and replaces NICE guideline CG67 and NICE technology appraisal guidance 94. The recommendations are labelled according to when they were originally published (see update information for details). Cardiovascular disease (CVD) describes disease of the heart and blood vessels caused by the process of atherosclerosis. It is the leading cause of death in England and Wales, accounting for almost one-third of deaths according to UK National Statistics. In 2010, 180,000 people died from CVD around 80,000 of these deaths were caused by coronary heart disease and 49,000 were caused by strokes. Of the 180,000 deaths, 46,000 occurred before people were aged 75 years, and 70% of those were in men. Death rates from CVD peaked in the 1970s and 1980s but have more than halved since then. Rates have fallen more rapidly in older age groups compared with younger ones, with an approximately 50% reduction in the 55- to 64-year age group compared with a 20% reduction in men aged 35 to 44 years. Despite evidence that mortality from CVD is falling, morbidity appears to be rising. CVD has significant cost implications and was estimated to cost the NHS in England almost 6,940 million in 2003, rising to 7,880 million in 2010. CVD shows strong age dependence and predominantly affects people older than 50 years. Risk factors for CVD include non-modifiable factors such as age, sex, family history of CVD, ethnic background and modifiable risk factors such as smoking, raised blood pressure and cholesterol. 