Cardiovascular risk reduction - quality prescribing guidance 2026-2029: consultation

1. Clinical foreword

In Scotland, 16% of adults reported living with any form of cardiovascular disease (CVD) in 2024, a figure that is unchanged since 2003. ^[1] CVD is the second largest cause of overall disease burden and second most common cause of death in Scotland after cancer.

Cardiovascular disease is largely preventable and many modifiable risk factors increase the likelihood of developing CVD, ^[2] however, many people do not know they are living with CVD risk factors. For example, of the 1.5 million people in Scotland estimated to have high blood pressure, only 860,000 have been diagnosed. Of those diagnosed, only 24% (206,000) are adequately controlled.2

Adopting a healthier lifestyle can reduce an individual's risk of cardiovascular disease. This guide highlights how individuals can be supported in modifying lifestyle risk factors such as diet, healthy weight, alcohol, physical activity, stress and tobacco smoking. These factors are also important as part of a holistic approach to preventing ill health overall, especially the cessation of tobacco smoking.

This guide focuses on prescribing advice for early detection and treatment of hypertension, hyperlipidaemia, diabetes, obesity and smoking with the aim of reducing the long-term impact of cardiovascular disease. It is complementary to SIGN and NICE guidance, providing practical prescribing advice to all healthcare professionals working in this area, supporting good clinical practice for the people of Scotland.

This guide promotes the use of the 7-Steps person-centred medication review before initiating any treatment. This puts the individual at the centre of any conversation about their care and guides decision-making in subsequent steps that consider medication need, effectiveness, and safety before a therapeutic plan and follow-up strategy are agreed upon.

This guide was developed by the collaborative efforts of a multidisciplinary team of clinicians, academics, patient groups and policy makers from across Scotland, from Scottish Government and NHS Scotland.

We are extremely grateful to all those who contributed to the working group, the review and development of this guide.

Prof. Alpana Mair Head of Effective Prescribing and Therapeutics

Prof. Sir Gregor Smith Chief Medical Officer

Prof. Alison Strath Chief Pharmaceutical Officer

Prof. Aisha Holloway Chief Nursing Officer