Last week, the UK’s National Institute for Health and Clinical Excellence (NICE) published a draft cardiovascular risk assessment, specifically on the treatment of lipids in the primary and secondary prevention of cardiovascular disease. The draft is an update to current guidance and recommends lowering the criteria for initiating statin therapy for the prevention of cardiovascular disease, including coronary heart disease and stroke. NICE recommends the use of QRISK2 (which includes risk factors such as age, smoking history, cholesterol, blood pressure, atrial fibrillation, body mass index and family history of premature heart disease) to calculate the percentage of cardiovascular events and recommends atorvastatin 20mg/day for primary prevention of cardiovascular disease and 80mg/day for people with cardiovascular disease, type 1 or type 2 diabetes. NICE also emphasizes the importance of lifestyle improvements, particularly in the areas of smoking cessation and alcohol restriction, healthy diet, weight loss and increased exercise. the NICE new draft guidance review will be launched on March 26, with final guidance to be published in June 2014. As soon as the new draft was published, it was immediately criticized by some academics, who pointed out that statin drugs have side effects, that large-scale use is still risky, and recommended that priority be given to improving patients’ lifestyles. Seven million people are already taking statins in the UK and once the NICE guidelines are implemented, the number of statin users will increase by millions. The 2013 AHA/ACC lipid guidelines have adopted a new risk prediction formula, which has been controversial, and Dr. Ridker and Dr. Cook have suggested that cardiovascular risk may be overestimated by a factor of 2 based on the latest guidelines. equations. Drs. Ridker and Cook argue that no statin study has chosen a global risk prediction score as an inclusion criterion, so it is not easy to use statins based on that criterion on an evidence-based basis. Dr. Loannidis mentioned in JAMA that even in areas with substantial clinical data and clinical trial support, the ACC/AHA lipid guidelines still lack key evidence for statin treatment criteria and hopes for studies to establish optimal risk prediction models and initiate statin treatment criteria. Experts are still questioning the credibility of cardiovascular risk prediction models, and how do physicians and patients decide when to start statin use? However, at a minimum, multiple calibrations of risk prediction models in cohort studies are needed. Currently, the QRISK2 website has issued a disclaimer that the scoring model is for risk assessment purposes only and that ” the authors and this website will not be held responsible for the use or misuse of the score.” In the absence of definitive criteria for initiation of statin therapy, physicians and patients must be aware that lipid levels can no longer be reduced simply through lifestyle improvements.