The video version of this podcast can be found here: ·      https://youtu.be/j5z0Qv35dWEThis episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in July 2025 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only.  I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.   Disclaimer:The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions. In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido. Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through  There is a podcast version of this and other videos that you can access here: Primary Care guidelines podcast:  ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for July 2025 can be found here: ·      https://www.nice.org.uk/guidance/published?from=2025-07-01&to=2025-07-31&ndt=Guidance&ndt=Quality+standardThe updated quality standard Cardiovascular risk assessment and lipid modification [QS100]  can be found here: ·      https://www.nice.org.uk/guidance/qs100 The new technology appraisal Dapagliflozin for treating chronic kidney disease [TA1075] can be found here: ·      https://www.nice.org.uk/guidance/ta1075 TranscriptIf you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description.Hello and welcome! I’m Fernando, a GP in the UK. In today’s episode, we’ll look at the NICE updates published in July 2025, focusing on what is relevant in Primary Care only.Today we just have two clinical areas to discuss, the updated quality standard on cardiovascular risk assessment and a new technology appraisal on Dapagliflozin for CKD.Right, let’s jump into it.There are only 5 updated quality standard on cardiovascular risk assessment and lipid modification, so let’s have a look at them:  Quality statement 1 refers to the identification of adults who are likely to be at high CV risk.What does the new statement say?It says that General practices should systematically search their patient records to identify people who are likely to be at high risk of CVD. Using routinely collected data, practices can estimate someone's 10-year risk of CVD ideally using the QRISK3 tool.What’s different from the old guideline?Previously, the guidance said that If a person between 25–84 was flagged as having an increased CVD risk, we would offer them a formal QRISK3 assessment.Now, the focus is to use a proactive, structured search of patient records to find those likely to be at risk. So instead of waiting for risk to be flagged, we now go looking for it.However, we have to be cautious and use clinical judgment, especially in groups which may have missing or incomplete data in their records, which can lead to their risk being underestimated. Let’s now look at Quality Statement 2, which covers Diet and lifestyle advice for primary prevention. What does the new guideline say?Someone with a CVD risk of 10% or more, should be given lifestyle advice and this should happen within 3 months of their risk score being recorded.What’s different from the older guidelines?The previous (now obsolete) standards said that:People should be assessed for secondary causes before being offered statins and thatThey should get lifestyle advice before being offered statins.So, this update simplifies and strengthens this advice. Everyone with a ≥10% CVD risk should get lifestyle advice within 3 months. It's no longer just a “before statins” step. It’s a core part of primary prevention.Let’s move on to Quality Statement 3, on Lipid-lowering treatment for primary prevention.What does the new guideline say?People with a 10-year CVD risk of 10% or more should be prescribed a high-intensity statin unless it's not suitable for them. If they can’t tolerate statins or have a medical reason not to take them, then an alternative lipid-lowering treatment should be offered.The recommended statin here is atorvastatin 20 mg, which is proven to be effective.What’s different?Under the obsolete standards we were first advised to try lifestyle changes, and only if those changes were ineffective or unsuitable, would a discussion about statin therapy take place Now, the emphasis is on timely treatment. If a person has a 10-year CVD risk of 10% or more, and they choose to start treatment, they should be prescribed a high-intensity statin straightaway, usually atorvastatin 20 mg. There is no longer a requirement to try lifestyle changes first. While lifestyle advice remains important, it’s not a prerequisite to offering statins. This change reflects stronger evidence that earlier intervention with statins in high-risk people can significantly reduce the risk of CVD events.But let’s remember other key considerations:For those close to the 10% threshold, we will need to use our clinical judgement.For Trans people we need to be aware that QRISK3 needs the biological sex, which may not reflect an individual’s gender identity, so adjustment may be necessary.And for people aged 85 and over: Atorvastatin 20 mg may still be appropriate, but we should consider factors like frailty, comorbidities, polypharmacy, etc.Quality statement 4 refers to Assessing response to lipid-lowering treatment. This one focuses on how we monitor people after starting or changing lipid-lowering treatment, such as statins.The obsolete guidance recommended that adults on a high-intensity statin should have a repeat lipid profile and liver transaminase levels measured after 2 to 3 months.What’s changed?The new quality statement broadens this. It now applies to all adults starting or changing any lipid-lowering treatment, not just those on high-intensity statins.This change recognises that monitoring response and safety is important for everyone, not just high-intensity statin users.And let’s remember that Fasting is not required for a full lipid profile, which should includeTotal cholesterolHDL cholesterol andTriglyceridesAnd that, from these, non-HDL and LDL cholesterol are calculatedLet’s now look at the final quality statement, Quality statement 5 which focuses on Secondary prevention of cardiovascular disease The previous (now obsolete) guidance said that people newly diagnosed with CVD should be offered atorvastatin 80 mg and that, if someone developed side effects, they should be offered a lower dose or a different statin.What’s changed?The new guidance shifts the focus from prescribing a specific drug or dose to achieving a specific cholesterol target. It says that people with CVD should have either:An LDL cholesterol which is 2 or below (≤ 2.0 mmol/L), Or a non-HDL cholesterol which is 2.6 or below (≤ 2.6 mmol/L)This is a move toward outcome-focused care, rather than just prescribing a medication and assuming it's effective.So, instead of asking:"Did we prescribe atorvastatin 80 mg?" We now ask: "Has this person’s cholesterol actually reached a level that protects them?"Besides, using non-HDL cholesterol as an alternative to LDL is helpful when LDL hasn't been specifically measured or calculated. Let’s remember that, for example,  LDL may not be calculated in people with very high triglycerides.Let’s now take a few minutes to go through the updated NICE guidance on dapagliflozin for chronic kidney disease. This updated recommendation replaces earlier guidance and reflects both new evidence and a broader treatment scope for patients with CKD.So, what’s changed?Under the previous guidance dapagliflozin was only recommended for people with CKD, with or without type 2 diabetes, but only if their eGFR was between 25 and 75.This meant that certain patients were excluded — for example:Those with mild CKD and an eGFR above 75Those with an eGFR between 25 and 45 with normal levels of albumin in their urineAnd notably, those without diabetes and without significant proteinuriaAt the time, these restrictions were based mostly on the inclusion criteria of the DAPA-CKD trial, and also concerns that the size of the eligible population might have been overestimated.Now, with this update, things have shifted significantly.The new guidance states that dapagliflozin can be used more widely, in people with an eGFR between 20 and 90 as long as certain conditions are met.For people with an eGFR between 20 and 45, no additional criteria are required. But for those with an eGFR between 45 and 90, they must also either:Have type 2 diabetes, orHave a urine albumin-to-creatinine ratio or ACR of 22.6 milligrams per millimole or moreSo, this new recommendation includes a much broader group of patients, especially those with early-stage CKD and diabetes, or those with elevated proteinuria but better preserved kidney function. Why has it changed?The change is due to new evidence, including meta-analyses and indirect treatment comparisons between dapagliflozin and empagliflozin. While the two haven’t been directly compared in a clinical trial, the available data suggest that they are similarly effective and safe for people with CKD.Also, the costs of dapagliflozin and empagliflozin are comparable, so there’s no financial reason to prefer one over the other.As a result, NICE has aligned the eligible population for dapagliflozin with that of empagliflozin creating a consistent and flexible approach to SGLT2 inhibitor use in CKD.It also reflects a more inclusive and practical approach, one that gives patients better access to effective treatment and gives clinicians greater flexibility when choosing between dapagliflozin and empagliflozin.So that is it, a review of the NICE updates relevant to primary care.We have come to the end of this episode. Remember that this is not medical advice but only my summary and my interpretation of the guidelines. You must always use your clinical judgement.Thank you for listening and goodbye.

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