Which statin dose is recommended for secondary prevention in NICE guidance?

• A. Atorvastatin 80 mg once daily
• B. Simvastatin 20 mg
• C. Rosuvastatin 5 mg
• D. Pravastatin 40 mg

Answer: (A)

For patients with established cardiovascular disease, guidelines aim for high-intensity statin therapy to achieve a substantial reduction in LDL cholesterol and lower the risk of recurrent events. Among the options, a high-dose atorvastatin regimen fits this goal best, since starting at 80 mg daily commonly yields around a 50% drop in LDL-C for many people. This level of intensity is what NICE guidance supports for secondary prevention, unless there are tolerability or safety concerns.

The other dosing choices correspond to lower or moderate-intensity therapy, which NICE guidance generally does not recommend as the first-line approach for secondary prevention. If a patient cannot tolerate a high-intensity statin, clinicians may adjust the dose or consider alternatives while still aiming to maintain cardiovascular risk reduction.