From Screening to Prescribing: Implementing Lipid Point-of-Care Testing to Optimise Lipid-Lowering Therapy in Community Pharmacy in North London

Background 

In the UK, national guidelines (NICE NG238) support systematic risk assessment, lipid optimisation, and targeted intervention in high risk populations to reduce cardiovascular morbidity and mortality.  CVD remains a leading cause of premature death in England and disproportionately affects socioeconomically deprived communities. Individuals living in the most deprived areas experience markedly higher premature mortality than compared to people in more affluent areas.  Dyslipidaemia is frequently asymptomatic, and early identification in underserved populations is central to guideline-directed prevention. 

Purpose

This service evaluation examined whether community pharmacy based cardiovascular risk assessment using lipid point of care testing (PoCT) aligns with recommended prevention strategies by enabling early detection, risk stratification, and initiation of lipid lowering therapy in high risk underserved populations. 

Methods

Between 1 January 2025 and 14th March 2026, up to 66 community pharmacies located in North London  were equipped with Afinion 2 lipid PoCT lipid analysers integrated with HealtTab digital clinical decision support technology.  Trained pharmacy professionals conducted lipid testing and calculated 10 year CVD risk using NICE recommended QRISK3 in adults aged ≥25 years without established CVD and not receiving lipid-lowering therapy, consistent with guideline directed primary prevention. 

Demographics, Index of Multiple Deprivation (IMD), and ethnicity were recorded to assess equity of access. Results were shared with general practitioners and made accessible via the NHS App. Sixteenpharmacies participated in an independent prescribing pathfinder pilot, enabling on-site initiation of statins in accordance with risk-based treatment thresholds. 

Results

A total of 2,067 tests have been undertaken to support CVD risk assessments across 66 pharmacies in North London (mean age 49 years; 35% male).

• 32% resided in the 20% most deprived areas

• 56% were from global majority ethnic backgrounds

• 19% had QRISK3 ≥10%, meeting criteria for consideration of stating therapy under primary prevention guidance. 

Among those with QRISK3 ≥10%:

• 33% were from the most deprived quintile

• 50% were from global majority ethnic backgrounds

Among 103 individuals with type 2 diabetes, 50% had QRISK3 ≥10%.  Twenty six individuals were referred for management of significant hypercholesterolaemia. At the time of analysis, 88 individuals had initiated statin therapy, most via independent prescribing pharmacies, reducing delay between risk identification and treatment initiation. 

Conclusion

Community pharmacy based lipid PoCT with structured cardiovascular risk estimation operationalises key prevention principles; systematic risk stratification, equitable access to screening, and timely initiation of lipid lowering therapy.  This model successfully identified individuals at elevated cardiovascular risk within deprived and ethnically diverse populations, supporting earlier preventive intervention.    Embedding guideline directed CVD prevention within community pharmacy may represent a scalable strategy to reduce health inequalities and improve implementation of prevention recommendations in real world primary care settings.