Hippo Labs uses the official NHS England QOF Business Rules to help practices manage cholesterol control and lipid-lowering therapy across high-risk groups. These indicators ensure consistent secondary prevention for patients with cardiovascular disease and chronic kidney disease.
💬 Just a reminder: these indicators aren’t clinical guidelines — they’re operational definitions used for QOF measurement. They define which patients appear for recall, how achievement is calculated, and where gaps may occur.
📋 The Cholesterol Registers
There are two registers supporting the cholesterol indicators. They capture patients at cardiovascular risk or already diagnosed with major vascular disease.
🩸 CHOL_REG — Main Cholesterol Register
Includes:
Patients with CHD, Peripheral Arterial Disease (PAD), Stroke, or Transient Ischaemic Attack (TIA),
Or patients aged 18+ with CKD stage 3–5 (and not resolved or downgraded to CKD 1–2).
✅ In short: this register includes adults with vascular disease or CKD 3–5 who should be on lipid-lowering therapy.
❤️ CHOL2_REG — Secondary Prevention Register
Includes:
Patients with CHD, PAD, Stroke, or TIA only.
✅ In short: this subset focuses on patients with established cardiovascular disease for cholesterol target monitoring.
🩺 The Indicators
These indicators measure both cholesterol-lowering treatment and cholesterol control in high-risk patients.
💊 CHOL003 — Lipid-Lowering Therapy
Measures:
% of patients on the cholesterol register who are:
Prescribed a statin, or
Where statins are unsuitable or declined, prescribed another lipid-lowering therapy (LLT) such as bempedoic acid, ezetimibe, inclisiran, or PCSK9 inhibitors.
Counts as complete if:
Patient has a statin prescription in the last 6 months,
orStatin is declined, contraindicated, or intolerant, and another LLT is prescribed in the last 6 months.
Exclusions (Personalised Care Adjustments):
Haemorrhagic stroke diagnosis
Diabetes diagnosis (these are covered separately under QOF diabetes indicators)
Palliative care patients
On maximum tolerated cholesterol therapy
Declined, contraindicated, or not indicated for all LLTs
Two lipid-monitoring invites ≥7 days apart with no response (removed for payment only)
Newly registered within the last 3 months
⚠️ Common pitfalls:
Recording statin intolerance or decline but not prescribing an alternative
Not coding contraindications for all LLTs (which leaves the patient uncaptured)
Using free-text or non-SNOMED entries for medications
Missing recent prescriptions (must be within the last 6 months)
✅ In short: every high-risk patient should be on a statin or another lipid-lowering therapy — or have a clear contraindication or decline recorded.
🧫 CHOL004 — Cholesterol Control
Measures:
% of patients on the CHOL2 register (CHD, PAD, Stroke, TIA) whose most recent cholesterol in the last 12 months is:
≤ 2.0 mmol/L (LDL cholesterol), or
≤ 2.6 mmol/L (non-HDL cholesterol).
Counts as complete if:
Most recent LDL ≤ 2.0 mmol/L,
orMost recent non-HDL ≤ 2.6 mmol/L (if LDL not available).
Exclusions (Personalised Care Adjustments):
Haemorrhagic stroke
On maximum tolerated therapy
Unsuitable for cholesterol care
Declined cholesterol test or review
Two invites for lipid monitoring (≥7 days apart) with no response
Recent diagnosis or registration (within 9 months)
⚠️ Common pitfalls:
Using total cholesterol instead of LDL or non-HDL
Missing the “adequate” coded test result (must have a numerical value)
Not prioritising LDL when both results are recorded
Not re-inviting patients with high cholesterol or no reading before year end
✅ In short: CHOL004 measures whether cholesterol is controlled (LDL ≤ 2.0 or non-HDL ≤ 2.6) in patients with CHD, PAD, Stroke, or TIA.
🧩 Putting It All Together
Indicator | Focus | Who It Applies To | What It Shows | What to Do |
CHOL003 | Lipid-lowering therapy | CHD, PAD, Stroke, TIA, or CKD 3–5 | Whether patients are prescribed or appropriately excluded from lipid therapy | Prescribe a statin or another LLT, or record contraindication/decline |
CHOL004 | Cholesterol control | CHD, PAD, Stroke, TIA | Cholesterol management and control | Record LDL ≤2.0 or non-HDL ≤2.6 in last 12 months |
🌟 Why This Matters
Following these indicators helps practices:
Ensure all high-risk patients receive appropriate lipid management
Track cholesterol control across secondary prevention populations
Improve QOF performance through consistent coding and proactive recall
Reduce cardiovascular risk and prevent avoidable events
✅ In short: the Cholesterol Indicators ensure that every high-risk patient is on appropriate lipid-lowering therapy and has cholesterol levels monitored and controlled annually.
📚 Sources
NHS England QOF Business Rules v50.0 (Cholesterol, April 2025)
Primary Care Domain Reference Sets (TRUD Portal)