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How do the Australian guidelines for lipid-lowering drugs perform in practice? Cardiovascular disease risk in the AusDiab Study, 1999–2000

Lei Chen, Sophie L Rogers, Stephen Colagiuri, Dominique A Cadilhac, Timothy H Mathew, Andrew N Boyden, Anna Peeters, Dianna J Magliano, Jonathan E Shaw, Paul Z Zimmet and Andrew M Tonkin
Med J Aust 2008; 189 (6): 319-322.

Summary

Objective: To determine how well the current Pharmaceutical Benefits Scheme (PBS) eligibility criteria for subsidy of lipid-lowering drugs compare with current national guidelines for determining the population at high risk of developing cardiovascular disease (CVD).

Design and participants: Analyses of the population-based, cross-sectional Australian Diabetes, Obesity and Lifestyle (AusDiab) study, conducted in 1999–2000. The 1991 Framingham risk prediction equation was used to compute 5-year risk of developing first-time CVD in 8286 participants aged 30–74 years with neither CVD nor diabetes. Based on the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand guidelines, people with either 5-year CVD risk ≥ 15% or with 5-year CVD risk of 10%–< 15% and the metabolic syndrome were defined as having estimated high absolute CVD risk.

Main outcome measures: 5-year CVD risk; estimated population with high CVD risk.

Results: Among participants without prevalent CVD or diabetes, 7.9% of men and 1.5% of women had a 5-year CVD risk ≥ 15%. Of the estimated residential Australian population in 2000 aged 30–74 years without CVD or diabetes, 717 000 people were considered to be at high absolute CVD risk. Among the high-risk AusDiab participants without CVD or diabetes, only 16.9% of men and 15.4% of women were being treated with lipid-lowering drugs. Of the 9.6% of participants free of CVD and diabetes who were untreated but eligible for subsidy under PBS criteria, only 27.4% had an estimated high absolute CVD risk.

Conclusion: Strategies for CVD prevention using lipid-lowering medications can be improved by adoption of the absolute-risk approach.

  • Lei Chen1
  • Sophie L Rogers2
  • Stephen Colagiuri3
  • Dominique A Cadilhac4
  • Timothy H Mathew5
  • Andrew N Boyden6
  • Anna Peeters1
  • Dianna J Magliano7
  • Jonathan E Shaw7
  • Paul Z Zimmet7
  • Andrew M Tonkin1

  • 1 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 2 Centre for Eye Research Australia, University of Melbourne, Melbourne, VIC.
  • 3 Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW.
  • 4 Public Health Division, National Stroke Research Institute, Melbourne, VIC.
  • 5 Kidney Health Australia, Adelaide, SA.
  • 6 National Heart Foundation of Australia, Canberra, ACT.
  • 7 Baker IDI Heart and Diabetes Institute, Melbourne, VIC.


Acknowledgements: 

The work described here was partly supported by a grant from the Commonwealth Department of Health and Aged Care. Lei Chen is supported by an Australian Postgraduate Award scholarship. We are grateful to the following for their support of the AusDiab study: the Commonwealth Department of Health and Aged Care, Abbott Australasia, Alphapharm, AstraZeneca, Aventis, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Merck Lipha, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pharmacia and Upjohn, Pfizer, Roche Diagnostics, Sanofi Synthelabo, Servier, BioRad, HITECH Pathology, the Australian Kidney Foundation, Diabetes Australia, Diabetes Australia (Northern Territory), Queensland Health, South Australian Department of Human Services, Tasmanian Department of Health and Human Services, Territory Health Services, Victorian Department of Human Services, and Health Department of Western Australia. For their invaluable contribution to AusDiab set-up and field activities, we are grateful to A Allman, B Atkins, S Bennett, S Chadban, S Colagiuri, M de Courten, M Dalton, M D’Embden, D Dunstan, T Dwyer, D Jolley, I Kemp, P Magnus, J Mathews, D McCarty, A Meehan, K O’Dea, P Phillips, P Popplewell, C Reid, A Stewart, R Tapp, H Taylor, T Welborn and F Wilson.

Competing interests:

Andrew Tonkin has received speaker fees from AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer and Schering-Plough, and travel assistance from Pfizer and Schering-Plough.

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