Lipid treatment guidelines and cardiovascular risk for Aboriginal people in Central Australia

Joanne N Luke, Alex Brown, David N O’Neal, Kerin O’Dea, Alicia J Jenkins, Margaret Kelaher, James D Best and Kevin G Rowley
Med J Aust 2009; 190 (10): 552-556.


Objective: To evaluate the extent to which the current Pharmaceutical Benefits Scheme (PBS) guidelines for patient eligibility for lipid-lowering medication are applicable to Aboriginal people in Central Australia.

Design, setting and participants: A 10-year cohort study of 659 Aboriginal people who participated in population-based cardiovascular disease (CVD) risk factor surveys in 1995 and who were free of CVD at baseline, for the period from 1995 to 2004–2005  or until first CVD event. Evidence of atherosclerotic CVD (ischaemic heart disease, ischaemic stroke, and peripheral vascular disease) was sought from hospital, primary health care and death records. PBS eligibility was assigned according to the current PBS criteria, which were amended in 2006 to include Aboriginal-specific criteria, using participants’ baseline (1995) and 10-year follow-up data.

Main outcome measures: Proportions of PBS-eligible and PBS-ineligible participants who had CVD events during the study period; sensitivity and specificity of the criteria.

Results: Of 42 participants who had CVD events during the study period, 35 were PBS-eligible (incidence, 1130/100 000 person-years; relative risk compared with PBS-ineligible population, 4.87 [95% CI, 2.19–10.80]) and seven were PBS-ineligible. PBS eligibility was associated with older mean age (37 v 32 years) and male sex (48% v 37%), with 50.7% of participants (334/659) meeting eligibility criteria. The mean high-density lipoprotein cholesterol level at baseline was very low in both groups (0.81 v 0.87 mmol/L). The current PBS guidelines have low specificity (52%) in this population, which was found to improve (to 71%–82%) by incorporating additional non-lipid criteria (age and multiple non-lipid risk factors).

Conclusion: The current PBS lipid treatment criteria, which include any Aboriginal person with diabetes and less stringent cholesterol thresholds than the previous version, identify a group at very high risk of CVD. Global risk assessment may better identify those at risk.

  • Joanne N Luke1
  • Alex Brown2
  • David N O’Neal3
  • Kerin O’Dea4
  • Alicia J Jenkins3
  • Margaret Kelaher5
  • James D Best3
  • Kevin G Rowley1

  • 1 Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne,
  • 2 Centre for Indigenous Diabetes and Vascular Disease Research, Baker IDI Heart and Diabetes Institute, Alice Springs, NT.
  • 3 Department of Medicine (St Vincent’s Hospital), University of Melbourne, Melbourne, VIC.
  • 4 Sansom Institute, University of South Australia, Adelaide, SA.
  • 5 Centre for Health Policy and Program Evaluation, School of Population Health, University of Melbourne, Melbourne, VIC.



We thank the Elders, community members and medical service providers of the Central Australian communities involved in the project; and Peter Howard, Leah Johnston, Zaimin Wang, Zhiqiang Wang and Andrea Neale for expert assistance. This study was funded by a National Health and Medical Research Council (NHMRC) “HOMELANDS” Program grant. Kevin Rowley is supported by an NHMRC Senior Research Fellowship.

Competing interests:

Alex Brown received support from Alphapharm to attend the Cardiac Society of Australia and New Zealand Conference in Adelaide in 2008. There was no associated impact or influence on the development of this article.

  • 1. Li SQ, Guthridge SL. Mortality in the Northern Territory: 1981–2000. Darwin: NT Department of Health and Community Services, 2004.
  • 2. Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples, 2008. Canberra: Commonwealth of Australia, 2008. (ABS Cat. No. 4704.0, AIHW Cat. No. IHW 21.)
  • 3. Brown AD, Morrissey MJ, Sherwood JM. Uncovering the determinants of cardiovascular disease among Indigenous people. Ethn Health 2006; 11: 191-210.
  • 4. Dempsey KE, Condon JR. Mortality in the Northern Territory, 1979–1997. Darwin: Territory Health Services, 2000.
  • 5. de Backer G, de Bacquer D, Kornitzer M. Epidemiological aspects of high density lipoprotein cholesterol. Atherosclerosis 1998; 137 Suppl: S1-S6.
  • 6. O’Neal DN, Piers LS, Iser DM, et al. Australian Aboriginal people and Torres Strait Islanders have an atherogenic lipid profile that is characterised by low HDL-cholesterol levels and small LDL particles. Atherosclerosis 2008; 201: 368-377.
  • 7. McDermott R, Rowley KG, Lee AJ, et al. Increase in prevalence of obesity and diabetes and decrease in plasma cholesterol in a central Australian Aboriginal community. Med J Aust 2000; 172: 480-484. <MJA full text>
  • 8. Australian Government Department of Health and Ageing. PBS-eligibility criteria for lipid lowering drugs fact sheet. Canberra: DoHA, 2006. (accessed Mar 2008).
  • 9. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 7-22.
  • 10. National Prescribing Service. Revised PBS criteria for lipid-modifying drugs (October, 2006). Sydney: NPS, 2007. (accessed Apr 2008).
  • 11. Wang Z, Hoy WE. Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people? Med J Aust 2005; 182: 66-69. <MJA full text>
  • 12. Rowley KG, Iser DM, Best JD, et al. Albuminuria in Australian Aboriginal people: prevalence and associations with components of the metabolic syndrome. Diabetologia 2000; 43: 1397-1403.
  • 13. Wang Z, Knight S, Wilson A, et al. Blood pressure and hypertension for Australian Aboriginal and Torres Strait Islander people. Eur J Cardiovasc Prev Rehabil 2006; 13: 438-443.
  • 14. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499-502.
  • 15. Collins R, Armitage J, Parish S, et al; Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet 2004; 363: 757-767.
  • 16. Barter PJ, Rye KA. High density lipoproteins and coronary heart disease. Atherosclerosis 1996; 121: 1-12.
  • 17. Tonkin AM, Lim SS, Schirmer H. Cardiovascular risk factors: when should we treat [editorial]? Med J Aust 2003; 178: 101-102. <MJA full text>
  • 18. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey, 2004–05. Canberra: ABS, 2006. (ABS Cat. No. 4715.0.)
  • 19. Chen L, Rogers SL, Colagiuri S, et al. How do the Australian guidelines for lipid-lowering drugs perform in practice? Cardiovascular disease risk in the AusDiab Study, 1999–2000. Med J Aust 2008; 189: 319-322. <MJA full text>


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