MJA
MJA InSight
MJA Careers
Editorials

Australia's role in improving global cardiovascular health

Peter L Thompson
Med J Aust 2014; 200 (8): 434-435.
doi:
10.5694/mja14.00373

Do Australian trends in cardiovascular disease have lessons for other countries?

On 4–7 May this year, Melbourne will host the World Congress of Cardiology, a tribute to the high international regard in which Australian cardiology research and practice are held. Australia's achievements in cardiology are considerable, with well substantiated claims for the invention of the world's first cardiac pacemaker in the 1920s1 and the establishment of the first coronary care unit in the 1960s.2

Discoveries made early in the careers of distinguished Australian cardiac investigators, such as Philip Barter on the role of transfer proteins in high-density lipoprotein (HDL) cholesterol metabolism, and Murray Esler on the role of the sympathetic nervous system in blood pressure control, have led to extensive clinical testing of modifiers of HDL cholesterol3 and renal denervation as a potential major advance in the treatment of hypertension.4 Both these developments are the subject of active current controversy and ongoing clinical trials to clarify their roles in the treatment of dyslipidaemia and hypertension. They are inspiring examples of how decades of dedicated basic research can open up new and unexpected pathways for clinical progress.

Australia's impressive collaborative capability for large-scale, nationally inclusive clinical projects has been demonstrated by the LIPID and ANBP2 study groups, with their respective major practice-changing trials of statin therapy after acute coronary syndromes5 and comparisons of antihypertensive therapies.6 The recent national ACACIA and CONCORDANCE registries and the binational SNAPSHOT audit of acute coronary syndromes confirm a strong Australian appetite for collaborative cardiovascular research.7

The theme of the 2014 World Congress is global health, with a stated aim to reduce premature deaths from cardiovascular disease globally by 25% by 2025. Perhaps the most important Australian contribution to global cardiovascular health may come from an examination of our dramatic, if uneven, decline in the rate of cardiovascular disease since the 1960s. The Australian statistics in this regard are particularly impressive: rates of premature cardiovascular death have declined to less than a third of the level in the late 1960s; non-fatal myocardial infarction and stroke have declined; and survival after a coronary event has improved.8

The role of health promotion bodies such as the Heart Foundation has been an important key to this success. Although changes towards a lower-fat Australian diet have no doubt contributed, the current ready access to high-energy foods and a high prevalence of obesity remain concerning. With 28.3% of the adult population being obese, Australia already ranks among the top three most obese nations in the world and is growing fatter faster than almost any other nation.9 On the other hand, Australia's decline in rates of adult smoking has been impressive and continues.10 Innovative and persistent campaigns from public health advocates such as Simon Chapman have stimulated effective community support and government action on tobacco control.11 Australia's world-leading introduction of plain packaging laws will almost certainly see the trend to limit smoking continue.

However, Australia's decline in coronary mortality, while impressive, is unevenly shared throughout the community. It may have slowed in younger age groups, and obesity trends may reverse some of the decline. Importantly, the Indigenous population continues to have excessively high rates of cardiovascular disease and has not shared in the improvements in cardiovascular health.12

We have much to be proud of in a vigorous basic cardiovascular research effort that can translate to major clinical improvements. We need to balance our basic research effort with clinical and population research. A fruitful Australian contribution to reducing the global burden of cardiovascular disease may be a critical analysis of what we are doing right, where we are not succeeding and how we can maximise the trends seen in Australia. We can then assess whether lessons learned here are applicable in other countries.

Provenance: 
Commissioned; externally peer reviewed.
Peter L Thompson, AM, MD, FRACP, FACC, Cardiologist and Director of the Heart Research Institute,1 and Clinical Professor of Medicine and Population Health2
1 Sir Charles Gairdner Hospital, Perth, WA.
2 School of Medicine and Pharmacology and School of Population Health, University of Western Australia, Perth, WA.
Competing interests: 

No relevant disclosures.

Reference Text: 
Mond HG, Wickham GG, Sloman JG. The Australian history of cardiac pacing: memories from a bygone era. Heart Lung Circ 2012; 21: 311-319.
Reference Order: 
1
Reference Text: 
Julian DG, Valentine PA, Miller GG. Routine electrocardiographic monitoring in acute myocardial infarction. Med J Aust 1964; 1: 433-436.
Reference Order: 
2
Reference Text: 
Rye KA, Barter PJ. Regulation of high-density lipoprotein metabolism. Circ Res 2014; 114: 143-156.
Reference Order: 
3
Reference Text: 
Esler M. Renal denervation for hypertension: observations and predictions of a founder. Eur Heart J 2014; Mar 4 [Epub ahead of print]. doi: 10.1093/eurheartj/ehu091.
Reference Order: 
4
Reference Text: 
The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
Reference Order: 
5
Reference Text: 
Wing LM, Reid CM, Ryan P, et al; Second Australian National Blood Pressure Study Group. A comparison of outcomes with angiotensin-converting–enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003; 348: 583-592.
Reference Order: 
6
Reference Text: 
Chew DP, French J, Briffa TG, et al. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Med J Aust 2013; 199: 185-191.
Reference Order: 
7
Reference Text: 
Australian Institute of Health and Welfare. Cardiovascular disease mortality: trends at different ages. Canberra: AIHW, 2010. (Cat. No. CVD 47.) http://www.aihw.gov.au/publication-detail/?id=6442468344 (accessed Apr 2014).
Reference Order: 
8
Reference Text: 
Organisation for Economic Co-operation and Development. Health at a glance 2013: OECD indicators. OECD Publishing, 2013. http://dx.doi.org/10.1787/health_glance-2013-en (accessed Apr 2014).
Reference Order: 
9
Reference Text: 
National Heart Foundation of Australia. Smoking statistics [fact sheet]. Canberra: NHFA, 2012. http://www.heartfoundation.org.au/SiteCollectionDocuments/Factsheet-Smoking.pdf (accessed Mar 2014).
Reference Order: 
10
Reference Text: 
Chapman S. Public health advocacy and tobacco control: making smoking history. Oxford: Blackwell Publishing, 2007.
Reference Order: 
11
Reference Text: 
Australian Bureau of Statistics. Australian social trends 2007. Selected chronic conditions among Aboriginal and Torres Strait Islander peoples. Canberra: ABS, 2007. (ABS Cat. No. 4102.0.)
Reference Order: 
12