Objective: To quantify absolute cardiovascular disease (CVD) risk and treatment in Australian adults.
Design, participants: Cross-sectional representative study of 9564 people aged 18 years or more who had participated in the 2011–12 Australian National Health Measures Survey (response rate for those aged 45–74 years: 46.5%).
Main outcome measures: Prior CVD was ascertained and 5-year absolute risk of a primary CVD event calculated (using the Australian National Vascular Disease Prevention Alliance algorithm; categories: low [< 10%], moderate [10–15%], and high [> 15%] risk) on the basis of data on medical history, risk factors and medications, derived from interviews, physical measurements, and blood and urine samples.
Results: Absolute CVD risk increased with age and was higher among men than women. Overall, 19.9% (95% CI, 18.5–21.3%) of Australians aged 45–74 years had a high absolute risk of a future CVD event (an estimated 1 445 000 people): 8.7% (95% CI, 7.8–9.6%) had prior CVD (estimated 634 000 people) and 11.2% (95% CI, 10.2–12.2%) had high primary CVD risk (estimated 811 000 people). A further 8.6% (95% CI, 7.4–9.8%, estimated 625 000) were at moderate primary CVD risk. Among those with prior CVD, 44.2% (95% CI, 36.8–51.6%) were receiving blood pressure- and lipid-lowering medications, 35.4% (95% CI, 27.8–43.0%) were receiving only one of these, and 20.4% (95% CI, 13.9–26.9%) were receiving neither. Corresponding figures for high primary CVD risk were 24.3% (95% CI, 18.3–30.3%); 28.7% (95% CI, 22.7–34.7%); and 47.1% (95% CI, 39.9–54.3%).
Conclusions: About one-fifth of the Australian population aged 45–74 years (about 1.4 million individuals) were estimated to have a high absolute risk of a future CVD event. Most (estimated 970 000) were not receiving currently recommended combination blood pressure- and lipid-lowering therapy, indicating substantial potential for health gains by increasing routine assessment and treatment according to absolute CVD risk.
- 1. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197-2223.
- 2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095-2128.
- 3. Jackson R, Lawes CM, Bennett DA, et al. Treatment with drugs to lower blood pressure and blood cholesterol based on an individual’s absolute cardiovascular risk. Lancet 2005; 365: 434-441.
- 4. Blood Pressure Lowering Treatment Trialists Collaboration, Sundstrom J, Arima H, et al. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 2014; 384: 591-598.
- 5. Turnbull F, Arima H, Heeley E, et al. Gender disparities in the assessment and management of cardiovascular risk in primary care: the AusHEART study. Eur J Cardiovasc Prev Rehabil 2011; 18: 498-503.
- 6. New Zealand Guidelines Group. The assessment and management of cardiovascular risk. Wellington: New Zealand Guidelines Group, 2003. https://www.health.govt.nz/system/files/documents/publications/cvd_risk_full.pdf (accessed Mar 2015).
- 7. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Canberra: NVDPA, 2012. https://strokefoundation.com.au/∼/media/strokewebsite/resources/treatment/absolutecvd_gl_webready.ashx?la=en (accessed Mar 2015).
- 8. Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129: S49-S73.
- 9. JBS3 Board. Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart 2014; 100 Suppl 2: ii1-ii67.
- 10. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129: S1-S45.
- 11. Australian Bureau of Statistics. 4363.0.55.001. Australian Health Survey: users’ guide, 2011–13 [website]. 2013. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4363.0.55.001 (accessed May 2015).
- 12. Anderson KM, Wilson PW, Odell PM, et al. An updated coronary risk profile. A statement for health professionals. Circulation 1991; 83: 356-362.
- 13. D’Agostino RB, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117: 743-753.
- 14. Jackson R, Kerr A, Wells S. Vascular risk calculators: essential but flawed clinical tools? Circulation 2013; 127: 1929-1931.
- 15. National Heart Foundation of Australia. Hypertension management for doctors 2004. Canberra: NHFA, 2003.
- 16. National Heart Foundation of Australia; Cardiac Society of Australia and New Zealand. Position statement on lipid management. Heart Lung Circ 2005; 14: 275-291.
- 17. Tattersall MC, Gangnon RE, Karmali KN, et al. Trends in low-density lipoprotein cholesterol goal achievement in high risk United States adults: longitudinal findings from the 1999–2008 National Health and Nutrition Examination Surveys. PLoS One 2013; 8: e59309.
- 18. Tattersall MC, Karmali KN, Gangnon RE, et al. The population effects of the global cardiovascular risk model in United States adults: findings from the National Health and Nutrition Surveys, 2005–2006. J Clin Lipidol 2011; 5: 166-172.
- 19. Mehta S, Wells S, Grey C, et al. Initiation and maintenance of cardiovascular medications following cardiovascular risk assessment in a large primary care cohort: PREDICT CVD-16. Eur J Prev Cardiol 2014; 21: 192-202.
- 20. Heeley E, Peiris DP, Patel AA, et al. Cardiovascular risk perception and evidence — practice gaps in Australian general practice (the AusHEART study). Med J Aust 2010; 192: 254-259. <MJA full text>
- 21. Peiris DP, Patel AA, Cass A, et al. Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: findings from the Kanyini Audit. Med J Aust 2009; 191: 304-309. <MJA full text>
- 22. Webster RJ, Heeley EL, Peiris DP, et al. Gaps in cardiovascular disease risk management in Australian general practice. Med J Aust 2009; 191: 324-329. <MJA full text>
- 23. Sheppard JP, Fletcher K, McManus RJ, et al. Missed opportunities in prevention of cardiovascular disease in primary care: a cross-sectional study. Br J Gen Pract 2014; 64: e38-e46.
- 24. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376, 162 patients. Am J Med 2012; 125: 882-887.
- 25. Vos T, Carter R, Barendregt J, et al. Assessing cost-effectiveness in prevention. ACE-Prevention. Final report. Brisbane, University of Queensland and Melbourne: Deakin University, 2010. https://public-health.uq.edu.au/filething/get/1836/ACE-Prevention_final_report.pdf (accessed Mar 2015).
- 26. Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581-590.
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