Volume 206 - Issue 1
Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia
Authors: Satvinder S Dhaliwal and Timothy A Welborn
Med J Aust 2017; 206 (1): 51. || doi: 10.5694/mja16.00599
Published online: 16 January 2017
Published online: 16 January 2017
n/a
To the Editor:
In a recent issue of the MJA, Banks and colleagues1 reported that one-fifth of the Australian population aged 45–74 years have a high absolute risk of a cardiovascular disease (CVD) event over 5 years, and they conclude by recommending an escalation of drug therapy to lower blood pressure and lipid levels. This view was supported by Chow and Rodgers2 in their accompanying editorial.
We are concerned that their guidelines do not include advice on obesity, alcohol intake, cigarette smoking and exercise, even though some measures of these lifestyle risk factors are in their database, including body mass index (BMI).
Prospective studies of Australian population samples show that measures of obesity, BMI, waist circumference (WC) and waist-to-hip ratio (WHR) have close correlations with blood pressure and lipid levels, and are strong predictive variables for CVD. The WHR is superior to BMI in predictive ability and precision and is not influenced by ethnicity.3
Exercise provides semi-quantitative and independent benefits to those at risk.4 Although high level evidence about physical activity is limited, an overwhelming volume of compelling descriptive data suggests that generally adults should accumulate at least 60 minutes of moderate physical activity daily (more is better) to offset the risks of CVD and other chronic conditions.5
A recent large scale population study among men acknowledges that lipid-lowering and anti-hypertensive medications effectively reduce CVD risk by 20–30%, whereas optimal healthy lifestyle practices reduce incident CVD by 62% in men who are not taking medication, and by 57% in those on pharmacological therapy.6
We agree with the authors that population data on absolute CVD risk have the potential to influence programs, policy and planning, but we lament their omission of behavioural and lifestyle risk factors. Support for spirited lifestyle interventions at an individual and a population level should reduce the burden of dependence on and the expense of multiple drug therapy. This non-pharmacological approach may effectively prevent CVD, even among those on anti-hypertensive or lipid-lowering medications.
Competing interests
No relevant disclosures.
References
- Banks E, Crouch SR, Korda RJ, et al. Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia. Med J Aust 2016; 204: 320.
- Chow CK, Rodgers A. Lost in transition: the gap between what we know and what we do about cardiovascular disease. Med J Aust 2016; 204: 291-292.
- Welborn TA, Dhaliwal SS, Bennett SA. Waist–hip ratio is the dominant risk factor predicting cardiovascular disease. Med J Aust 2003; 179: 580-585.
- Dhaliwal SS, Welborn TA, Howat PA. Recreational physical activity as an independent predictor of multivariable cardiovascular disease risk. PLoS One 2013; 8: e83435.
- Warburton DE, Charlesworth S, Ivey A, et al. A systematic review of the evidence for Canada’s physical activity guidelines for adults. Int J Behav Nutr Phys Act 2010; 7: 39.
- Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation 2006; 114: 160-167.