Absolute risk of cardiovascular disease events and blood pressure- and lipid-lowering therapy in Australia

The National Vascular Disease Prevention Alliance (NVDPA) Guidelines for the management of absolute cardiovascular disease risk are the current Australian guidelines, which contain recommendations on assessment of an individual’s absolute risk of having a primary cardiovascular disease (CVD) event in the next 5 years, and on optimal management based on this assessment.1

For all CVD risk levels, the NVDPA guidelines recommend risk factor modification, including lifestyle interventions — such as smoking cessation, weight loss and increased physical activity — where appropriate.1 Our article2 focused on people at high absolute risk of CVD, including those who have existing CVD and those found to be at high primary risk at assessment (ie, > 15% 5-year probability of a CVD event).2 These patients’ very high risk means that we need to offer everything possible to prevent future CVD events, and lifestyle intervention alone is insufficient.1 Hence, as mentioned in our article: “The 2012 NVDPA guidelines recommend combination treatment with BP- [blood pressure] and lipid-lowering medications unless contraindicated or clinically inappropriate, together with lifestyle advice, for those with a 5-year primary CVD risk of more than 15%”.2

Our findings indicate that around 20% of the Australian population aged 45–74 are at high risk of a future CVD event, and that over two-thirds of high risk individuals are not receiving the currently recommended combined blood pressure- and lipid-lowering therapies.2 They also indicate that 13.7% with prior CVD and 22.9% at high primary CVD risk are current smokers; 46.4% and 46.1%, respectively, are obese; and 46.8% and 47.3%, respectively, are sedentary.2

Large-scale randomised trial data show that the risk of major CVD events is reduced by 17% per 5 mmHg reduction in blood pressure levels,3 and by 22% for each 1 mmol/L reduction in low-density lipoprotein cholesterol levels.4 Given the effectiveness of these medications, the risk reduction from optimal combined blood pressure and lipid-lowering therapies is likely to exceed the estimates presented by Dhaliwal and Welborn in their letter.

Overall, the current data highlight high levels of CVD risk in the population and the huge potential for improving health through offering appropriate medication and other interventions to modify risk factors.