Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians

We agree with Schultz that most Aboriginal and Torres Strait Islander Australians are not at high absolute risk of cardiovascular disease (CVD); 1.1% of those aged 18–24 years and 4.7% of those aged 25–34 years are at high risk. Our central point is that this risk profile is not seen in the non-Indigenous population until 20 years later; that is, the risk levels among Aboriginal and Torres Strait Islander Australians aged 25–34 years are similar to the levels among non-Indigenous Australians at 45–54 years.1

We also agree that CVD preventive treatment should be appropriately targeted. While 13% of people classified as low risk are receiving lipid-lowering therapy, it is possible that they are at low risk because they are receiving therapy. As these are cross-sectional data, we cannot assess potential overtreatment.

Our team is well aware of the pathologising of indigeneity and the ongoing deficit discourse.2 Rejecting deficit discourse does not mean pretending there are no challenges.3 Our article highlights the risk of CVD and asks that systems relevant to CVD screening be changed to adequately address community needs, including through revision of guidelines. Our article in no way places this responsibility on the shoulders of Aboriginal and Torres Strait Islander Australians.

Indigenous Australian control of data and the statistics produced has been a long-standing program of work for our team, including founding membership of the Maiam nayri Wingara Indigenous Data Sovereignty Collective. Principles of Indigenous data sovereignty and governance across many data holdings have been articulated in a recent communique,4 which we contributed to.