Research

Open access  CC BY 4.0

Cardiovascular diseases Primary care
Volume 224 - Published ahead of Issue 9

Distribution of Cardiovascular Disease Risk Based on the Updated 2023 Guideline-Recommended Australian Cardiovascular Disease Risk Algorithm and Comparison With the 2012 Algorithm: An Observational Study

Authors:  Nina Lazarevic, Meghana Bhat, Grace Joshy, Danielle C. Butler, Mark Woodward, Anushka Patel, Rod T. Jackson, Garry Jennings, Rosemary Wyber, Ellie Paige, Emily Banks

Correspondence: nina.lazarevic@anu.edu.au

Med J Aust 2026 || doi: 10.5694/mja2.70280
Published online: 2 September 2026
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Abstract

Objectives 

To quantify cardiovascular disease (CVD) risk, and implications for targeting preventive pharmacotherapy, using the 2023 guideline-recommended Australian CVD risk algorithm, and compare this to the previous (2012) algorithm.

Study Type

Application and comparison of two risk prediction algorithms.

Setting and Participants

Data from 115,873 people aged 45–74 years without existing CVD, who had a clinical encounter between September 2020 and August 2022, recorded within MedicineInsight, a longitudinal primary care database covering 8% of Australian general practices.

Main Outcome Measures

CVD risk distribution and risk categorisation into low-, intermediate- and high-risk groups under the 2023 and 2012 algorithms. Cohen's kappa and Bland–Altman plots were used to assess agreement and concordance.

Results

Using the 2023 CVD risk algorithm and revised thresholds, 9.7% of participants were at high CVD risk (≥ 10% 5-year risk or clinically determined high risk); 26.4% were at intermediate CVD risk (5% to < 10% 5-year risk) and 63.9% were at low CVD risk (< 5% 5-year risk). Corresponding 2012 figures for CVD risk were 17.6% high (> 15% 5-year risk or clinically determined high risk), 11.6% intermediate (10%–15% 5-year risk) and 70.8% low (< 10% 5-year risk). Differences in proportions at high risk were largely driven by changes to clinically determined criteria for high risk. Overall, there was moderate-to-substantial agreement (linear-weighted kappa = 0.62) and concordance (Kendall's tau-b = 0.74) between algorithms.

Conclusion

Proportions estimated at low risk and not routinely recommended pharmacotherapy align with international standards and were similar between guidelines. Although fewer people would be recommended pharmacotherapy due to being high risk under the updated versus previous guidelines, this likely reflects more accurate updated CVD risk estimation for the contemporary Australian population. The 2023 guidelines include a discretionary step (untested in our study) allowing adjustment based on additional factors. To ensure continued reduction of CVD burden across the population, we emphasise the use of this reclassification step by clinicians and consideration of the benefits of pharmacotherapy for those at intermediate risk.

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