New Australian Cardiovascular Disease Guidelines Released

Are we Functioning with an Outdated Approach?

In the realm of cardiovascular disease (CVD) research, Australia has historically turned to the United States for cutting-edge insights and frontline guidelines. The robust body of work originating from American institutions has long served as a benchmark for Australian healthcare professionals, shaping our preventive and therapeutic strategies. However, as the landscape of medical research evolves, it has become increasingly clear that Australia is uniquely positioned to address the nuances of cardiovascular disease independently.

Australia’s distinct demographic, environmental, and lifestyle factors necessitate a tailored approach to cardiovascular health. Emerging research highlights that traditional guidelines, largely influenced by international data, may not fully capture the intricate patterns and underlying causes of CVD within our population. Modern lifestyle factors—ranging from dietary habits and physical activity levels to socioeconomic variables and genetic predispositions—present new challenges and opportunities in understanding and combating cardiovascular disease. As we delve deeper into these nuances, the need for Australian-specific guidelines becomes evident, paving the way for more precise, effective, and contextually relevant interventions.

Reviewing and Resetting our Guidelines

Cardiovascular disease (CVD) remains a major cause of morbidity and premature mortality in Australia, with ischaemic heart disease and cerebrovascular disease among the top three causes of death nationally in 2020. The risk of developing CVD is influenced by a complex interplay of social and environmental determinants that vary across populations. Comprehensive risk assessment that integrates multiple factors is fundamental to effective primary prevention, as it provides a more accurate prediction of cardiovascular risk compared to evaluating single risk factors in isolation. This approach supports shared decision-making with patients, targets pharmacotherapy to those who benefit most, and informs clinical decision-making.

The guideline for assessing absolute CVD risk in Australia, released in 2012, relied on a Framingham-based risk equation. However, this model has become outdated, overestimating risk in the general population and underestimating it in First Nations populations. Although many countries now favour using specific CVD risk equations tailored to their populations, Australia has lacked a contemporary, representative dataset with sufficient scale and detail to develop its own risk equation.

In response, the Australian Government Department of Health and Aged Care contracted the National Heart Foundation of Australia in June 2020 to develop a new guideline, including a contemporary CVD risk prediction equation. This project, undertaken on behalf of the Australian Chronic Disease Prevention Alliance, aims to provide more accurate and relevant tools for CVD risk assessment. In 2024, the newly developed Australian guideline for assessing and managing CVD risk, along with the Aus CVD Risk Calculator, offers clear recommendations for assessing CVD risk, practical advice on applying these recommendations in clinical practice, and tools to support effective communication of CVD risk to patients. It also includes specific guidance on managing CVD risk, a summary of the evidence supporting the recommended approaches to risk assessment and management, and tailored recommendations for assessing and managing CVD risk in First Nations people.

Trends and Changes to the National Guidelines

The updated Australian guidelines for assessing and managing cardiovascular disease (CVD) risk reflect significant advancements in understanding and addressing this critical health issue. Several key trends and changes have been introduced to improve the accuracy and effectiveness of CVD risk assessment and management.

A major shift in the new guidelines is the emphasis on a comprehensive approach to CVD risk assessment. Instead of focusing on single risk factors in isolation, the guidelines advocate for integrating multiple factors to provide a more accurate prediction of cardiovascular risk. This holistic assessment supports shared decision-making with patients and helps target pharmacotherapy to those who will benefit the most.

The guidelines also expand into age-specific assessments, recommending specific age ranges for assessing CVD risk. This includes for individuals without known CVD, assessment should occur between ages 45–79; for those with diabetes, assessment should start at age 35; whilst for First Nations people, individual risk factors should be assessed from ages 18–29, with full CVD risk assessment starting at age 30. These age-specific guidelines ensure early and appropriate intervention based on the individual’s risk profile.

The guidelines identify certain high risk populations as having a clinically determined high risk of CVD. This includes people with moderate to severe chronic kidney disease (CKD) and those with familial hypercholesterolaemia. For these groups, the Aus CVD Risk Calculator is not recommended, and they should be managed as high-risk patients.

The intervals for reassessing CVD risk using the Aus CVD Risk Calculator are determined by the most recent estimated risk level. For those at high risk, formal reassessment is generally not recommended, and management should be guided by clinical context. Intermediate-risk individuals who are not receiving pharmacological treatment should be reassessed every two years, while low-risk individuals should be reassessed every five years.

The guidelines introduce recommendations for reclassifying CVD risk based on ethnicity and other factors. For First Nations people, the estimated CVD risk may be reclassified to a higher risk category based on their clinical, psychological, and socio-economic circumstances, as well as community CVD prevalence. Similar considerations apply to Māori, Pacific Islander, South Asian, and East Asian populations.

The guidelines also account for factors such as family history of premature CVD, severe mental illness, and CKD. For individuals with these conditions, reclassification of CVD risk to a higher category may be warranted.

Effective communication of CVD risk is crucial for patient engagement and informed decision-making. The guidelines recommend using decision aids and various formats to communicate risk, accommodating different health literacy needs and learning styles. Management of CVD risk involves encouraging lifestyle modifications, such as smoking cessation, healthy eating, regular physical activity, maintaining a healthy weight, and reducing alcohol consumption.

Pharmacotherapy is also a key component, with specific recommendations for blood pressure-lowering and lipid-modifying treatments based on the individual’s estimated risk level. For high-risk individuals, these treatments are strongly recommended, while for intermediate-risk individuals, they are considered after discussing the benefits and harms.

Implementation into Practice

The newly updated Australian guidelines for assessing and managing cardiovascular disease (CVD) risk mark a pivotal shift towards a more tailored approach to cardiovascular care. By integrating multiple factors into risk assessments, specifying age ranges for different populations, and incorporating considerations for high-risk groups and ethnic variations, these guidelines offer a more precise and effective framework for preventing and managing CVD in Australia.

The impact of these guidelines is profound, as they address the unique needs of Australia’s diverse population, ensuring that interventions are both timely and appropriately targeted. The guidelines’ emphasis on holistic risk assessment supports shared decision-making and enables healthcare professionals to tailor pharmacotherapy and lifestyle interventions to those most likely to benefit. This approach not only improves patient outcomes but also enhances the efficiency of healthcare delivery by focusing resources on high-impact areas.

However, to fully realise the benefits of these new guidelines, it is crucial to upskill and disseminate this information to all primary healthcare professionals across the country. This widespread knowledge transfer will facilitate the consistent application of the guidelines, ultimately leading to improved cardiovascular health outcomes on a national scale.

For more information and to access the guidelines, visit: https://www.cvdcheck.org.au/for-health-professionals 

Australian Bureau of Statistics. Causes of death, Australia (2021). Canberra: ABS, 2022. https://www.abs.gov.au/statistics/health/causes‐death/causes‐death‐australia/2022.

Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts. Canberra: AIHW, 2023. https://www.aihw.gov.au/reports/heart‐stroke‐vascular‐disease/hsvd‐facts/contents/disease‐types.

Nelson, M. R., Banks, E., Brown, A., Chow, C. K., Peiris, D. P., Stocks, N. P., Ao, R. D., Raffoul, N., Kalman, L., Bradburn, E., & Jennings, G. (2024). 2023 Australian guideline for assessing and managing cardiovascular disease risk. Medical Journal of Australia, 220(9), 482–490. https://doi.org/10.5694/mja2.52280