The 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk with its new calculator takes a more holistic approach to estimating risk and patient classification. Apart from the classic risk factors of age, sex, smoking status, diabetes, blood pressure (BP) and lipids, it also considers the use of BP-lowering and lipid-modifying medicines, a diagnosis of atrial fibrillation and postcode as a surrogate for socioeconomic status.
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- The 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk recommends cardiovascular disease (CVD) risk assessment for people aged 45 to 79 years, for people with diabetes from the age of 35 years, and for First Nations people from the age of 30 years. Individual CVD risk factors should be assessed in First Nations people aged 18 to 29 years.
- The new Australian CVD risk (Aus CVD Risk) calculator includes optional risk factors that were not part of the previous Framingham-based equation, including a diagnosis of atrial fibrillation and socioeconomic status through a surrogate of residency postcode. It also allows for improved CVD risk estimation in people with type 2 diabetes, factoring in glycated haemoglobin, time since diagnosis of diabetes (measured in years), urinary albumin-to-creatinine ratio, estimated glomerular filtration rate, body mass index and the use of insulin in the previous six months.
- Risk categories have been redefined in the new Aus CVD Risk calculator, providing a more accurate risk prediction than the previous calculator. Reclassification factors have been introduced to allow for improved individual management.
- Relevant decision aids should be used to support effective risk communication and enable informed decisions about reducing CVD risk.
- Managing CVD risk should always include advice on appropriate healthy lifestyle and behaviours, with or without blood pressure-lowering and lipid-modifying pharmacotherapy.
‘What’s my heart disease risk, doctor?’ If only our patients started a consultation with this request. In reality, it is often the doctor who needs to raise this issue prompted by their knowledge of the patient’s age, sex, cultural background and cardiovascular disease (CVD) risk factors. Historically, doctors approached this by monitoring risk factors such as blood pressure (BP) and cholesterol and giving a BP- or lipid-lowering medication to a patient who crossed an arbitrary individual risk-factor threshold. Over a decade ago, peak bodies recommended moving from this approach to a more holistic one, leading to formal calculation of a validated risk score that best identifies those most likely to have a major adverse cardiovascular event (MACE) in the intermediate future and, therefore, who to treat.1 Subsequent research showed that these guidelines were not universally observed, with 60% of high-risk individuals not receiving lipid- and BP-lowering therapy as recommended.2 The passage of time and the need to reinvigorate this approach led to the development of a new risk calculator and the publication of the 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk.3