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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

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Prevention of vascular and metabolic disease

Cardiovascular disease occurs in 18% of the population, with 6.9% estimated to have an associated disability.159 The majority of deaths from CVD can be prevented by changing behavioural and physiological risk factors. Behavioural risk factors include smoking, poor nutrition, hazardous alcohol consumption and physical inactivity as outlined in Chapter 7 Prevention of chronic disease. In addition, depression, social isolation and lack of quality social support are risk factors for coronary heart disease.298

Changing the following physiological risk factors has been demonstrated to reduce vascular events including stroke and myocardial infarction:

  • lowering BP in patients with hypertension or high absolute cardiovascular risk
  • reducing blood levels of total cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides and raising high density lipoprotein (HDL) cholesterol levels, and
  • maintaining good glycaemic control in patients with diabetes.

These multiple factors contribute to the risk of vascular disease. Absolute CVD risk is the probability that an individual will develop a cardiovascular event (coronary infarct or stroke) within 5 years. Preventive actions based on estimated absolute risk are more effective and efficient than those based on individual risk factors as they acknowledge the synergistic effects of multiple risk factors combined.

Intervention Technique Reference
Absolute cardiovascular risk assessment

The National Vascular Disease Prevention Alliance recommends that:299
Absolute cardiovascular risk assessment, using the Framingham Risk Equation to predict risk of a cardiovascular event over the next 5 years, should be performed for all adults aged 45–74 years who are not known to have CVD or to be at high risk of CVD (including people with diabetes under the age of 60 years). This should be re-assessed every 2 years (or more frequently if a change in treatment is considered).
In adults without known CVD, a comprehensive assessment of cardiovascular risk includes consideration of the following:

  • age and gender
  • BP
  • serum lipids
  • diabetes
  • renal function (microalbumin ± urine protein, estimate of glomerular filtration rate)
  • family history of premature CVD or familial hypercholesterolaemia
  • evidence of atrial fibrillation (history, examination, electrocardiogram)
  • waist circumference and BMI
  • smoking, nutrition, physical activity level and alcohol intake
  • social history including ethnicity, SES, and mental health.

See Appendix 3 for cardiovascular risk tables; <10% is considered low risk, 10–15% medium risk, and >15% high risk. Adults with any of the following specific conditions do not require absolute cardiovascular risk assessment using the Framingham Risk Equation as they are already known to be at increased risk of CVD:

  • diabetes and age >60 years or microalbuminuria
  • moderate or severe chronic kidney disease
  • previous diagnosis familial hypercholesterolaemia
  • systolic BP =180 mmHg or diastolic BP =110 mmHg or serum total cholesterol >7.5 mmol/L. Absolute risk should be assessed from 35 years of age in Aboriginal people and Torres Strait Islanders (although this might underestimate their risk).207
 300

 

Health inequality

Low socioeconomic status is associated with an increased risk of CVD.301 Data from the National Nutrition Survey suggests that people of low SES or those living in rural locations have higher dietary saturated fat intake, although relationship with serum cholesterol levels is less clear.302 People of low SES have a higher prevalence of diabetes.303 This group is less likely to access the full range of clinical services including screening.

Hypertension and CVD are more common in low socioeconomic groups including Aboriginal people and Torres Strait Islanders and the unemployed.303,304 The incidence of end stage renal disease (ESRD) among Aboriginal people and Torres Strait Islanders varies from up to 30 times the national incidence in some remote areas to around double in some urban areas.305,306 Factors that affect rates of ESRD in Aboriginal people and Torres Strait Islanders include low birth weight, poor nutrition, infections such as scabies, smoking, other behavioural risk factors and socioeconomic disadvantage.307–309 There is also 3-fold variation within urban areas among non-Indigenous Australians, with higher ESRD incidence in more disadvantaged areas.310

Preventive care is less likely to be provided to these patients.311 There is evidence that there is a differential in statin prescribing on the basis of SES.312


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