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Prevention of vascular and metabolic disease

Introduction

Guidelines for preventive activities in general practice
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Cardiovascular disease (CVD) occurs in 18% of Australians. It accounts for 36% of all deaths and 6.9% of all disability.1 The most important behavioural and physiological risk factors for CVD are smoking, diabetes, raised blood pressure (BP), dyslipidaemia, obesity, physical inactivity and poor diet.2 These risk factors are common in the Australian population: 90% of adults aged >45 years have at least one modifiable risk factor and 66% have three or more risk factors for CVD.3 In addition to these, a family history of premature heart disease in a first-degree relative,4 history of depression, social isolation and lack of quality social support are recognised risk factors for coronary heart disease (CHD).5

What are the key equity issues and who is at risk?

Cardiovascular disease (CVD)

Socioeconomic disadvantage is associated with higher rates of CVD. Aboriginal and Torres Strait Islander peoples, people living in rural and remote areas, and people in lower socioeconomic groups, all have an increased risk of cardiovascular disease.6Minority groups have high risk factor rates of cardiovascular disease globally.6,7

Type 2 diabetes (T2D)

There is a higher prevalence of T2D among Australians in the lower socioeconomic groups.8 T2D is more than twice as common in the most disadvantaged communities.9 Certain ethnic groups are more at risk.10Aboriginal and Torres Strait Islander peoples are three times more likely to have diabetes than non-Indigenous Australians, and T2D is a direct or indirect cause for 20% of Aboriginal and Torres Strait Islander deaths.11

CVD risk factors

Biological and behavioural risk factors play a role in increasing cardiovascular risk (refer to Chapter 7. Prevention of chronic disease). However, while smoking, nutrition, alcohol and physical activity (SNAP) risk factors exhibit clear socioeconomic gradients,10,12 the higher prevalence of vascular and metabolic disease is only partly mediated by behavioural risk factors and is more consistently observed in women.13 Diabetes and CVD are more common in rural populations, and this is exacerbated by poorer access to healthcare.14There is evidence that men from socioeconomically disadvantaged backgrounds may be less likely to be offered statins.15

Chronic kidney disease (CKD)

Disadvantaged groups have higher rates of CKDfor which type 2 diabetic nephropathy is a common cause.16,17 Over the past 25 years, the number of Aboriginal and Torres Strait Islander peoples commencing renal replacement therapy was 3.5 times greater than the majority of the population. CKD has an earlier onset in Indigenous peoples.18–20 Aboriginal and Torres Strait Islander peoples are 10 times more likely than non-Indigenous Australians to be hospitalised for CKD, and, from 2008 to 2012, CKD was responsible for or associated with 16% of Aboriginal and Torres Strait Islander deaths.11

What can GPs do?

  • Inequities in diabetes care can be ameliorated using a structured systems-based approach to care targeting at-risk and minority populations using diabetes registries.21
  • Social disadvantage may be a factor in poor medication adherence in patients with chronic disease.22,23 Interventions that can help improve medication adherence include those that target the barriers created by socioeconomic status (SES) and the treatment itself.23 Underuse of cardiovascular medications is common in older adults at high risk of CVD, and may be a factor in inequity in cardiovascular outcomes.24
  • Effective chronic disease interventions are likely to be those that address the determinants of behavioural risk factors that arise from root social causes such as poverty and low health literacy.6Interventions delivered in community settings that target families and are multifaceted to incorporate the social context are generally the most successful.25,26
  • Trust is an important element in the delivery of culturally competent health service to patients with chronic diseases, particularly Aboriginal and Torres Strait Islander peoples. Key ways to improve healthcare delivery are to respond to social complexity; promote empowerment, trust and rapport; and reduce discrimination and racism. To do so requires not only practice-system change but also Aboriginal and Torres Strait Islander cultural training of health professionals to build culturally safe environments.27,28 Continuity of care and patient-centred care are also important. Culturally specific interventions are needed and there are ongoing initiatives to develop these.29–33
  1. Australian Institute of Health and Welfare. Australia’s health 2006. Canberra: AIHW, 2006.
  2. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case control sudy. Lancet. 2004;364:937–52.
  3. Australian Institute of Health and Welfare. Health determinants, the key to preventing chronic disease. Canberra: AIHW, 2011.
  4. Chow CK, Pell AC, Walker A, O’Dowd C, Dominiczak AF, Pell JP. Families of patients with premature coronary heart disease: An obvious but neglected target for primary prevention. BMJ (Clinical research ed). 2007;335(7618):481–85.
  5. Bunker S, Colquhoun D, Esler M. ‘Stress’ and coronary heart disease: Psychosocial risk factors. National Heart Foundation of Australia position statement update. Med J Aust 2003;178:272–76.
  6. Mendis S, Banerjee A. Cardiovascular disease: Equity and social determinants. In: Blas E, Kurup AS, editors. Equity, social determinants and public health programmes. Geneva: World Health Organization, 2010.
  7. McGorrian C, Daly L, Fitzpatrick P, et al. Cardiovascular disease and risk factors in an indigenous minority population. The All-Ireland Traveller Health Study. Eur J Prev Cardiol 2012;19(6):1444–53.
  8. Australian Institute of Health and Welfare. Diabetes. Canberra: AIHW, 2016 diabetes [Accessed 16 February 2016].
  9. Australian Institute of Health and Welfare. Cardiovascular disease, diabetes and chronic kidney disease: Australian facts: Prevalence and incidence. Canberra: AIHW, 2014. [Accessed 16 February 2016].
  10. Whiting D, Unwin N, Roglic G. Diabetes: Equity and social determinants. In: Blas E, Kurup AS, editors. Equity, social determinants and public health programmes. Geneva: World Health Organization, 2010. [Accessed 16 February 2016].
  11. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2015. Canberra: AIHW, 2015. [Accessed 16 February 2016].
  12. Palomo L, Felix-Redondo FJ, Lozano-Mera L, Perez-Castan JF, Fernandez-Berges D, Buitrago F. Cardiovascular risk factors, lifestyle, and social determinants: A cross-sectional population study. Br J Gen Pract 2014;64(627):e627–33. [Accessed 16 February 2016].
  13. Kavanagh A, Bentley RJ, Turrell G, Shaw J, Dunstan D, Subramanian SV. Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. Soc Sci Med 2010;71(6):1150–60. [Accessed 16 February 2016].
  14. O’Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health. 2012;126(10):813–20. [Accessed 16 February 2016].
  15. Stocks N, Ryan P, Allan J, Williams S, Willson K. Gender, socioeconomic status, need or access? Differences in statin prescribing across urban, rural and remote Australia. Aust J Rural Health 2009;17(2):92–96. [Accessed 16 February 2016].
  16. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013;382(9888):260–72. [Accessed 16 February 2016].
  17. Sabanayagam C, Lim SC, Wong TY, Lee J, Shankar A, Tai ES. Ethnic disparities in prevalence and impact of risk factors of chronic kidney disease. Nephrol Dial Transplant 2010;25(8):2564–70. [Accessed 16 February 2016].
  18. Garcia-Garcia G, Jha V, World Kidney Day Steering C. Chronic kidney disease in disadvantaged populations. Brazil J Med Biol Res 2015;48(5):377–81. [Accessed 16 February 2016].
  19. White A, Wong W, Sureshkumur P, Singh G. The burden of kidney disease in Indigenous children of Australia and New Zealand, epidemiology, antecedent factors and progression to chronic kidney disease. J Paediatr Child Health 2010;46(9):504–09. [Accessed 16 February 2016].
  20. Hoy WE. Kidney disease in Aboriginal Australians: A perspective from the Northern Territory. Clin Kidney J 2014;7(6):524–30. [Accessed 16 February 2016].
  21. Baty PJ, Viviano SK, Schiller MR, Wendling AL. A systematic approach to diabetes mellitus care in underserved populations: Improving care of minority and homeless persons. Fam Med 2010;42(9):623–27. [Accessed 16 February 2016].
  22. Randall L, Begovic J, Hudson M, et al. Recurrent diabetic ketoacidosis in inner-city minority patients: Behavioral, socioeconomic, and psychosocial factors. Diabetes Care 2011;34(9):1891–96. [Accessed 16 February 2016].
  23. Laba TL, Bleasel J, Brien JA, et al. Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: A systematic review. Int J Cardiol [Accessed 16 February 2016].
  24. 2013;167(6):2430–40. [Accessed 16 February 2016].
  25. Qato DM, Lindau ST, Conti RM, Schumm LP, Alexander GC. Racial and ethnic disparities in cardiovascular medication use among older adults in the United States. Pharmacoepidemiol Drug Saf 2010;19(8):834–42. [Accessed 16 February 2016].
  26. Lirussi F. The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups. Diabetes Metab Res Rev 2010;26(6):421–32. [Accessed 16 February 2016].
  27. Wee LE, Wong J, Chin RT, et al. Hypertension management and lifestyle changes following screening for hypertension in an asian low socioeconomic status community: A prospective study. Ann Acad Med Singapore 2013;42(9):451–65. [Accessed 16 February 2016].
  28. Department of Health and Ageing. National Aboriginal and Torres Strait Islander Health Plan 2013–2023. Canberra: DoHA, 2013. [Accessed 16 February 2016].
  29. Rix EF, Barclay L, Wilson S, Stirling J, Tong A. Service providers’ perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: A qualitative study. BMJ Open 2013;3(10):e00358–1 [Accessed 16 February 2016].
  30. Bradford D, Hansen D, Karunanithi M. Making an APPropriate care program for Indigenous cardiac disease: Customization of an existing cardiac rehabilitation program. Stud Health Technol Inform 2015;216:343–47. [Accessed 16 February 2016].
  31. Brown A, O’Shea RL, Mott K, McBride KF, Lawson T, Jennings GL. Essential service standards for equitable national cardiovascular care for Aboriginal and Torres Strait Islander people. Heart Lung Circ 2015;24(2):126–41. [Accessed 16 February 2016].
  32. Kritharides L, Lowe HC. Extracting the ESSENCE – Cardiovascular health for Aboriginal and Torres Strait Islander Australians. Heart Lung Circ 2015;24(2):107–09. [Accessed 16 February 2016].
  33. Schembri L, Curran J, Collins L, et al. The effect of nutrition education on nutrition-related health outcomes of Aboriginal and Torres Strait Islander people: A systematic review. Aust N Z J Public Health 2016;40(Suppl 1):S42–47. [Accessed 16 February 2016].
  34. Ski CF, Vale MJ, Bennett GR, et al. Improving access and equity in reducing cardiovascular risk: The Queensland Health model. Med J Aust 2015;202(3):148–52. [Accessed 16 February 2016].
  35. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Melbourne: National Stroke Foundation, 2012. [Accessed 16 February 2016].
  36. National Vascular Disease Prevention Alliance. Guidelines for the assessment of absolute cardiovascular disease risk. Melbourne: National Heart Foundation of Australia, 2009. [Accessed 16 February 2016].
  37. van Dis I, Kromhout D, Geleijnse JM, Boer JM, Verschuren WM. Body mass index and waist circumference predict both 10-year nonfatal and fatal cardiovascular disease risk: Study conducted in 20,000 Dutch men and women aged 20–65 years. Eur J Cardiovasc Prev Rehabil 2009;16:729–34. [Accessed 16 February 2016].
  38. Levy PJ, Jackson SA, McCoy TP, Ferrario CM. Clinical characteristics of patients with premature lower extremity atherosclerosis associated with familial early cardiovascular disease and/or cancer. Int Angiol 2006;25:304–09. [Accessed 16 February 2016].
  39. Welborn TA, Dhaliwal SS, Bennett SA. Waist–hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Med J Aust 2003;179(11/12):580–85. [Accessed 16 February 2016].
  40. Vasan RS, Larson MG, Leip EP, Kannel WB, Levy D. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: A cohort study. Lancet. 2001;358(9294):1682–86. [Accessed 16 February 2016].
  41. National Blood Pressure and Vascular Disease Advisory Committee. Guide to management of hypertension 2008 (Updated Dec 2010). Melbourne: National Heart Foundation of Australia, 2008. [Accessed 16 February 2016].
  42. US Preventive Services Task Force. Screening for high blood pressure: US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2007;147:783–86. [Accessed 16 February 2016].
  43. The Royal Australian College of General Practitioners. Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice, 2nd edn. East Melbourne, Vic: RACGP, 2015. [Accessed 16 February 2016].
  44. National Heart Foundation. Guideline for the diagnosis and management of hypertension in adults. Melbourne: National Heart Foundation, 2016. [Accessed 16 February 2016].
  45. Culleton B, Larson M, Wilson P, Evans J, Parfrey P, Levy D. Cardiovascular disease and mortality in a communitybased cohort with mild renal insufficiency. Kidney Int 1999;56(6):2214–19. [Accessed 16 February 2016].
  46. Go A, Chertow G, Fan D, McCulloch C, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–305. [Accessed 16 February 2016].
  47. Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard bloodpressure control. N Engl J Med. 2015;373(22):2103–16. [Accessed 16 February 2016].
  48. National Heart Foundation and High Blood Pressure Research Council of Australia Ambulatory Blood Pressure Monitoring Consensus Committee. Ambulatory blood pressure monitoring. Aust Fam Physician 2011;40(11):877–80. [Accessed 16 February 2016].
  49. Department of Health. Australia’s physical activity and sedentary behaviour guidelines. Canberra: DoH, 2014 nsf/content/health-pubhlth-strateg-phys-act-guidelines [Accessed 21 March 2016].
  50. Australian Medicines Handbook. Adelaide: AMH, 2016. [Accessed 21 March 2016].
  51. Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: Clinical and laboratory implications including flagging at desirable concentration cut-points-a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J 2016;37(25):1944–58. [Accessed 21 March 2016].
  52. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Reducing risk in heart disease: An expert guide to clinical practice for secondary prevention of coronary heart disease. Melbourne: National Heart Foundation of Australia, 2012. [Accessed 21 March 2016].
  53. Kirke A, Watts GF, Emery J. Detecting familial hypercholesterolaemia in general practice. Aust Fam Physician 2012;41(12):965–68. [Accessed 21 March 2016].
  54. National Heart Foundation of Australia, The Cardiac Society of Australia and New Zealand. Position statement on lipid management 2005. Heart Lung Circ 2005;14:275–91. [Accessed 21 March 2016].
  55. Bradford RH, Bachorik PS, Roberts K, Williams OD, Gotto AM Jr. Blood cholesterol screening in several environments using a portable, dry-chemistry analyzer and fingerstick blood samples. Lipid Research Clinics Cholesterol Screening Study Group. Am J Cardiol 1990;65(1):6–13. [Accessed 21 March 2016].
  56. Bachorik PS, Cloey TA, Finney CA, Lowry DR, Becker DM. Lipoprotein-cholesterol analysis during screening: Accuracy and reliability. Ann Intern Med 1991;114(9):741–47. [Accessed 21 March 2016].
  57. National Health and Medical Research Council. National evidence based guidelines for case detection and diagnosis of type 2 diabetes. Canberra: NHMRC, 2009. [Accessed 21 March 2016].
  58. Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int 2003;63:1468–74. [Accessed 21 March 2016].
  59. Colagiuri S, Davies D, Girgis S, Colagiuri R. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Canberra: Diabetes Australia and the National Health and Medical Research Council, 2009. [Accessed 21 March 2016].
  60. Siu AL. Screening for abnormal blood glucose and type 2 diabetes mellitus: US Preventive Services Task Force recommendation statement. Ann Intern Med 2015;163(11):861–68. [Accessed 21 March 2016].
  61. d’Emden MC, Shaw JE, Jones GR, Cheung NW. Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus. Med J Aust 2015;203(2):89–90. [Accessed 21 March 2016].
  62. World Health Organization. Report of a World Health Organization Consultation – Use of glycated haemoglobin (HbA1c) in the diagnosis of diabetes mellitus. Diabetes Res Clin Pract 2011;93:299–309. [Accessed 21 March 2016].
  63. Knowler WC, Barrett-Connor E, Fowler S, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Eng J Med 2002;346:393–403. [Accessed 21 March 2016].
  64. Pan X, Li G, Hu Y, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerence: The Da Qing IGT and Diabetes Study. Diabetes Care 1997;20:537–44. [Accessed 21 March 2016].
  65. Tuomilehto J, Lindstrom J, Eriksson J, et al. Prevention of type 2 diabetes melllitus by changes in lifestyle among subjects with impaired glucose tolerance. N Eng J Med 2001;344:1343–50. [Accessed 21 March 2016].
  66. Williamson DF, Vinicor F, Bowman BA. Primary prevention of type 2 diabetes mellitus by lifestyle intervention: Implications for health policy. Ann Intern Med 2004;140(11):951–57. [Accessed 21 March 2016].
  67. National Heart Foundation of Australia. National Heart Foundation position statement on non-valvular atrial fibrillation and stroke prevention. Med J Aust 2001;174:234–348. [Accessed 21 March 2016].
  68. Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2006;113(24):e873–923. [Accessed 21 March 2016].
  69. Alberts MJ, Eikelboom JW, Hankey GJ. Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation. Lancet Neurol 2012;11(12):1066–81. [Accessed 21 March 2016].
  70. Sauve J, Thorpe KE, Sackett DL, Taylor W. Can bruits distinguish high-grade from moderate symptomatic carotid stenosis? The North American Symptomatic Carotid Endarterectomy Trial. Ann Intern Med 1994;120(8):633–37. [Accessed 21 March 2016].
  71. Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruit as a prognostic indicator of cardiovascular death and myocardial infarction: A meta-analysis. Lancet 2008;371:1587–94. [Accessed 21 March 2016].
  72. Floriani M, Giulini SM, Bonardelli S, Portolani N. Value and limites of ‘critical auscultation’ of neck bruits. Angiology 1988;39:967–72. [Accessed 21 March 2016].
  73. National Stroke Foundation. Clinical guidelines for stroke management. Melbourne: NSF, 2010. [Accessed 21 March 2016].
  74. Lane DA, Lip GY. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation 2012;126(7):860–65. [Accessed 21 March 2016].
  75. Wolf PA, Abbot RD, Kannel WB. Atrial fibrillation as an independent risk facor for stroke: The Framingham study. Stroke 1991;22:983–88. [Accessed 21 March 2016].
  76. Australian Bureau of Statistics. Australian health survey: Biomedical results for chronic diseases, 2011–12. Canberra: ABS, 2013. [Accessed 21 March 2016].
  77. Australian Bureau of Statistics. Australian health survey: First results 2011–12. Canberra: ABS, 2012. [Accessed 21 March 2016].
  78. Tonelli M, Muntner P, Lloyd A, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: A population-level cohort study. Lancet 2012;380(9844):807–14. [Accessed 21 March 2016].
  79. Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. 3rd edn. South Melbourne, Vic: Kidney Health Australia, 2015. [Accessed 21 March 2016].
  80. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: A systematic review and meta-analysis. Kidney Int 2008;73(1):19–33 [Accessed 21 March 2016].
  81. Johnson D. Evidence-based guide to slowing the progression of early renal insufficiency. Intern Med J 2004;34:50–57. [Accessed 21 March 2016].
  82. Hallan SI, Dahl K, Oien CM, et al. Screening strategies for chronic kidney disease in the general population: Follow-up of cross sectional health survey. BMJ 2006;333(7577):1047. [Accessed 21 March 2016].
  83. Fox C, Larson MG, Leip EP, Culleton B, Wilson PWF. Predictors of new-onset kidney disease in a communitybased population. JAMA 2004;291:844–50. [Accessed 21 March 2016].
  84. Crowe E, Halpin D, Stevens P. Early identification and management of chronic kidney disease: Summary of NICE guidance. BMJ 2008;337:a1530. [Accessed 21 March 2016].
  85. Chadban S, Briganti EM, Kerr PG, et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol 2003;14(7 Suppl 2):S131–38. [Accessed 21 March 2016].
  86. Astor BC, Hallan SI, Miller ER, Yeung E, Coresh J. Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. Am J Epidemiol 2008;167(10):1226–34. [Accessed 21 March 2016].
  87. Angelantonio ED, Chowdhury R, Sarwar N, Aspelund T, Danesh J, Gudnason V. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: Prospective population based cohort study. BMJ 2010;341:4986. [Accessed 21 March 2016].
  88. Hoy W, Mathews J, McCredie D, Pugsley D, Hayhurst B. The multidimensional nature of renal disease: Rates and associations of albuminuria in an Australian Aboriginal community. Kidney Int 1998;54:1296–304. [Accessed 21 March 2016].
  89. Methven S, MacGregor MS, Traynor JP, Hair M, St J O’Reilly D, Deighan CJ. Comparison of urinary albumin and urinary total protein as predictors of patient outcomes in CKD. Am J Kidney Dis 2010;57(1):21–28. [Accessed 21 March 2016].
  90. Levey AS, Coresh J, Balk E, Kausz AT, Levin A. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003;139(2):137–47. [Accessed 21 March 2016].
  91. Eknoyan G, Hostetter T, Bakris GL, et al. Proteinuria and other markers of chronic kidney disease: A position statement of the National Kidney Foundation (NKF) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Am J Kidney Dis 2003;42:617–22. [Accessed 21 March 2016].
  92. Bleyer A, Shemanski LR, Burke GL, Hansen KJ. Tobacco, hypertension, and vascular disease: Risk factors for renal functional decline in an older population. Kidney Int 2000;57:2072–79. [Accessed 21 March 2016].
  93. Scottish Intercollegiate Guidelines Network. Diagnosis and management of chronic kidney disease: A national clinical guideline. Edinburgh: SIGN, 2008. [Accessed 21 March 2016].
  94. National Aboriginal Community Controlled Health Organisation and The Royal Australian College of General Practitioners. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 2nd edn. East Melbourne, Vic: RACGP, 2012. [Accessed 21 March 2016].
  95. Kidney Health Australia. National Chronic Kidney Disease Strategy. Melbourne: KHA, 2006. [Accessed 21 March 2016].
  96. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150(9):604–12. [Accessed 21 March 2016].
  97. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: The Framingham Heart Study. Circulation 2004;110(9):1042–46. [Accessed 21 March 2016].
  98. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics – 2008 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117(4):e25–146. [Accessed 21 March 2016].
  99. Kalman JM, Sanders P, Brieger DB, et al. National Heart Foundation of Australia consensus statement on catheter ablation as a therapy for atrial fibrillation. Med J Aust 2013;198(1):27–28. [Accessed 21 March 2016].
  100. Moran PS, Flattery MJ, Teljeur C, Ryan M, Smith SM. Effectiveness of systematic screening for the detection of atrial fibrillation. Cochrane Database Syst Rev 2013;4:Cd009586. [Accessed 21 March 2016].
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