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Clinical guidelines

Guidelines for preventive activities in general practice 9th edition

8.1 Assessment of absolute cardiovascular risk

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 > 80

Aboriginal and Torres Strait Islander peoples

Age 0-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-79 > 80

Absolute CVD risk assessment combines risk factors to calculate the probability that an individual will develop a cardiovascular event (eg myocardial infarction, stroke) or other vascular disease within a specified time frame (usually five years). Absolute CVD risk assessment should be conducted at least every two years in all adults aged >45 years who are not known to have CVD or to be at clinically determined high risk (B).34 This calculation requires information on the patient’s age, sex, smoking status, total and high-density lipoprotein-cholesterol (HDL–C), systolic blood pressure (SBP) and whether the patient is known to have diabetes or left ventricular hypertrophy (LVH). In adults at low absolute CVD risk, blood test results within five years may be used for review of absolute CVD risk unless there are reasons to the contrary.34

Adults >74 years of age may have their absolute CVD risk assessed with age entered as 74 years. This is likely to underestimate five-year risk but will give an estimate of minimum risk.35 Patients with a family history of premature CVD (in a first-degree relative – men aged <55 years, women aged <65 years)4 or obesity (body mass index [BMI] above 30 kg/m2 or more) may be at greater risk.36–38 Similarly, patients with depression and atrial fibrillation (AF) may also be at increased risk.34

Table 8.1.1. Cardiovascular disease: Identifying risk
Population groupWhat should be done?How often?
Adults aged ≥45 years not known to have cardiovascular disease (CVD) or not clinically determined to be at high risk Calculate absolute CVD risk* 45–74 years (II, B) 34 Every two years†
(IV, C)
Aboriginal and Torres Strait Islander peoples aged ≥35 years not known to have CVD or not clinically determined to be at high risk Assess absolute CVD risk (may underestimate risk; IV, C) Every two years
(IV, C)
*Calculate risk using the National Heart Foundation of Australia’s risk charts (refer to Appendix 8A. Australian cardiovascular disease risk charts) or online at www.cvdcheck.org.au

Blood lipid results within five years can be used in the calculation of absolute CVD risk, but blood pressure (BP) should be measured at the time of assessment.

On-therapy measures of BP and cholesterol may underestimate absolute risk, and thus, recently recorded pre-treatment measures may be more appropriate to use if available. An electrocardiogram (ECG) is not required to determine left ventricular hypertrophy (LVH) if it is not previously known. Other absolute CVD risk calculators have been developed but most should not be applied to the Australian population.

†Adults with any of the following do not require absolute CVD risk assessment using the absolute risk calculator, because they are already known to be at clinically determined high risk of CVD (IV, D):
  • diabetes and >60 years of age
  • diabetes with microalbuminuria (>20 μg/min or urine albumin-to-creatinine ratio (UACR) >2.5 mg/mmol for males, >3.5 mg/mmol for females)
  • moderate or severe chronic kidney disease (CKD; persistent proteinuria or estimated glomerular filtration rate [eGFR] <45 mL/min/1.73 m2)
  • previous diagnosis of familial hypercholesterolaemia (FH)
  • Systolic blood pressure (SBP) ≥180 mmHg or diastolic blood pressure (DBP) ≥110 mmHg
  • serum total cholesterol >7.5 mmol/L
  • Aboriginal or Torres Strait Islander peoples aged >74 years (Practice Point)
BP, blood pressure; CKD, chronic kidney disease; CVD, cardiovascular disease; DBP, diastolic blood pressure; ECG, electrocardiogram; eGFR, estimated glomerular filtration rate; FH, familial hypercholesterolaemia; LVH, left ventricular hypertrophy; SBP, systolic blood pressure; UACR, urine albumin-to-creatinine ratio

References

  1. 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.
  2. Australian Institute of Health and Welfare. Health determinants, the key to preventing chronic disease. Canberra: AIHW, 2011.
  3. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Melbourne: National Stroke Foundation, 2012.
  4. National Vascular Disease Prevention Alliance. Guidelines for the assessment of absolute cardiovascular disease risk. Melbourne: National Heart Foundation of Australia, 2009.
  5. 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.
  6. 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.
  7. 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.
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