Our approach to estimating risk in some patients should be updated and the role of coronary artery calcium scoring evaluated
While about one in five Australians aged 45–74 years are at high absolute cardiovascular risk, fewer than half of these people are taking lipid‐ and blood pressure‐lowering medications.1,2 New Medicare Benefits Schedule items for heart health checks (items 699 and 177) were introduced to reduce this gap,3 but the problem remains that recommended risk calculators are inaccurate and misclassification rates are high.4
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- 2. Banks E, Crouch SR, Korda RJ, et al. Absolute risk of cardiovascular disease events, and blood pressure‐ and lipid‐lowering therapy in Australia. Med J Aust 2016; 204: 320. https://www.mja.com.au/journal/2016/204/8/absolute-risk-cardiovascular-disease-events-and-blood-pressure-and-lipid
- 3. National Heart Foundation of Australia. Cardiovascular disease (CVD) risk assessment and management. 2019. https://www.heartfoundation.org.au/conditions/cvd-risk-assessment-and-management (viewed May 2020).
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- 7. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74: e177–e232.
- 8. Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010; 303: 1610–1616.
- 9. US Preventive Services Task Force. Cardiovascular disease: risk assessment with nontraditional risk factors. JAMA 2018; 320: 272–280.
- 10. Budoff MJ, Young R, Burke G, et al. Ten‐year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi‐ethnic study of atherosclerosis (MESA). Eur Heart J 2018; 39: 2401–2408.
- 11. Nasir K, Bittencourt MS, Blaha MJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (Multi‐Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2015; 66: 1657–1668.
- 12. Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing. J Am Coll Cardiol 2011; 57: 1622–1632.
- 13. Hamilton‐Craig CR, Chow CK, Younger JF, et al. Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring. Med J Aust 2017; 207: 357–361. https://www.mja.com.au/journal/2017/207/8/cardiac-society-australia-and-new-zealand-position-statement-executive-summary
- 14. Venkataraman P, Stanton T, Liew D, et al. Coronary artery calcium scoring in cardiovascular risk assessment of people with family histories of early onset coronary artery disease. Med J Aust 2020; 213: 170–177.
Harry Klimis is supported by a Royal Australian College of Physicians Fellows Research Entry Scholarship and a Research Training Program Scholarship. Clara Chow is supported by a National Health and Medical Research Council Career Development Award (APP1105447) co‐funded by a Future Leader Fellowship from the National Heart Foundation.
No relevant disclosures.