Are we behind the times on cardiovascular risk assessment in Australia?

Klimis, Harry; Chow, Clara K

doi:10.5694/mja2.50711

Topics

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

1 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
2 Westmead Hospital, Sydney, NSW
3 Westmead Clinical School, University of Sydney, Sydney, NSW

Correspondence: clara.chow@sydney.edu.au

Acknowledgements:

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.

Competing interests:

No relevant disclosures.

1. Chow CK, Rodgers A. Lost in translation: the gap between what we know and what we do about cardiovascular disease. Med J Aust 2016; 204: 291–292. https://www.mja.com.au/journal/2016/204/8/lost-translation-gap-between-what-we-know-and-what-we-do-about-cardiovascular
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).
4. Albarqouni L, Doust JA, Magliano D, et al. External validation and comparison of four cardiovascular risk prediction models with data from the Australian Diabetes, Obesity and Lifestyle study. Med J Aust 2019; 210: 161–167. https://www.mja.com.au/journal/2019/210/4/external-validation-and-comparison-four-cardiovascular-risk-prediction-models
5. D'Agostino RB, Grundy S, Sullivan LM, Wilson P; CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001; 286: 180–187.
6. Pylypchuk R, Wells S, Kerr A, et al. Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study. Lancet 2018; 391: 1897–1907.
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.

Online responses are no longer available. Please refer to our instructions for authors page for more information.