Primary Absolute Cardiovascular Disease Risk and Prevention in Relation to Psychological Distress in the Australian Population: A Nationally Representative Cross-Sectional Study

Abstract

People who experience psychological distress have an elevated risk of incident cardiovascular disease (CVD). However, the extent to which traditional CVD prevention strategies could be used to reduce the CVD burden in this group is unclear because population-level data on CVD risk profiles and appropriate management of risk in relation to distress are currently not available. The aim of this study was to use nationally representative data to quantify variation in CVD risk and appropriate management of risk according to level of psychological distress in the Australian population. Data were from 2,618 participants aged 45-74 years without prior CVD who participated in the 2011-12 Australian Health Survey, a cross-sectional and nationally representative study of Australian adults. Age-and sex-adjusted prevalence of 5-year absolute risk of primary CVD (low <10%, moderate 10-15%, or high >15%), CVD risk factors, blood-pressure, and cholesterol assessments, and appropriate treatment (combined blood pressure- and lipid-lowering medication) if at high primary risk, were estimated. Prevalence ratios (PR) quantified variation in these outcomes in relation to low (Kessler-10 score: 10-<12), mild (12-<16), moderate (16-<22) and high (22-50) psychological distress, after adjusting for sociodemographic characteristics. The prevalence of high absolute risk of primary CVD for low, mild, moderate and high distress was 10.9, 12.3, 11.4, and 18.6%, respectively, and was significantly higher among participants with high compared to low distress (adjusted PR:1.62, 95%CI:1.04-2.52). The prevalence of CVD risk factors was generally higher in those with higher psychological distress. Blood pressure and cholesterol assessments were reported by the majority of participants (>85%) but treatment of high absolute risk was low (<30%), and neither were related to psychological distress. Our findings confirm the importance of recognizing people who experience psychological distress as a high risk group and suggest that at least part of the excess burden of primary CVD events among people with high psychological distress could be reduced with an absolute risk approach to assessment and improved management of high primary CVD risk.

Keywords: absolute risk; cardiovascular disease; prevention; psychological distress; risk factors.

Figure 1

National Vascular Disease Prevention Alliance (NVDPA) absolute CVD risk assessment algorithm. ¹Participants are automatically determined to be at high risk if they meet one or more of the following clinical criteria: Diabetes and aged over 60 years; diabetes with microalbuminuria; moderate or severe chronic kidney disease; systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg; serum total cholesterol >7.5 mmol/L. ²The Framingham risk equation uses information on age, sex, smoking status, total: HDL cholesterol, systolic blood pressure, and diabetes to calculate absolute risk of CVD.

Figure 2

Age- and sex- adjusted prevalence ratios (PR) (and 95% CI) between categories of psychological distress and risk factors for cardiovascular disease. Notes: % are weighted. Obesity is BMI≥30 kg/m². At-risk waist circumference is ≥92 cm for men and ≥80 cm for women. High alcohol intake is more than two standard drinks per day. Standard errors for chronic kidney disease were estimated with robust standard errors because models failed to converge when applying the Jackknife method.