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Review
. 2024 Apr;47(2):57-63.
doi: 10.18773/austprescr.2024.014.

Assessing, communicating and managing cardiovascular disease risk: a practical summary of the 2023 guideline

Garry Jennings  1 , Natalie Raffoul  2 , Mark Nelson  3 , Expert Steering Group For The Australian Guideline For Assessing And Managing Cardiovascular Disease Risk  4
Affiliations
Review

Assessing, communicating and managing cardiovascular disease risk: a practical summary of the 2023 guideline

Garry Jennings et al. Aust Prescr. 2024 Apr.

Abstract

The outdated cardiovascular disease risk calculator has been reported to overestimate cardiovascular disease risk for a contemporary Australian population, and does not include relevant variables, such as socioeconomic disadvantage, which has been shown to increase the incidence of both heart attack and stroke. The 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk marks a major milestone as the first update to Australia's cardiovascular disease prevention guideline in over a decade. The new guideline may help to refine and recategorise risk estimates, hence improving the discriminatory and predictive value of the new calculator. The new Australian Cardiovascular Disease Risk Calculator expresses risk scores as a percentage estimate of a person's probability of dying or being hospitalised due to cardiovascular disease within the next 5 years. The new calculator expresses risk scores as low (less than 5%), intermediate (5% to less than 10%), or high (10% or higher) risk over 5 years. Reclassification factors built into the new calculator are designed to help clinicians individualise risk estimates. These factors include ethnicity (e.g. First Nations status), family history of premature cardiovascular disease, severe mental illness, kidney disease and coronary artery calcium score. The new calculator also uses optional diabetes-specific variables (supporting a more granular cardiovascular disease risk assessment of people with type 2 diabetes). People who meet the clinically determined high-risk criteria (chronic kidney disease, familial hypercholesterolaemia) should not progress through the Australian Cardiovascular Disease risk calculator, but move straight to management. For a person with a cardiovascular disease risk score recorded from the outdated calculator, clinicians may want to reassess their risk using the new calculator the next time the person attends.

Keywords: cardiovascular disease; cardiovascular disease risk calculator; coronary heart disease; primary prevention.

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Conflict of interest statement

Conflicts of interest: Garry Jennings is the Chief Medical Advisor of the National Heart Foundation of Australia (NHFA; NHFA, on behalf of the Australian Chronic Disease Prevention Alliance, received funding from the Australian Government Department of Health and Aged Care to develop the 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk and the Australian CVD Risk Calculator and led its implementation in general practice). He is a cardiologist at the Baker Heart & Diabetes Institute, and Associate Editor of Hypertension, a journal of the American Heart Association. He is on the Advisory Board of SiSu Health, and is a past Member of the Global Vaccine Advisory Board, Sanofi Pasteur. Natalie Raffoul is the Healthcare Programs Manager of the NHFA; NHFA, on behalf of the Australian Chronic Disease Prevention Alliance, received funding from the Australian Government Department of Health and Aged Care to develop the 2023 Australian Guideline for Assessing and Managing Cardiovascular Disease Risk and the Australian CVD Risk Calculator and led its implementation in general practice). She received speaker fees for presentation at educational events sponsored by Amgen and Novartis. Mark Nelson is a Senior Member of the Menzies Institute for Medical Research, University of Tasmania, and Adjunct Professor at the Department of Epidemiology and Preventive Medicine, Monash University. He is the Deputy-Chair of the Research Advisory Committee for the Stroke Foundation and was a member of Novartis’s Inclisiran Advisory Board, for which he received payments prior to membership of the guideline committee.

Figures

A 100-person chart depicting a percentage risk score in the population as a number of red person icons among 100 grey person icons. In this example the number is 7 people out of 100 or a 7% risk.
Figure 1
Example of a risk communication tool (100-person chart) to help clinicians explain risk to patients
See this image and copyright information in PMC

References

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