Breaking Down the New Australian Government Guidelines for Cardiovascular Health

The Australian Government Department of Health and Aged Care updated the 2012 Guidelines for the management of absolute cardiovascular disease risk in June 2020 in partnership with the National Heart Foundation of Australia, speaking for the Australian Chronic Disease Prevention Alliance (ACDPA). The new recommendation emphasizes utilizing a validated risk equation to assess and treat cardiovascular disease risk as the global best practices.

The new methodology recognizes the Framingham Risk Equation’s limitations in effectively calculating risk for the whole Australian community as well as Aboriginal and Torres Strait Islander groups, even though the 2012 guidelines used it. The revised recommendation takes into account more than 350 risk calculators, ratings, or methods for determining an individual’s likelihood of getting cardiovascular disease.

Exploring the recent changes in the guideline

1. Different age groups for risk assessment

The updated Australian cardiovascular disease guidelines now extend the use of the risk calculator to a wider age group, covering individuals aged 45 to 79 years without known cardiovascular disease. Moreover, the target age ranges for risk assessment using the risk calculator have been customized based on diabetes and First Nations status for those without known CVD.

• people with diabetes from age 35-79 years.
• First Nations people from age 30-79 years.
• First Nations people aged 18-29 years should have their individual risk factors assessed.

2. Redefined risk categories

The risk estimates now signify the probability of experiencing a cardiovascular event in the upcoming 5 years. These estimates are based on the updated Aus CVD Risk Calculator, offering improved and more accurate risk predictions compared to the previous calculator. With the introduction of new risk categories, it’s important to note that they are not directly interchangeable with the classifications used in the 2012 guidelines. As a result, we now observe distinct risk percentile ranges for high, intermediate, and low-risk classifications.

The new CVD risk categories are:

• high (≥10% risk over 5 years)
• intermediate (5 to <10% risk over 5 years)
• low (<5% risk over 5 years).

3. New Australian cardiovascular disease risk calculator

The new Aus CVD Risk Calculator now includes additional risk factors that were missing in the previous Framingham-based equation. It considers your geographical area, using residential postcodes to indicate area-level deprivation, and even takes into account if you have a diagnosis of atrial fibrillation. This means the updated calculator provides a much more accurate estimation of your CVD risk, especially if you have type 2 diabetes. 

It also takes into account factors like glycated haemoglobin (HbA1c), time since diabetes diagnosis (in years), urinary albumin-to-creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), body mass index (BMI), and recent use of insulin. It works for individuals who are on blood pressure-lowering, lipid-modifying, and/or antithrombotic medications, as it even considers the effects of your treatment.

Updating the CVD risk Equation

The central framework in primary care for estimating the probability of a patient experiencing a first-time cardiovascular disease (CVD) event within the next five years is PREDICT equation which is specifically designed for the present-day New Zealand population.

In order to create a country-specific CVD risk prediction equation, Large-scale data on risk variables and CVD outcomes from one or more cohorts of people from the target nation are required. The risk equation is being designed for a primary care population, and the data used to validate it should ideally represent that population. Since it has already been calibrated for the New Zealand population, the relative differences in CVD event rates between the two populations can be used to update the PREDICT equation for the Australian population.

Understanding Cardiovascular Diseases

Cardiovascular disease (CVD), usually referred to as heart disease, is a general term that refers to a number of heart-related disorders. The most common ones are discussed below:

Coronary Heart Disease

The most prevalent kind of heart illness is coronary heart disease, also referred to as coronary artery disease (CAD). Plaque accumulation in the coronary arteries causes blockages, which results in CAD. The arteries shrink and stiffen, limiting the amount of blood that can reach the heart. The oxygen and essential nutrients the heart needs to pump correctly become starved from it. Aside from weakening the heart muscle over time, CAD can also cause arrhythmias and cardiac failure.

Heart attack, or myocardial infarction

A myocardial infarction (MI), sometimes referred to as a heart attack, happens when the heart muscle is irreparably damaged. A healthy heart requires a constant supply of blood that is rich in oxygen. Due to a buildup of fatty material known as plaque, the coronary arteries, which supply this blood, narrow in people with coronary artery disease, reducing the volume of blood that can reach the heart.

As the plaque accumulation breaks down, blood cells cling to the wounded area, causing a blood clot. The heart muscle becomes “starved” of oxygen when a blood clot fully blocks an artery. Rapid cell death in the heart muscle causes long-term harm.

Coronary Artery Spasm

Coronary Artery Spasm (CAS), commonly referred to as “Prinzmetal angina” is a momentary discomfort or pain brought on by a transitory spasm in one or more of the coronary arteries that supply the heart with oxygen and nutrients. People under the age of 50 have a higher risk of this ailment. Spasms can range in severity, and in extreme circumstances, they may even result in a full blockage of the coronary artery. The cardiac muscle may suffer long-term harm if a severe CAS episode lasts more than 15 minutes; this could result in a heart attack.

Tako-tsubo or “broken heart” syndrome

Tako-tsubo, commonly referred to as “broken heart” syndrome, is a potentially life-threatening cardiac condition frequently diagnosed in women following a sudden emotional shock or prolonged stress. This condition leads to the weakening of the heart’s main pumping chamber, the left ventricle. Despite its recognition, the precise cause of Tako-tsubo cardiomyopathy remains unknown.

To know more about Cardiovascular disease, you can read here.

In addition to the updated recommendations, the Albanese government has taken additional steps to lessen the burden of cardiovascular disease, such as extending the MBS Heart Health Assessment items and implementing 60-day prescriptions for many chronic illnesses like hypertension, high cholesterol, and other heart conditions.

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