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Introduction

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Of all the ailments which may blow out life’s little candle, heart disease is the chief.

William Boyd (1885–1979), Pathology for the Surgeon

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Cardiovascular disease includes mainly:

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  • coronary heart disease—myocardial ischaemia (CHAPTER 40)

  • cerebrovascular disease—strokes and transient ischaemia (CHAPTER 132)

  • peripheral vascular disease (CHAPTER 66)

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The number one cause of death in the world is coronary heart disease (CHD),1 whether from sudden fatal acute coronary events, particularly myocardial infarction (CHAPTER 40) or blocked arteries causing angina and eventually cardiac failure (CHAPTER 88). CHD is responsible for about 3 in 10 deaths in Australia.2 However, there has been a pleasing reduction in deaths from coronary heart disease and stroke in recent years because of improved preventive measures.

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Risk factors for CVD

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Modifiable:

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Non-modifiable

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  • Family history

  • Increasing age

  • Male gender

  • Social history inc. cultural/ethnic identity

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Related conditions:

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Assessment of absolute cardiovascular risk

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Target groups—recommended every 2 years:

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  • all adults ≥ 45 years without known history of CVD

  • ATSIP ≥ 35 years

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People for whom a high CVD risk can be assumed (e.g. diabetes, established CVD, hypertension) do not need an absolute CVD risk assessment using the Framingham Risk Equation.4

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Specific screening recommendations4

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  • Blood pressure should be measured in all adults from age 18 years at least every 2 years.

  • Adults should have their fasting blood lipids assessed starting at age 45 years, every 5 years (ATSIP: 35 years).

  • Adults should be screened for diabetes (fasting plasma glucose) every 3 years from age 40 years (ATSIP: from 18 years).

  • Adults at high risk should be screened for kidney disease every 1–2 years (ACR ratio and eGFR).

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Estimation of cardiovascular risk guidelines based on the key parameters—hypertension, diabetes, total cholesterol:HDL ratio, age and sex—are presented in FIGURES 85.1 and 85.2.

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FIGURE 85.1

Estimation of cardiovascular risk—women

Source: New Zealand Guidelines Group. New Zealand Cardiovascular Guidelines Handbook: Developed for primary care practitioners. Wellington: June 2005 <www.nzgg.org.nz>. Courtesy of the New Zealand Ministry of Health

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FIGURE 85.2

Estimation of cardiovascular risk—men

Source: New Zealand Guidelines Group. New Zealand Cardiovascular Guidelines Handbook: Developed for primary care practitioners. Wellington: June 2005 <www.nzgg.org.nz>. Courtesy of the New Zealand ...

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