Chapter 85: Cardiovascular disease

INTRODUCTION

Cardiovascular disease includes mainly:

• coronary heart disease—myocardial ischaemia (CHAPTER 40)

• cerebrovascular disease—strokes and transient ischaemia (CHAPTER 130)

• peripheral vascular disease (CHAPTER 66)

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. Continuing emphasis on behavioural modification of risk factors and healthy habits is essential to continue this trend.

RISK FACTORS FOR CVD

Modifiable:

• Hypertension (CHAPTER 86)

• Dyslipidaemia (CHAPTER 87)

• Smoking (CHAPTER 21)

• Diabetes (CHAPTER 20) with microalbuminuria

• Obesity (CHAPTER 78)

• Sedentary lifestyle

• Alcohol excess (CHAPTER 21)

• Poor nutrition (CHAPTER 10)

• Mental stress³ (CHAPTER 81)

Non-modifiable

• Family history

• Increasing age

• Male gender

• Social history, inc. cultural/ethnic identity

Related conditions:

• Chronic kidney disease (CHAPTER 31) with microalbuminuria

Assessment of absolute cardiovascular risk

The risk of having a cardiovascular event over the next 5 years (or sometimes 10) is an important assessment which should be estimated before deciding on preventative medication as it greatly influences the pros and cons of screening investigations and treatment. The following target groups should be reassessed every 2 years:

• all adults ≥45 years without known history of CVD

• Aboriginal and Torres Strait Islander people ≥35 years

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

SPECIFIC SCREENING RECOMMENDATIONS⁴

• 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 (Aboriginal and Torres Strait Islander people from 35 years).

• Adults should be screened for diabetes (fasting plasma glucose or HbA1c) every 3 years from age 40 years (Aboriginal and Torres Strait Islander people from 18 years).

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

Estimation of cardiovascular risk guidelines based on the key parameters—hypertension, diabetes, smoking, total cholesterol:HDL ...