Chapter 75: Cardiovascular disease

INTRODUCTION

Cardiovascular disease includes mainly:

• coronary heart disease—myocardial ischaemia (CHAPTER 30)

• cerebrovascular disease—strokes and transient ischaemia (CHAPTER 121)

• peripheral vascular disease (CHAPTER 55)

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 30) or blocked arteries causing angina and eventually cardiac failure (CHAPTER 76).

Cardiovascular disease was responsible for 18% of all deaths in Australia in 2017.² This percentage has steadily declined over the past 50 years; in 1968, CVD caused 45% of all deaths and the rate of deaths due to myocardial infarction was around 10 times that of today. This reduction is due to public health measures (particularly decreased smoking rates), improved preventative care (e.g. antihypertensives, statins) and improved emergency medical treatment of acute events. Continuing emphasis on behavioural modification of risk factors and healthy habits is essential to continue this trend.

RISK FACTORS FOR CVD

Modifiable:

• Hypertension (CHAPTER 77)

• Dyslipidaemia (CHAPTER 78)

• Smoking (CHAPTER 12)

• Diabetes (CHAPTER 11) with microalbuminuria

• Obesity (CHAPTER 80)

• Sedentary lifestyle

• Alcohol excess (CHAPTER 12)

• Poor nutrition (CHAPTER 5)

• Mental stress³ (CHAPTER 70)

Non-modifiable

• Family history

• Increasing age

• Male gender

• Social history, incl. cultural/ethnic identity

Related conditions:

• Chronic kidney disease (CHAPTER 79) 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. established CVD, diabetes in aged >60, hypertension) do not need an absolute CVD risk assessment using the Framingham Risk Equation, as they automatically fall into the high-risk category.⁴

SPECIFIC SCREENING RECOMMENDATIONS

• ⁴Blood 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). Non-fasting lipids are an acceptable alternative where practicality ...