Screening for Cardiovascular Disease

The Red Book recommends the use of absolute cardiovascular risk assessment for guiding preventative activities for cardiovascular diseases.

  • Risk Assessment: The guidelines recommend that an absolute risk approach should be used to guide the intensity of preventive activities. This involves using a validated tool to calculate a person’s risk of a cardiovascular event within the next five years. These tools usually take into account several factors, such as age, sex, smoking status, blood pressure, cholesterol levels, and whether the person has diabetes or existing kidney disease.
  • Who Should be Screened: Generally, the Red Book suggests performing an absolute cardiovascular risk assessment for all adults aged 45 years and over (or 18 years and over for ATSI) who have no known history of heart disease or stroke.
  • Frequency of Screening: The frequency of cardiovascular risk assessment is typically individualized, depending on a person’s initial risk level, but might be performed every two years for those at low risk.
  • Management: Depending on a person’s calculated risk, interventions to lower the risk of cardiovascular disease may be recommended. These can include lifestyle modifications such as smoking cessation, a healthy diet, regular physical activity, and potentially medication for conditions such as high blood pressure or high cholesterol.
  • High-Risk Groups: Certain populations are automatically classified as high risk:
    • under the old guidelines
      • diabetes and age 60 years
      • diabetes with microalbuminuria urinary albumin:creatinine ratio >2.5 mg/mmol for males, >3.5 mg/mmol for females
      • moderate and severe chronic kidney disease (eGFR < 45 mL/min/1.73 m2)
      • systolic BP ≥180 mm Hg; or diastolic BP ≥ 110 mm Hg
      • serum total cholesterol 7.5 mmol/L
      • previous diagnosis of familial hypercholesterolaemia
      • Aboriginal and Torres Strait Islander adults aged over 74 years
    • under the new guidelines, this is reduced to only 2 groups
      • moderate-severe CKD
        • sustained eGFR <45 mL/min/1.73 m²
        • persistent uACR >25 mg/mmol (men) or persistent uACR >35 mg/mmol(women)
      • familial hypercholesterolaemia

Targets

  • Cholesterol <4.0 mmol/L
  • Triglyceride <2.0 mmol/L
  • HDL – Cholesterol >=1.0 mmol/L
  • Non HDL – Chol. <2.5 mmol/L
  • LDL – Cholesterol <2.0 mmol/L

Risk Calculator

Frequency of checks

The Red Book recommends a personalized approach based on a person’s overall health, risk factors, and any existing conditions.

  1. Blood Pressure: For an average adult without known risk factors for hypertension, some guidelines suggest checking blood pressure every 2 years. If the person has higher blood pressure levels (within the normal range), or other risk factors for cardiovascular disease such as obesity, smoking, or a family history of cardiovascular disease, then more frequent checks (e.g., annually) may be recommended. People with diagnosed hypertension would usually have their blood pressure monitored more regularly.
  2. Cholesterol: For cholesterol, there’s also variability depending on individual risk factors. As a part of cardiovascular risk assessment, lipid levels (which include cholesterol) may be checked every 5 years in adults aged 45 years and over with no known history of heart disease. However, people with higher risk factors like a family history of early heart disease, or those who have conditions like diabetes or diagnosed heart disease need to have their cholesterol checked more frequently.
    • High risk – every 12 months
    • Medium risk – every 2 years
    • Low risk (> 45 years or >35 ATSI) – every 5 years