Screening for Cardiovascular Disease

The current approach is absolute cardiovascular risk, not treatment of isolated numbers. The Australian CVD Risk Calculator estimates the risk of a cardiovascular event over the next 5 years.

  1. Who gets an absolute CVD risk assessment
    • All people aged 45–79 years without known CVD.
    • People with diabetes aged 35–79 years.
    • Aboriginal and Torres Strait Islander people aged 30–79 years.
    • In Aboriginal and Torres Strait Islander people aged 18–29 years, assess individual CVD risk factors rather than using the calculator.
    • For expanded detail: ATSI Screening
  2. What goes into the calculator
    • age
    • sex
    • smoking
    • systolic BP
    • total cholesterol:HDL ratio
    • diabetes
    • CVD medications
    • postcode / socioeconomic disadvantage
    • history of atrial fibrillation.
    • In diabetes, additional variables include HbA1c, duration of diabetes, uACR, eGFR, BMI and insulin use.
  3. Risk categories
    • Low: <5% five-year risk
    • Intermediate: 5–<10%
    • High: ≥10%
  4. Clinically determined high risk
    • The old long list of automatic high-risk conditions has gone.
    • There are now only two conditions that automatically confer high risk without using the calculator:
      • moderate–severe CKD
      • familial hypercholesterolaemia.
    • Previous automatic categories such as diabetes ≥60 years, very high BP or cholesterol are no longer separate automatic high-risk categories under the current calculator.
  5. Refining the calculated risk
    • If the result is near a treatment threshold, consider factors that may justify reclassification:
      • ethnicity
      • family history of premature CVD
      • eGFR and uACR
      • severe mental illness
      • coronary artery calcium where appropriate.
    • Premature family history means coronary heart disease or stroke in a:
      • first-degree male relative <55 years, or
      • first-degree female relative <65 years.
  6. Blood pressure
    • Check BP opportunistically from age 18 years.
    • In people aged 18–44 years without another indication, generally no more often than every 2 years.
    • Confirm elevated BP with repeat measurements rather than diagnosing hypertension from a single reading.
    • For expanded detail: Hypertension – Non-pharmacological Management · Cardiac Check-up
  7. How often to repeat CVD risk assessment
    • For people aged 45–79 years, reassess approximately every 5 years if risk remains low and risk factors have not significantly changed.
    • Reassess earlier if risk factors worsen or clinical circumstances change.
    • The old shorthand of high yearly / medium 2-yearly / low 5-yearly is better removed; the current approach is individualised.
  8. Management
    • Address modifiable risk:
      • smoking
      • nutrition
      • physical activity
      • healthy weight
      • alcohol
      • blood pressure
      • lipids
      • diabetes.
    • High risk ≥10%: BP-lowering and lipid-modifying medication are generally recommended unless contraindicated or clinically inappropriate.
    • Intermediate and low risk: management depends on absolute risk, individual risk factors and shared decision-making.
    • For expanded detail: Smoking Cessation Medications · Cardiovascular Health
  9. Lipids
    • Measure lipids as part of overall CVD risk assessment.
    • Do not manage cardiovascular risk by chasing isolated universal cholesterol targets.
    • The old list:
      • total cholesterol <4.0
      • triglycerides <2.0
      • HDL ≥1.0
      • non-HDL <2.5
      • LDL <2.0
      is better removed from a screening page.
    • Current primary prevention management is driven principally by absolute CVD risk, with lipid lowering intensified according to risk and clinical context.
  10. Atrial fibrillation
    • Opportunistically check pulse or cardiac rhythm in people aged ≥65 years.
    • An irregular rhythm should be confirmed with ECG.
    • For expanded detail: Atrial Fibrillation / Flutter
  11. Who does not need the calculator
    • People with established atherosclerotic cardiovascular disease are already in secondary prevention.
    • People with moderate–severe CKD or familial hypercholesterolaemia are already considered high risk.

Current Key Resources

The just the facts version:

  • 18 → BP
  • 30 → ATSI calculator
  • 35 → diabetes calculator
  • 45 → everyone calculator
  • Risk Stratification
    • <5% = Low risk
    • 5-10% = Intermediate risk
    • ≥10% = High risk
  • Only CKD + FH bypass the calculator as primary-prevention high risk.