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Decade-old heart disease risk calculators finally overhauled

Guidelines for assessing heart disease risk have been overhauled for the first time in a decade, with new guidelines for diabetics and coronary artery calcium scoring now included.

Coronary artery calcium scoring can show whether plaque is present in the walls of the heart's arteries.
Coronary artery calcium scoring can show whether plaque is present in the walls of the heart's arteries.

Guidelines for assessing heart disease risk have been overhauled for the first time in a decade, with those with diabetes now recommended for assessment from the age of 35 and Aboriginal people urged to identify their individual risk factors from as young as the age of 18.

The Australian Chronic Disease Prevention Alliance, which includes the National Heart Foundation, Cancer Council and Diabetes Australia among others, reviewed the Australian Guidelines for Assessing and Managing Disease Risk, using a new large dataset from New Zealand to modify and recalibrate Australia’s cardiovascular disease risk calculator used by doctors.

Cardiovascular disease is Australia’s biggest killer and accounts for one in four Australian deaths.

The new calculator will now use postcode data and diagnosis of atrial fibrillation to calculate risk, and now has the capacity to include a number of health markers in people with diabetes that affect heart disease risk, including glycated haemoglobin levels, urinary albumin-to-creatinine ratio, and the use of insulin.

People with diabetes are twice as likely to develop heart disease as the rest of the population.

The guidelines also for the first time state that doctors may include a patient’s coronary artery calcium score as a “reclassification factor” to help refine and reclassify risk estimates. Other reclassification factors include ethnicity, kidney function measurements, severe mental illness, and a family history of premature CVD.

The guidelines have revised downward the recommendations on coronary calcium scoring, recognising the potential benefit of the test in low to intermediate risk patients. CAC scoring is performed via CT scan and can detect heart disease in those who “sit under the radar” of risk calculators but have plaque in their arteries despite being asymptomatic.

Cardiologists are strongly in favour of the tests and have argued risk guidelines miss a large proportion of people who may be at risk of having sudden heart attacks, while many others deemed at risk may have no plaque in their arteries at all and are unnecessarily taking statins.

The new guidelines state that CAC scoring “could be considered in the setting of CVD risk factors not already accounted for in the Aus CVD Risk Calculator as the risk score may be an underestimate”.

They recommend when CVD risk is assessed as low or intermediate, and the patient has one or more additional risk factors, CAC testing “can be considered if available and affordable”. The test is not currently covered by Medicare.

When a patient is at high CVD risk, the guidelines do not recommend CAC testing. Many cardiologists will disagree with this recommendation as some people who are assessed as high risk and are taking statins have zero calcium scores.

Federal Health Minister Mark Butler said the new CVD calculator “is the new gold standard in assessing the risk of cardiovascular disease in Australians”.

National Heart Foundation chief executive David Lloyd said the new guideline was a turning point in saving many Australians from cardiovascular disease.

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Original URL: https://www.theaustralian.com.au/nation/decadeold-heart-disease-risk-calculators-finally-overhauled/news-story/d6adc9a6d0ff5adb1d1964b4dbb4a900