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Call for revision to CVD screening and management guidelines for Indigenous Australians

By Kate Murchison
Researchers have called for revisions to CVD risk assessment and management guidelines for Aboriginal and Torres Strait Islander Australians following their findings that Indigenous Australians are at high absolute CVD risk and most of those at high risk are undertreated.

In their cross-sectional analysis of nationally representative data from 2820 Aboriginal and Torres Strait Islander participants aged 18 to 74 years, published in the Medical Journal of Australia, the researchers quantified absolute CVD risk and lipid-lowering medication use according to this risk. The research group was led by Dr Bianca Calabria from the Australian National University’s National Centre for Epidemiology and Population Health, Canberra, and UNSW’s National Drug and Alcohol Research Centre, Sydney.

The researchers found that 9.6% of Aboriginal and Torres Strait Islander people aged 35 to 74 years had prior CVD while a further 15.7% in this age group were at high absolute CVD risk (a greater than 15% risk of heart disease in the next five years). Of those at high absolute CVD risk, 82.6% were identified solely on the basis of clinical criteria.

Lipid-lowering therapy was being used by only 52.9% of those aged 35 to 74 years with prior CVD and 42.2% of those at high CVD risk.

High absolute CVD risk also affected 4.7% of those aged 25 to 34 years and 1.1% of those aged 18 to 24 years, age groups that were below the cut-off age for recommended screening, the researchers noted.

‘Given the significant contribution of CVD to the burden of disease experienced by Aboriginal and Torres Strait Islander Australians and indigenous people internationally, increasing the quality of our data and improving prevention with an absolute CVD risk approach must be priorities,’ they wrote.

In an accompanying editorial, Dr Jennifer Reath from Western Sydney University and Dr Peter O’Mara from the University of Newcastle said the study provided evidence on deficiencies undermining the prevention of CVD in Aboriginal and Torres Strait Islander people. They noted that the proportion of 25- to 34-year-old Indigenous Australians at high absolute CVD risk (4.7%) was larger than that for 45- to 54-year-old non-Indigenous Australians (4.0%), and they also called for CVD screening guidelines to be revised to reflect the new evidence of higher risk at younger age in Indigenous Australians.
Med J Aust 2018; doi: 10.5694/mja17.00897.
Med J Aust 2018; doi: 10.5694/mja18.00345.