University of Tasmania, Hobart, TAS.
National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.
Med J Aust. 2024 May 20;220(9):482-490. doi: 10.5694/mja2.52280. Epub 2024 Apr 16.
The 2023 Australian guideline for assessing and managing cardiovascular disease risk provides updated evidence-based recommendations for the clinical assessment and management of cardiovascular disease (CVD) risk for primary prevention. It includes the new Australian CVD risk calculator (Aus CVD Risk Calculator), based on an equation developed from a large New Zealand cohort study, customised and recalibrated for the Australian population. The new guideline replaces the 2012 guideline that recommended CVD risk assessment using the Framingham risk equation.
The new guideline recommends CVD risk assessment in people without known CVD: all people aged 45-79 years, people with diabetes from 35 years, and First Nations people from 30 years. The new Aus CVD Risk Calculator should be used to estimate and categorise CVD risk into low (< 5% risk over five years), intermediate (5% to < 10% risk over five years) or high risk (≥ 10% over five years). The following reclassification factors may be applied to recategorise calculated risk to improve accuracy of risk prediction, particularly in individuals close to a risk threshold: Indigenous status/ethnicity, estimated glomerular filtration rate, urine albumin to creatinine ratio measurements, severe mental illness, coronary artery calcium score and family history of premature CVD. A variety of communication formats is available to communicate CVD risk to help enable shared decision making. Healthy lifestyle modification, including smoking cessation, nutrition, physical activity and limiting alcohol, is encouraged for all individuals. Blood pressure-lowering and lipid-modifying pharmacotherapies should be prescribed for high risk and considered for intermediate risk individuals, unless contraindicated or clinically inappropriate. Reassessment of CVD risk should be considered within five years for individuals at low risk and within two years for those with intermediate risk. Reassessment of CVD risk is not recommended for individuals at high risk. CHANGES IN ASSESSMENT AND MANAGEMENT AS A RESULT OF THE GUIDELINE: The updated guideline recommends assessment over a broader age range and uses the Aus CVD Risk Calculator, which replaces the previous Framingham-based equation. It incorporates new variables: social disadvantage, diabetes-specific risk markers, diagnosis of atrial fibrillation and use of blood pressure-lowering and lipid-modifying therapies. Reclassification factors are also a new addition. Updated risk categories and thresholds are based on the new Aus CVD Risk Calculator. The proportion of the population in the high risk category (≥ 10% over five years) is likely to be broadly comparable to more than 15% risk from the Framingham-based equation. The full guideline and Aus CVD Risk Calculator can be accessed at www.cvdcheck.org.au.
2023 年澳大利亚心血管疾病风险评估和管理指南为一级预防的心血管疾病（CVD）风险的临床评估和管理提供了更新的循证建议。它包括了新的澳大利亚 CVD 风险计算器（Aus CVD Risk Calculator），该计算器基于来自新西兰大型队列研究的方程开发，针对澳大利亚人群进行了定制和重新校准。新指南取代了 2012 年建议使用Framingham 风险方程评估 CVD 风险的指南。
新指南建议在没有已知 CVD 的人群中进行 CVD 风险评估：所有 45-79 岁的人、35 岁及以上的糖尿病患者以及 30 岁及以上的原住民。应使用新的 Aus CVD Risk Calculator 来估计和分类 CVD 风险，将 CVD 风险分为低危（五年内风险<5%）、中危（五年内风险 5%-<10%）或高危（五年内风险≥10%）。以下重新分类因素可用于重新分类计算出的风险，以提高风险预测的准确性，特别是在接近风险阈值的个体中：原住民身份/种族、估计肾小球滤过率、尿白蛋白与肌酐比值测量、严重精神疾病、冠状动脉钙评分和家族史早发性 CVD。有多种沟通格式可用于传达 CVD 风险，以帮助实现共同决策。鼓励所有个体进行健康的生活方式改变，包括戒烟、营养、身体活动和限制饮酒。对于高危人群应开处方降压和调脂药物治疗，对于中危人群也可考虑使用，除非有禁忌或临床不适用。对于低危人群，应在五年内重新评估 CVD 风险，对于中危人群，应在两年内重新评估 CVD 风险。对于高危人群，不建议重新评估 CVD 风险。
由于指南的变化，评估和管理发生的变化：更新后的指南建议在更广泛的年龄范围内进行评估，并使用 Aus CVD Risk Calculator，该计算器取代了之前基于Framingham 的方程。它纳入了新的变量：社会劣势、糖尿病特异性风险标志物、心房颤动诊断以及使用降压和调脂药物治疗。重新分类因素也是一个新的补充。更新的风险类别和阈值基于新的 Aus CVD Risk Calculator。高危人群（五年内风险≥10%）的比例可能与基于 Framingham 的方程的 15%以上风险大致相当。完整的指南和 Aus CVD Risk Calculator 可在 www.cvdcheck.org.au 上获取。
