Cardiovascular Disease Risk Assessment and Management

What’s new in Cardiovascular Disease Risk Assessment and Management for Primary Care clinicians?

Online professional development for primary care

The Heart Foundation: Primary Care eLearning features a free cardiovascular disease risk assessment (CVDRA) and management in primary care course. Visit our eLearning platform.

Consensus statement

In February 2018, the Ministry of Health published a Consensus Statement on Cardiovascular Disease Risk Assessment and Management for Primary Care to update and refresh the CVD guidelines in the New Zealand Primary Care Handbook 2012.

The Consensus Statement references the New Zealand Primary Prevention Equations from the New Zealand PREDICT study. The Ministry of Health is looking at how to integrate the new equations into usual practice.

Management recommendations can be applied now using current CVD risk assessments identifying high, intermediate and low-risk individuals.

Encouraging a healthy lifestyle (smoking cessation, healthy diet, regular physical activity, optimal weight) remains a key foundation to the management of everyone regardless of CVD risk.

Communicating risk to individuals as part of shared decision making and CVD risk management is recommended.

Reviewed by: Associate Professor Gerry Devlin, Cardiologist and Medical Director Heart Foundation, Dr Fraser Hamilton, GP, and Dr Joan Leighton, GP Champion Heart Foundation

© 2018 Heart Foundation of New Zealand. All rights reserved. If you would like permission to reproduce in full or in part or have any queries, please contact hearthealthinfo@heartfoundation.org.nz.

CVD Risk Assessment and Management 2018

Important changes

Start earlier

For Māori, Pacific and South-Asian populations screening should begin at age 30 years for men and 40 years for women, 15 years earlier than populations without known risk factors.

Individuals with severe mental illness (schizophrenia, major depressive disorder, bipolar disorder, schizoaffective disorder) are a high-risk group and screening from age 25 years is recommended.

Assessment ages for other population subgroups are outlined below:

When to start risk assessments for men and women in different population subgroups

Population subgroupMenWomen
Individuals without known risk factorsAge 45 yearsAge 55 years
Maori, Pacific peoples or South-Asian* peoplesAge 30 yearsAge 40 years

People with other known cardiovascular risk factors or at high risk of developing diabetes.

Family history risk factors:

  • diabetes in first-degree relative (parent, brother or sister)
  • hospitalisation for or death from heart attack or stroke in a first-degree realative before the age of 50 years (father or brother, mother or sister)
  • familial hypercholesterolaemia

Personal history risk factors:

  • people who smoke
  • gestational diabetes
  • HbA1c 41-49 mmol/mol
  • BMI more than 30 or truncal obesity (waist circumference more than 102 cm in men or > 88 cm in women)
  • eGFR <60 but >45 ml/min/1.73 m2 **
  • atrial fibrillation
Age 35 yearsAge 45 years
People with diabetes (type 1 or 2) From the time of diagnosisFrom the time of diagnosis
People with severe mental illnessFrom age 25 yearsFrom age 25 years

* South-Asian peoples: India, including Fijian Indian, Sri Lankan, Afghani, Bangladeshi, Nepalese, Pakistani, Tibetan.

** eGFR estimated glomerular filtration rate.

Annual reviews recommended for high-risk individuals

Annual risk management reviews are recommended for all high-risk individuals and for individuals at intermediate risk on pharmacotherapy.

New clinical high-risk groups

Individuals with Heart Failure, a Glomerular Filtration Rate (e GFR) less than 30 ml/min (chronic kidney disease) and where available, a diagnosis of asymptomatic carotid disease or coronary disease (including coronary artery calcium score greater than 400 or plaque identified on CT angiography) are regarded as high risk for CVD and require intensive risk management.

Lipid management

Statins are the lipid-lowering agent of choice.

For high-risk individuals a LDL-C target of 1.8mmol/L or lower is recommended.

For intermediate-risk individuals the benefits and harms of lipid-lowering drugs should be presented and discussed to allow an individualised informed decision about whether to start treatment. A target LDL-C reduction of 40% or greater is recommended if drug treatment is commenced.

Blood Pressure

For high-risk individuals with persistent office BP 130/80mmHg or greater, or an equivalent level from ambulatory or home blood pressure monitoring, drug treatment in addition to lifestyle changes, is strongly recommended.

For intermediate risk individuals with persistent office BP of 140/90mmHg or greater, or an equivalent level from ambulatory or home BP monitoring, the benefits and harms of BP-lowering drugs should be presented and discussed to allow an individualised informed decision about whether drug treatment is commenced.

In all individuals if drug treatment is commenced, a target office BP less than 130/80mmHg is recommended.

Caution is recommended in lowering BP in elderly and comorbid individuals who may be at particular risk of treatment-related harms.

Aspirin

The benefits of the use of aspirin need to be carefully weighed up against the risks of bleeding and, in general, should only be considered in high-risk individuals under the age of 70 for primary CVD prevention alone.

Additional resources

Reference your regional health pathways for clinical management guidance of Cardiovascular Disease Risk Assessment (CVDRA).

BPAC - Cardiovascular disease risk assessment in primary care: managing lipids

Mōhio - Comprehensive clinical tool

My Heart Check - Consumer tool