Identifying people suitable for atherosclerotic cardiovascular disease risk estimation

Australian Chronic Disease Prevention Alliance, 2023

Risk estimation is not intended for people with established atherosclerotic cardiovascular disease (ASCVD). Preventive care is essential for people with known ASCVD; for advice on management, see Secondary prevention of ASCVD.

Note: Preventive care is essential for people with established atherosclerotic cardiovascular disease.
Risk calculation is not required for people with moderate or severe chronic kidney disease1 or familial hypercholesterolaemia, because they are considered to be at high risk of a cardiovascular event regardless of whether they have other risk factors. For these people, provide advice and treatment as for high ASCVD risk (see Management according to atherosclerotic cardiovascular disease risk estimate).

Use the Aus CVD risk calculator to estimate the risk of a cardiovascular event in people without known ASCVD who are:

  • 45 to 79 years
  • 35 to 79 years and have diabetes
  • 30 to 79 years and are a First Nations person.

The Aus CVD risk calculator has not been validated in people younger than 30 years or older than 79 years. In people older than 79 years, the calculator may underestimate risk; consider the individual patient profile and goals of care to inform the management of ASCVD risk. In people younger than 45 years (or 35 years with diabetes), use clinical judgement to identify those at high risk who may benefit from earlier screening for risk factors, for example patients who are presumed to have a trajectory of high ASCVD risk (eg high blood pressure, smoker).

Around 75% of First Nations adults younger than 35 years have at least one risk factor for ASCVDAgostino 2020. Although formal risk estimation using the Aus CVD risk calculator is only validated from 30 years of age, screen First Nations people for ASCVD risk factors from 18 years of ageAgostino 2020. Screening in this younger population should include assessment of:

  • smoking status
  • blood pressure
  • blood glucose concentration or glycated haemoglobin
  • estimated glomerular filtration rate (eGFR)
  • serum lipids
  • urine albumin-creatinine ratio (uACR)
  • familial hypercholesterolaemia.

For more information on ASCVD risk screening in First Nations peoples without existing ASCVD, see the consensus statement for cardiovascular disease risk assessment in Aboriginal and Torres Strait Islander adults aged under 35 years.

1 For the purposes of ASCVD risk assessment, moderate to severe chronic kidney disease is defined as sustained estimated glomerular filtration rate (eGFR) less than 45 mL/min/1.73 m2, or persistent albuminuria (urine albumin–creatinine ratio [uACR] above 25 mg/mmol for men or above 35 mg/mmol for women).Return