Overview of management of atherosclerotic cardiovascular disease risk
The goal of management of people with atherosclerotic cardiovascular disease (ASCVD) risk factors is to reduce the likelihood that they will experience a cardiovascular event. Encourage a healthy lifestyle for all patients (see modifiable risk factors for atherosclerotic cardiovascular disease risk.
Long-term drug therapy aims to reduce the ASCVD risk by improving modifiable risk factors (ie blood pressure [BP] and lipid levels), rather than trying to achieve a particular target risk estimate. Whenever drug therapy is being considered, discuss the likely benefits and potential harms with the patient in relation to their level of ASCVD risk, and consider patient preference. Patients with lower risk estimates may still prefer to start drug therapy, and even a small reduction in risk may be considered worthwhile by some patients. If one risk factor is particularly elevated, treatment of this risk factor has the greatest potential to reduce ASCVD risk. If the patient chooses to start drug therapy, monitor for adverse effects and other harms; decisions about continuing treatment should consider the overall benefit to the patient. If drug treatment is not started, reassess ASCVD risk periodically (see Reassessing ASCVD risk for information on how often to reassess risk).
In some circumstances, it may be appropriate to start lipid-modifying or BP-lowering therapy despite ASCVD risk being low. See How to decide when to start lipid modifying therapy and When to start blood pressure–lowering therapy for more information on indications for treatment not related to ASCVD risk.
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High risk clinically determined high risk [NB1] or calculated as more than 10% risk of a cardiovascular event over 5 years | |
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Lifestyle modification [NB2] |
Give frequent and sustained specific advice and support about diet and physical activity, including referral to relevant services (eg accredited practising dietitian, exercise physiologist) if appropriate. Provide advice, support and drug therapy for smoking cessation. Lifestyle advice should be given in combination with BP-lowering and lipid-modifying drug therapy. |
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Drug therapy [NB3] |
Discuss the likely benefits and harms of drug therapy with the patient and consider patient preference. Explain that to reduce overall ASCVD risk, lipid-modifying therapy and BP-lowering therapy are recommended even if individual risk factors are only slightly elevated. Treat with lipid-modifying therapy unless contraindicated or clinically inappropriate; see How to decide when to start lipid-modifying therapy. Treat with BP-lowering therapy unless contraindicated or clinically inappropriate. Withholding BP treatment may be reasonable in some patients; for example, those who are hypotensive. For detailed advice on BP treatment targets, see Blood pressure treatment targets. Aspirin (or other antiplatelet therapy) is not routinely recommended [NB4]. |
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Intermediate risk calculated as 5 to 10% risk of a cardiovascular event over 5 years | |
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Lifestyle modification [NB2] |
Provide patient-specific advice and support about diet and physical activity, including referral to relevant services (eg accredited practising dietitian, exercise physiologist) if appropriate. Provide advice, support and drug therapy for smoking cessation. |
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Drug therapy [NB3] |
Discuss the likely benefits and harms of drug therapy with the patient and consider patient preference. Consider BP-lowering and lipid-modifying therapy, unless contraindicated or clinically inappropriate Withholding BP treatment may be reasonable in some patients; for example, those who are hypotensive. For detailed advice on BP treatment targets, see Blood pressure treatment targets. |
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Low risk calculated as less than 5% risk of a cardiovascular event over 5 years | |
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Lifestyle modification [NB2] |
Give general advice about diet and physical activity, including referral to relevant services (eg accredited practising dietitian, exercise physiologist) if appropriate. Provide advice, support and drug therapy for smoking cessation. |
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Drug therapy [NB3] |
Not routinely recommended. Discuss the likely benefits and harms of drug therapy with the patient and consider patient preference. |
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Note:
ASCVD = atherosclerotic cardiovascular disease; BP = blood pressure; uACR = urine albumin to creatinine ratio NB1: People with moderate or severe chronic kidney disease (sustained eGFR less than 45 mL/min/1.73 m2, or persistent albuminuria [uACR above 25 mg/mmol for men or above 35 mg/mmol for women]). or familial hypercholesterolaemia are at clinically determined high risk of a cardiovascular event. NB2: For information on lifestyle modification, see Overview of modifiable lifestyle risk factors for atherosclerotic cardiovascular disease. NB3: For information on drug therapy, see Hypertension and blood pressure reduction and Lipid modification. NB4: For discussion, see Antiplatelet therapy and atherosclerotic cardiovascular disease risk. Source: Australian Chronic Disease Prevention Alliance. Australian Guideline for assessing and managing cardiovascular disease risk. Melbourne: National Heart Foundation of Australia; 2023. https://www.cvdcheck.org.au/ | |