Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement

Abstract

Summary Cardiovascular disease (CVD) is a leading cause of preventable morbidity and mortality in Aboriginal and Torres Strait Islander peoples. This statement from the Australian Chronic Disease Prevention Alliance, the Royal Australian College of General Practitioners, the National Aboriginal Community Controlled Health Organisation and the Editorial Committee for Remote Primary Health Care Manuals communicates the latest consensus advice of guideline developers, aligning recommendations on the age to commence Aboriginal and Torres Strait Islander CVD risk assessment across three guidelines. Main recommendations In Aboriginal and Torres Strait Islander peoples without existing CVD: CVD risk factor screening should commence from the age of 18 years at the latest, including for blood glucose level or glycated haemoglobin, estimated glomerular filtration rate, serum lipids, urine albumin to creatinine ratio, and other risk factors such as blood pressure, history of familial hypercholesterolaemia, and smoking status. Individuals aged 18–29 years with the following clinical conditions are automatically conferred high CVD risk: ▶type 2 diabetes and microalbuminuria; ▶moderate to severe chronic kidney disease; ▶systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg; ▶familial hypercholesterolaemia; or ▶serum total cholesterol > 7.5 mmol/L. Assessment using the National Vascular Disease Prevention Alliance absolute CVD risk algorithm should commence from the age of 30 years at the latest — consider upward adjustment of calculated CVD risk score, accounting for local guideline use, risk factor and CVD epidemiology, and clinical discretion. Assessment should occur as part of an annual health check or opportunistically. Subsequent review should be conducted according to level of risk. Changes in management as a result of this statement From age 18 years (at the latest), Aboriginal and Torres Strait Islander adults should undergo CVD risk factor screening, and from age 30 years (at the latest), they should undergo absolute CVD risk assessment using the NVDPA risk algorithm.

Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ)

“…Incidence rates for participants in the 4th waist circumference quartile were 38.3% for males and 47.2% for females [43]. The development of CVD at younger ages has led to recent calls for risk assessment for Aboriginal and Torres Strait Islander adults aged 35 years and under that are supported by the findings from this study [44].…”

National Heart Foundation of Australia: position statement on coronary artery calcium scoring for the primary prevention of cardiovascular disease in Australia

“…Practice advice: Before consideration of CAC scoring, assess CVD risk on clinical grounds. If the person is aged over 45 years (or over 30 years if Aboriginal or Torres Strait Islander 48 ), this should include an NVDPA absolute risk assessment 3 The 2012 NVDPA absolute risk algorithm may underestimate risk in certain populations, such as Aboriginal and Torres Strait Islander peoples, 49 or in others with known risk‐enhancing factors not fully captured in the NVDPA algorithm (Box 4).…”

Markers of chronic disease risk in a cohort of Aboriginal children: findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)

“…Recently updated guidelines suggest screening Aboriginal and Torres Strait Islander peoples for CVD risk factors from the age of 18 years and to perform absolute CVD risk assessment from the age of 30 years 12 . It is suggested that diabetes screening should also begin from the age of 18 years unless individuals are affected by overweight or obesity, as this can increase the risk of chronic disease 13 .…”