Cardiovascular risk assessment

Clinically determined high risk (do not use the calculator — manage as high risk directly): established cardiovascular disease (secondary prevention), moderate-to-severe chronic kidney disease, familial hypercholesterolaemia.

The 2023 guideline dropped diabetes, microalbuminuria, isolated high BP/TC readings and age-based ATSI status from this automatic list — diabetes is now entered into the calculator itself with diabetes-specific variables (HbA1c, time since diagnosis, uACR, eGFR, BMI, insulin use) rather than being automatically high risk.

Who to assess (Aus CVD Risk Calculator), if not already clinically determined high risk: all people without known CVD, aged 45–79 years; people with diabetes, aged 35–79 years; First Nations people, aged 30–79 years (assess individual CVD risk factors from age 18–29; for those younger than 30 who meet the clinically-determined-high-risk criteria, manage as high risk).

Calculator variables: age, sex, smoking status, systolic BP, TC:HDL-C ratio, diabetes status, CVD medicines, postcode, and history of AF.

Risk categories (estimated 5-year CVD risk): low <5%, intermediate 5% to <10%, high ≥10%.

Reassessment: not generally needed once someone is high risk; for intermediate/low risk, reassess if a new risk factor emerges, existing risk factors worsen, or ~5-10 years have passed depending on how close the last estimate was to the high-risk threshold.

Reclassification factors (can shift an intermediate-risk estimate up or down; not part of the calculator itself):** ethnicity (e.g. South Asian and First Nations ancestry increase risk; East Asian ancestry decreases it), coronary artery calcium (CAC) score, Family history of premature CVD — defined as coronary heart disease or stroke in a first-degree female relative aged <65 or a first-degree male relative aged <55, eGFR and urine albumin-to-creatinine ratio (uACR), and Severe mental illness — a current or recent condition requiring specialist treatment (received or not) in the preceding 5 years.

Management once risk is known: Lifestyle: smoking cessation, nutrition, physical activity, healthy weight, limiting alcohol — for all risk categories. High risk: add both BP-lowering and lipid-modifying pharmacotherapy (not one or the other). Intermediate risk: consider pharmacotherapy, informed by reclassification factors and patient preference.

Other CVD risk factors (beyond the reclassification factors above): smoking, elevated blood pressure, dyslipidaemia, diabetes, age, sex, left ventricular hypertrophy, central obesity, poor nutrition, sedentary lifestyle, excessive alcohol intake, lower socioeconomic status, chronic kidney disease, familial hypercholesterolaemia, mental health disorders (e.g. depression), obstructive sleep apnoea, insomnia, shift work, family history of premature cardiovascular disease [NB2], cultural identity and ethnicity (eg Aboriginal and Torres Strait Islander, South Asian, Maori and Pacific Islander, Middle Eastern peoples), and drugs that worsen cardiovascular risk factors (eg drugs that increase blood pressure).

Young adults — a screening/awareness gap

A 2024 AJGP viewpoint highlights that young Australian adults have poor awareness of their own cardiovascular risk factors — 2017–18 ABS data found 96.6% of adults aged 18–34 with high blood pressure did not report being hypertensive (vs 56% of those ≥75). Young adults are less likely to have a regular GP or be screened, and tend to perceive themselves as low-risk regardless of actual risk factor status. Since the risk calculator above starts at age 45 (35 with diabetes, 30 for First Nations), younger patients rely on opportunistic screening and lifestyle risk factor discussion rather than formal calculator-based assessment — worth a lower threshold to check BP, lipids, and glucose opportunistically in this age group even without a formal risk score to act on yet.