Diseases affecting the heart or blood vessels (cardiovascular disease) have a big impact on our population. 

More than 4 million Australian adults report living with cardiovascular disease (CVD). In addition, over half a million people go to hospital each year because of a heart or blood vessel problem. 

One quarter of all deaths (26%)  in Australia in 2015 are due to cardiovascular disease.

The good news is that this can change

The most common types of cardiovascular disease affect the blood vessels of the heart (coronary heart disease), which leads to heart attack or angina, or the blood vessels of the brain, which can lead to stroke. 

These types of cardiovascular disease can often be prevented. 

Even if you have been diagnosed with a heart or blood vessel problem, there are treatments that can help lower your risk of having a heart attack or stroke in the future. 

A process called atherosclerosis (narrowing of the arteries) is the main cause of cardiovascular diseases such as angina, heart attacks and some strokes. 

There are many risk factors for atherosclerosis, and the more of these you have, then the greater the chance you may end up with cardiovascular disease.

Some factors can’t be changed, such as:

• age (many cardiovascular disease conditions become more common with older age)
  
• gender (men are at higher risk of some cardiovascular diseases than women during middle age. After menopause this changes and women are as likely as men to develop certain conditions)
  
• ethnicity (people from certain backgrounds are at greater risk of some cardiovascular diseases)
  
• family history (let your healthcare professional know if someone in your family has cardiovascular disease).
  

While you can’t do much about the above factors, there are  others that can be changed to help reduce your chances of developing heart and blood vessel problems. These include:

• Behavioural factors – the type of foods you eat, the level of activity you do, whether you smoke or drink large amounts of alcohol.
  
• Biological factors – having high blood pressure, high cholesterol levels, or diabetes, being overweight or obese.
  
• Psychological factors – experiencing depression, social isolation or lack of social support.
  

Signs of heart or blood vessel diseases are often not obvious until it is too late and a heart attack or stroke occurs. This is why it is important for people aged 45 years and over, or 35 years and over for Aboriginal and Torres Strait Islander people, to know their current risk of heart disease and stroke. Then they can take action to minimise their risk of future problems.

Health professionals can measure how likely you are to have a heart attack or stroke in the next 5 years. This measurement is called an absolute cardiovascular risk score. 

It can be calculated by your doctor or nurse using the following information:

• your age
  
• your gender
• the amount of total and LDL (‘bad’) cholesterol in your blood
• your blood pressure level
  
• your lifestyle (eg, do you smoke)
  
• other medical conditions you might have, such as diabetes.
  

Understanding how each of these individual factors can contribute to your overall risk is more accurate than making treatment decisions based on a single factor. 

An absolute cardiovascular risk score is your chance of having an event like a heart attack or stroke in the next 5 years. The lower your score, the less chance you have.

A risk score of less than 10% means you are at low risk of getting cardiovascular disease in the next 5 years. 

A risk score between 10% and 15% means you are at moderate risk. 

A risk score of above 15% means you are at high risk. About 1 in 7 people at high risk will get cardiovascular disease in the next 5 years.

Are you already at high risk?

Some people do not need a risk score because they are already at high risk. They might have already experienced a heart attack or stroke, or have particular medical conditions. If you are in this group your doctor will advise you on what to do to reduce your risk.

You may already be at high risk if you have:

• diabetes and are 60 years or older
  
• diabetes with microalbuminuria
  
• moderate or severe chronic kidney disease
  
• been diagnosed with familial hypercholesterolaemia
  
• high blood pressure (SBP ≥ 180 mmHg or DBP ≥ 110 mmHg)
  
• total cholesterol ≥ 7.5 mmol/L
  

I have my risk score - what happens now?

Whatever your risk score is now, you can take action to change it for the better. This can include making positive changes to your diet, activity levels and weight, as well as stopping smoking.

If you have a moderate or high risk score, your doctor may also prescribe medicines. Depending on your personal risk score, your doctor may prescribe medication to lower your cholesterol, or blood pressure, or both at the same time.

You will also need to have your risk score monitored. If you currently have a low risk score, ask your doctor to measure your risk again in two years. If you currently have a moderate risk score, ask your doctor to measure your risk twice a year.

You can help to lower your risk of heart disease and stroke by leading a healthy lifestyle, which includes:

• being smoke free (if you need advice or support to stop smoking visit www.quitnow.gov.au or call the Quitline 13 7848)
  
• being physically active for at least 30 minutes on most days of the week
  
• not adding salt to foods, and choosing 'no added salt', 'low salt' or 'salt reduced' foods where possible
  
• eating a variety of foods including plenty of vegetables, foods containing wholegrains, lean meats, oily fish, fruit, low fat dairy, vegetable/seed oils, nuts, seeds and legumes.
  

Set realistic goals

Setting goals will help you decide what you want to change and how you are going to get there. It can be tempting to make drastic changes to your lifestyle straight away. However, setting realistic goals and gradually making a series of small changes can make a bigger difference in the long term, because you're more likely to stick with them.

Remember, it's normal to have days when you slip up or when it all becomes too hard. Don't let these days stop you altogether. Just keep going with your changes the next day.

Learn more about making healthy lifestyle changes.

Keeping ‘bad’ cholesterol (or LDL cholesterol) at a low level in the blood is one of the best ways to reduce the risk of cardiovascular disease. 

Blood cholesterol levels can be lowered with diet and exercise, but many people at high risk also need a cholesterol-lowering medicine to help them reduce their risk of having a heart attack or stroke.

There are a number of different types of medicines available to help reduce your blood cholesterol levels. These include:

• statins
  
• ezetimibe
  
• PCSK9 inhibitors
• bile acid-binding resins
  
• nicotinic acid, and
  
• fibrates. 
  

For people with high levels of blood triglycerides (a type of fat), high doses of fish oils may be prescribed. 

All of these medicines reduce blood levels of cholesterol, but they do so in different ways.

Statin medicines are the most common type of cholesterol-lowering medicine prescribed in Australia. However, some people will need to take an additional medicine to help them reach their cholesterol targets, or may need to take a different medicine because they cannot tolerate a statin.

Learn more about statin medicines.

Use a calendar, alarm or other system to help you remember to take your medicine

For medicines to reduce your risk of heart attack or stroke they need to be taken every day and for the long term. Yet, like maintaining a healthy diet or exercising regularly, many people at risk of heart attack or stroke can find it challenging to stick with their prescribed cholesterol-lowering medicine.

In fact, about 1 in 4 Australians prescribed a cholesterol-lowering medicine stop taking it within the first year. One of the most common reasons people don’t take their medicines is because they forget. Make a note, tick off a calendar, or use a WebsterPak, dose set box or a plastic box with compartments to help you remember whether you’ve taken your medicine.

You can also use an app on your smartphone to remind yourself.

Learn how our MedicineWise smartphone app can help you stay on top of your medicines.

Tell your doctor if you think you are experiencing a side effect

All medicines can potentially cause side effects. Before you start a medicine, ask your doctor, nurse or pharmacist for information about possible side effects and how to manage them. 

It is also a good idea to read the Consumer Medicine Information (CMI) leaflet available for the medicine. Use our Medicine Finder to locate the CMI for your prescription medicines. 

Find out more about medicine side effects and interactions.

You can also call Medicines Line on 1300 MEDICINE for more information about medicines or side effects.

Statins are currently the most effective group of oral medicines available to reduce blood cholesterol levels. They work by reducing the amount of cholesterol being made by the liver.

As well as lowering cholesterol, statins reduce the risk of heart attack or stroke for people at high risk but with ‘normal’ cholesterol levels. Although there are a number of alternatives to statins, no other oral cholesterol-lowering medicines is as effective in reducing the risk of cardiovascular events.

For every 10,000 people treated for 5 years with an average dose of a statin medicine, there are around 1000 fewer cardiovascular events in people who have already had a heart attack or stroke (this is called secondary prevention), and 500 fewer events in people who haven’t had any events but are at high risk (this is called primary prevention).

Like all medicines, statins can cause side effects in some people. In general, these are mild and temporary. Muscle aches and pains are a commonly reported effect, although this does not mean statins are always the true cause. Many people not taking statins also experience non-specific muscle problems. Serious muscle problems are rare. 

People taking statins should report any muscle pain or weakness to their doctor to assess whether the medicine could be the cause.

Find out more about statins.

In Australia, guidelines recommend that people with high cardiovascular risk are first prescribed a statin medicine to help lower their risk. In some cases, however, a non-statin medicine may need to be prescribed, either in addition to the statin, to help lower cholesterol even further, or to replace a statin if side effects have become intolerable.

There are several types of non-statin medicines.

• Ezetimibe – this medicine stops the intestine from absorbing any cholesterol from the diet. It can be used alone or in combination with other cholesterol-lowering medicines. The most commonly reported side effects are headache and diarrhoea.
  
• Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors – these are a newer class of medicines that lower LDL cholesterol significantly. All other cholesterol-lowering medicines are taken orally, while PCSK9 inhibitors are injected under the skin. These medicines  commonly prescribed for people with a condition known as familial hypercholesterolaemia (a genetic condition that causes high cholesterol).
• Bile acid-binding resins – these medicines stop bile acids being reabsorbed from the intestine. Bile acids are made in the gallbladder using cholesterol. They help absorb fats from food in the intestine. Problems with the intestinal tract such as constipation, diarrhoea, nausea and vomiting are the most commonly reported side effects.
• Nicotinic acid – this medicine is also known as niacin, a B vitamin. However, at the doses needed for cholesterol-lowering, many find it has side effects they are unable to manage. The most commonly reported side effects are flushing (temporary warming and reddening) of the skin and upset stomach.
• Fibrates – these medicines reduce the amount of cholesterol produced by the body, but not as effectively as statins. Fibrates are prescribed to help reduce high levels of blood triglycerides. Stomach and intestinal upsets are the most commonly reported side effects.

Look for resources that may help you to reduce your risk. Start with these websites for lots of helpful information.

• www.heartfoundation.org.au
  
• www.diabetesaustralia.com.au
  
• kidney.org.au
  
• strokefoundation.com.au