Time to End Cardiovascular Complacency
Achievements in preventing loss of life from cardiovascular disease over the last 50 years are at risk of being lost.
- Huge gains maid in Cardiovascular health are now in jeopardy as the decline in the death rate from CVD has flattened over the last 5 years in the USA.
- We are living longer but Cardiovascular disease remains our biggest killer and most expensive disease.
- We are facing a tidal wave if ‘diabesity’
- Key Cardiovascular disease risk factors are not being successfully treated.
TRENDS: THE FUTURE AS A MIRROR TO THE PAST
Advances in medicine and public health have helped to control the epidemic of atherosclerotic disease (coronary heart disease and stroke), which peaked about 50 years ago. However, cardiovascular disease (CVD) remains the leading disease in Australia — accounting for 19% of the burden of disease.1
Moreover, failure to continue steps to control the causes of CVD could create a resurgence of the problem. There is evidence that this is exactly what is happening — recent overseas
data show that over the past five years, death rates from coronary heart disease and stroke have not reduced as much as before. The increasing prevalence of type 2 diabetes and obesity (known as ‘diabesity’) suggest that it is possible that some of the achievements of the past 50 years may be lost.
The huge gains made in cardiovascular health are now in jeopardy as the decline in the death rate from CVD has flattened over the past five years.
CONTROL OF RISK FACTORS FOR CARDIOVASCULAR DISEASE
The burden of CVD is strongly linked to well-established risk factors (high blood pressure, high cholesterol, high blood sugar levels, and smoking). Australians who are not being treated or who are not being treated properly for abnormal cholesterol, high blood pressure and type 2 diabetes are a growing concern. Changes are needed on how risks for CVD are managed in primary care — in many cases, this requires using existing therapies more effectively, and in other cases, novel therapies may help to increase the number of people who are treated successfully.
Atherosclerosis starts developing when a person is young, so prevention should begin early in life with a whole-of-population approach. Population-level interventions that should be considered include the control of dietary salt, energy intake and physical inactivity. In addition, changes to health policy, taxation, regulation and urban planning should also be part of a multifaceted approach to tackling CVD. Strategies for the primary prevention of CVD include interventions to modify risk factors such as smoking and improving diet, controlling cholesterol and high blood pressure through medication, and managing the combined effect of risk factors (absolute CVD risk) rather than treating individual risk factors. Technological advances mean that modern imaging can also play a role in helping to identify individuals at risk of CVD.
Too many Australians with risk factors for cardiovascular disease, such as high blood pressure or type 2 diabetes, remain untreated or not treated to recommended targets. Attention is especially needed to better control risk factors among vulnerable groups, particularly in the Aboriginal and Torres Strait Islander community.
THE NEW EPIDEMICS OF CARDIOVASCULAR DISEASE
The ageing Australian population adds a new dimension to the burden of CVD. In the past half century, the life expectancy of an Australian when they are born has increased by more than 10 years. The growing number of the old (>70 years) and very old (>85 years) are prone to four important and expensive types of CVD — heart failure, atrial fibrillation, stroke and aortic stenosis. The costs of being in hospital for these diseases are an important contributor to the overall cost of CVD. The contribution that atrial fibrillation and heart failure make to the overall burden of all disease in Australia now appears to be growing.
Advances in treatment — both drugs and procedures — will help to reduce hospital admissions of people diagnosed with CVD. However, with more old and very old Australians needing care, new challenges, such as evaluating and caring for people who are frail, have cognitive impairment or are sick with more than one disease, need to be considered. Additional research is needed to know how to best manage these conditions.
We are unprepared for either a resurgence of atherosclerotic vascular disease or an increase in CVD burden from the epidemics of old age. A national CVD Policy would provide a consistent approach across Australia. At the moment, prevention programs are available state-wide in some states of Australia, and only through some public hospital programs or Private Health Funds.
Atherosclerosis and heart attack in middle age are being taken over by the new epidemics of CVD including atrial fibrillation, which is projected to increase by 60% over the next 15 years, and heart failure, which is already a leading cause of hospitalisation in Australia.
THE FINANCIAL COST OF CARDIOVASCULAR DISEASE
Of all disease groups that contribute to Australia’s healthcare expenditure, CVD continues to be the most costly. The direct costs of illness, being absent from work, family stress and premature death lead to an enormous social and financial burden on our economy. CVD has a higher level of economic burden than any disease group in Australia. The ageing population and the ongoing epidemic of chronic cardiovascular conditions such as coronary heart disease, atrial fibrillation and heart failure, will lead to increases in allocated expenditure for hospital-admitted patient services over the coming decades. Controlling admission and readmission is an important way to control hospital expenditure.
CVD is already the most costly disease group in the country. Expenses for CVD are already increasing, and when combined with the new epidemics of old age, the strain on the hospital system will be immense. Not treating CVD successfully will cause hospital admissions to increase, and put a strain on the healthcare budget.
WHAT THIS MEANS FOR AUSTRALIA
With increasing life expectancy and an ageing population, more people will require hospital admission. Challenges will arise when integrating CVD care with frailty, cognitive impairment and the management of multiple diseases.
Growing rates of ‘diabesity’ and public complacency could undermine half a century of achievements for cardiovascular health. More investment in prevention and research is critical to better identify those at risk of CVD earlier and to enhance the diagnosis and management of people with CVD.
As CVD is already the most costly disease group in Australia, investment in the prevention of CVD is critical. This includes the provision of Medicare funding for well-established and effective assessments, such as 24-hour blood pressure monitoring. More research is also essential to better manage CVD, to investigate the role of aspirin in primary prevention, to improve the identification of people in the early phases of CVD, and to provide more effective prevention and management options for potentially deadly conditions such as rheumatic heart disease.
The purpose of this report is to summarise the current and future importance of CVD in the Australian community, and to serve as a call to action for policy-makers.
To read the full report CLICK HERE