| Version 1.0 2023

1. Different age groups for risk assessment

A broader range of people without known CVD aged 45 to 79 years are recommended to use the new Australian cardiovascular disease risk calculator.

Target age ranges for risk assessment have also been tailored according to diabetes and First Nations status (for people without known CVD):

• people with diabetes should have their CVD risk assessed using the Australian cardiovascular disease risk calculator from age 35-79 years.
• First Nations people should have their CVD risk assessed using the Australian cardiovascular disease risk calculator from age 30-79 years.
• First Nations people aged 18-29 years should have their individual risk factors assessed.

2. New Australian cardiovascular disease risk calculator

The new Australian cardiovascular disease risk calculator (Aus CVD Risk Calculator) is based on the PREDICT-1° equation which was developed from a large New Zealand population cohort study. The calculator has been recalibrated and modified for the Australian population and health setting. 

The Aus CVD Risk Calculator includes optional risk factors not included in the previous Framingham-based equation, including geographical area (using residential postcodes as markers of area-level deprivation) and a diagnosis of atrial fibrillation. 

The Aus CVD Risk Calculator allows for improved CVD risk estimation in people with type 2 diabetes, factoring in glycated haemoglobin (HbA1c), time since diagnosis of diabetes (measured in years), urinary albumin-to-creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), body mass index (BMI) and the use of insulin in the previous 6 months. 

The Aus CVD Risk Calculator can be used for people being treated with blood pressure-lowering, lipid-modifying and/or antithrombotic pharmacotherapy, as it includes a variable that accounts for treatment.

3. Redefined risk categories

Risk estimates represent the chance of having a cardiovascular event in the next 5 years. New risk categories have been defined according to the new Aus CVD Risk Calculator which provides a more accurate risk prediction than the previous calculator.

The new categories are not directly interchangeable with previous 2012 Guidelines for the management of absolute cardiovascular disease risk equation categories. This difference has resulted in different risk percentile ranges for high, intermediate and low risk classifications.

The new CVD risk categories are:

• high (≥10% risk over 5 years)
• intermediate (5 to <10% risk over 5 years)
• low (<5% risk over 5 years).

A systematic review was undertaken to identify which categories would benefit most from pharmacotherapy. For evidence and rationale see CVD risk categories and Risk treatment thresholds.

4. Reclassification factors

New guidance has been provided on factors that may help clinicians refine and reclassify risk estimates when using the Aus CVD Risk Calculator; this is particularly relevant for people whose estimated risk is close to the threshold of another risk category.

Reclassification factors include ethnicity, eGFR and uACR measurements, severe mental illness, a coronary artery calcium score and family history of premature CVD.^b

5. Communicating risk

There is a new emphasis on communicating CVD risk effectively, with recommendations to use a relevant decision aid to support effective risk communication and informed decision making, and combine risk communication tools with behavioural strategies to reduce CVD risk.

6. Considerations for First Nations people

Specific recommendations, resources and practice points for First Nations people have been embedded throughout the guideline.

7. Pregnancy complications

New information is provided about the association between CVD risk and pregnancy complications such as hypertensive disorders of pregnancy (including pre-eclampsia) and gestational diabetes.

8. New terminology

The term ‘risk estimate’ is preferred over ‘absolute risk’ in this guideline as the output of the new Australian cardiovascular disease risk calculator is an estimate of the overall individual risk of a person that considers multiple CVD risk factors specific to that person.

1. Severe mental illness: current or recent mental health condition requiring specialist treatment, whether received or not, in the 5 years prior to the CVD risk assessment. Derived from PREDICT cohort.⁵⁰
2. Family history of premature CVD: coronary heart disease or stroke in a first-degree female relative aged <65 years or a first-degree male relative aged <55 years.