New 'Code Red' report calls for action on heart risks

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The Baker Heart and Diabetes Institute has released an analysis of the first new Australian cholesterol data in general practice in nearly a decade.

The report highlights what it says is a "worrying picture" of high 'bad’ cholesterol (LDL) among those who have experienced a cardiovascular event and who are most at risk of another.

The report - Code Red: Overturning Australia’s cholesterol complacency - examined data over a ten-year period from 2010 of 107,000 Australians who have experienced a cardiovascular event. The report was supported by an unrestricted educational grant from Amgen.

“With this study, we were shocked to find that 48 per cent of Australians living with CVD [cardiovascular disease] are not reaching national guideline-recommended targets for LDL (‘bad’) cholesterol,” said Baker Institute director and report co-author, Professor Tom Marwick.

“This means that over the past decade, more than one in three Australians who have CVD are vulnerable to further cardiovascular events that could result in greater disability or death.

“These findings should reignite action, and make clear that greater understanding is needed of the issues facing Australia’s heart patients, along with more intensive management of cholesterol in high-risk patients. We can, and should, do more for these vulnerable Australians.”

CVD remains the leading cause of death in Australia. Too much cholesterol can clog arteries supplying blood to the heart and other parts of the body leading to heart attack or stroke. Yet every 1 mmol/L reduction in LDL cholesterol reduces the risk of a major vascular event by approximately 20 per cent after around five years of taking statin medication.

The Baker Institute’s head of Pre-Clinical Disease and Prevention and report lead author, Associate Professor Melinda Carrington, said the report also uncovered a disturbing gender imbalance that should be closely examined.

“In this study, not only did Australian women record higher levels of LDL or ‘bad’ cholesterol than men, but 56% were not meeting the optimal target of 1.8 mmol/L compared to just 42% of men,” said Professor Carrington.

The analysis also found that 58 per cent of Australians who had experienced a more recent CVD event within the last five years did not achieve target LDL cholesterol levels – suggesting this group is not being treated quickly or intensively enough.

Around 57,000 Australians suffer a heart attack each year and on average 20 die from a heart attack every day. One-in- ten heart attack survivors will have another heart attack within a year.

In 2017, there were more than 56,000 new and recurrent strokes in Australia – one stroke every nine minutes. Within three months, nearly one-in-five people who have experienced a stroke will have another stroke.

Professor Marwick said the report called for a dramatic shift in our complacency towards cholesterol management.

“The findings in CODE RED demonstrate a systematic and stepped care approach is needed to reform cholesterol management, in a way that unites the sector – from policy and political decision-makers, to the manufacturers, as well as the patient, clinical, and advocacy communities.

“Greater education for both GPs and patients about the importance of treating to target and intensifying treatment to achieve the target goals for secondary prevention of CVD is crucial,” he said.

“We also need a system redesign in hospitals to focus on secondary prevention, easier access to additional cholesterol medication for patients on statins, acceptance of risk stratification in secondary prevention to identify how best to target those at the highest risk, and wider access to a new class of medication (PCSK9 inhibitors).

"This requires a focus not just on primary care but the whole healthcare system. Action on cholesterol, particularly among Australians at high-risk of subsequent events, must be a key pillar of such reform.

“If we act now to better manage those who have already experienced at least one heart event, 3,738 lives could be saved and 13,740 heart attacks or strokes avoided over the next five years. At the same time, avoidance of further crises could save the nation up to $66.6 million.”