New report calls for action on CV testing and treatment

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A new report supported by Amgen has created what it describes as a 'simple roadmap' for action on the management of cholesterol.

The report has been developed by evohealth with advice from a group of leading cardiovascular (CVD) experts.

It aims to provide a simple but 'actionable roadmap' for the federal government to help prevent thousands of unnecessary and silent deaths among the over one million Australians considered ‘high risk’ by addressing ‘bad’ cholesterol.

People considered to be at high risk are those who have already had a CVD event, such as a heart attack or stroke, and are three to five times more likely to have another CVD event.

One-in-ten heart attack survivors experience another event within twelve months and nearly one-in-five people (18 per cent) who have experienced a stroke will have another within three months.

The new roadmap is underpinned by a recommendation for an ongoing cycle of annual lipid testing followed by treatment optimisation where needed - ‘test and treat’ - to ensure that all high-risk Australians know, and treat if appropriate, their ‘bad cholesterol’ level.

Other recommendations include standardising lipid profile reporting across Australia, updating the guidelines to reflect best practice for secondary prevention of CVD and enhancing the role of cardiac rehabilitation across the country.

Interventional Cardiologist and University of Sydney Professor, Gemma Figtree, believes the proposed five-point plan can be rolled out quickly across the country – especially in a COVID-19 pandemic environment.

“The proposed reforms are simple, can be actioned immediately, and amid the pandemic will ultimately ensure the current infrastructure, policies and practices work harder to deliver for vulnerable Australians at the highest risk of a second, third or fourth heart attack or stroke.”

The target is for Australians to reduce their bad cholesterol (LDL) to below <1.8 mmol/L. Yet 40 per cent of Australians have levels above this.

Lifestyle factors are considered important to controlling and limiting the risk of a CVD event. However, research demonstrates that for the high-risk population, lifestyle modifications result in only a 10-15 per cent reduction in bad cholesterol.

The experts say this highlights the importance of continuing to test and treat with lipid-lowering therapies.

PBS-listed treatment options include cholesterol-lowering statins or newer biologics. 

Amgen's biologic REPATHA (evolocumab) was originally listed in 2016 but its reimbursement was extended earlier this year to include patients with forms of familial and non-familial high cholesterol.

The new report says Australia needs to see a 28 per cent reduction in patients with a bad cholesterol level at target or below and a significant (70 per cent) reduction in those not on any treatment.

It says that, over a lifetime, it anticipates these reforms would result in almost 65,000 patients avoiding a non-fatal heart attack or stroke and approximately 20,000 fewer deaths.

“We know that bad cholesterol significantly contributes to the risk of a secondary cardiovascular disease event; every 1 mmol/L reduction in LDL-C reduces the risk of an event by 20%,” said Professor Figtree.

“What this report demonstrates is that we have a golden opportunity to address this issue, and do a far better job of lowering LDL-C levels to target through effective treatment adjustments combined with lifestyle changes and cardiac rehabilitation to ensure all high-risk Australians are reducing their risk of an event.”

Cardiac rehabilitation is a medically supervised program for patients who have had an acute event or undergone surgical intervention. However, participation in cardiac rehabilitation across Australia is poor with just one in three patients referred at discharge.

The report calls for action to address shortcomings in Australia's management of cardiac rehabilitation.

“Cardiac rehabilitation has been proven time and time again to be incredibly effective,” said Professor Robyn Gallagher from the Australian Cardiovascular Health and Rehabilitation Association.

“On average, by ensuring participation and enhancing that offering, we see a 65% improvement in medical adherence, 26% decrease in mortality for at-risk patients, and an 18% reduction in hospital readmissions alone.”