How do the Australian guidelines for lipid-lowering drugs perform in practice? Cardiovascular disease risk in the AusDiab Study, 1999-2000.
OBJECTIVE
To determine how well the current Pharmaceutical Benefits Scheme (PBS) eligibility criteria for subsidy of lipid-lowering drugs compare with current national guidelines for determining the population at high risk of developing cardiovascular disease (CVD).


METHODS
Analyses of the population-based, cross-sectional Australian Diabetes, Obesity and Lifestyle (AusDiab) study, conducted in 1999-2000. The 1991 Framingham risk prediction equation was used to compute 5-year risk of developing first-time CVD in 8286 participants aged 30-74 years with neither CVD nor diabetes. Based on the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand guidelines, people with either 5-year CVD risk > or = 15% or with 5-year CVD risk of 10%-< 15% and the metabolic syndrome were defined as having estimated high absolute CVD risk.


METHODS
5-year CVD risk; estimated population with high CVD risk.


RESULTS
Among participants without prevalent CVD or diabetes, 7.9% of men and 1.5% of women had a 5-year CVD risk > or = 15%. Of the estimated residential Australian population in 2000 aged 30-74 years without CVD or diabetes, 717 000 people were considered to be at high absolute CVD risk. Among the high-risk AusDiab participants without CVD or diabetes, only 16.9% of men and 15.4% of women were being treated with lipid-lowering drugs. Of the 9.6% of participants free of CVD and diabetes who were untreated but eligible for subsidy under PBS criteria, only 27.4% had an estimated high absolute CVD risk.


CONCLUSIONS
Strategies for CVD prevention using lipid-lowering medications can be improved by adoption of the absolute-risk approach.
Chen
Lei
L
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Rogers
Sophie L
SL
Colagiuri
Stephen
S
Cadilhac
Dominique A
DA
Mathew
Timothy H
TH
Boyden
Andrew N
AN
Peeters
Anna
A
Magliano
Dianna J
DJ
Shaw
Jonathan E
JE
Zimmet
Paul Z
PZ
Tonkin
Andrew M
AM
D000328:Adult; D000368:Aged; D001315:Australia; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment
D000960:Hypolipidemic Agents