Risky business – Managing residual CVD risk

In recent decades, the management of modifiable risk factors, such as dyslipidaemia, hypertension and hyperglycaemia has undergone significant advancement.
 
New and more aggressive pharmacotherapy regimes have driven treatment targets to levels not previously achievable and led to improvements in cardiovascular outcomes.
 
Yet cardiovascular disease (CVD) remains a leading cause of death in Australia.
 
Even when guideline-based preventive measures are implemented and target levels for modifiable risk factors are achieved, a significant risk of CVD events persists. This is known as residual CVD risk.
 
Several potential factors contribute to residual CVD risk.
 
Beyond traditional risk factors, drivers of residual risk include inflammatory, pro-thrombotic and metabolic pathways, which are frequently undetected and not directly addressed through current management strategies. 
 
A recent meta-analysis involving more than 31,000 people taking statins for dyslipidaemia found that residual inflammatory risk is more strongly associated with recurrent cardiovascular events and death than baseline LDL-C.
 
However, the potential benefits of anti-inflammatory agents on cardiovascular outcomes are still being tested in clinical trials and results so far have been underwhelming. An ongoing challenge is to identify an optimal inflammatory biomarker that accurately reflects the risk and response to treatment.
 
Routine anticoagulation may have a role in addressing residual thrombotic risk in secondary prevention as an adjunct to aspirin for patients at high risk of a recurrent CVD event.
 
Beyond LDL-C, there are other atherogenic lipoproteins that may contribute to residual CVD risk. Lipoprotein(a) levels are not significantly influenced by guideline-based management approaches, such as statin therapy, and are a strong risk factor for cardiovascular events irrespective of LDL cholesterol.
 
Novel risk prediction strategies, such as polygenic risk scores also have the potential to improve the accuracy of CVD risk prediction.
 
Utilisation of genomic information to anticipate lifelong trajectories of CVD risk may enable more targeted and timely prevention. Polygenic risk scores require further investigation, consensus and harmonisation before they can be widely used in practice.
 
Better understanding these drivers of residual risk will help target interventions that prevent recurrent CVD events and identify risk in people who are traditionally classified as low risk.
 
GPs wanting the latest evidence about managing residual CVD risk can register for the Heart Week 2023 clinical webinar. A panel of international and Australian experts will explore novel biomarkers, predictors and treatment for residual risk, supported by a case study to illustrate application in primary care.
 
During Heart Week (1–7 May), the Heart Foundation is encouraging GPs to prioritise prevention. Every 30 minutes, one Australian loses their life to heart disease. It takes 30 minutes or less to conduct a Heart Health Check.
 
Nearly 425,000 Heart Health Checks have been conducted as of 31 January 2023, bringing us close to our target of 450,000. These checks are projected to prevent 4670 heart attacks, strokes or deaths related to cardiovascular disease within the next five years.
 
This Heart Week, GPs can take three simple steps to keep more Australian hearts healthy:

1. Get your free resource pack
2. Use the Heart Health Check Toolkit to streamline CVD prevention
3. Register for the Heart Week webinar on residual CVD risk. Facilitated by Professor Garry Jennings, Heart Foundation Chief Medical Advisor, the expert panel includes:
   • Professor Sandosh Padmanabhan, Professor of Cardiovascular Genomics and Therapeutics, University of Glasgow
   • Associate Professor Peter Psaltis, co-Deputy Director at South Australian Health and Medical Research Institute
   • Professor Sophia Zoungas, Head of School of Public Health and Preventive Medicine, Monash University
   • Professor Jan Radford, Professor in General Practice and Director of the Launceston Clinical School, University of Tasmania.

cardiovascular disease heart Foundation Heart Week webinar