Heart Attack Prevention: Who Should Consider Medicines?

What did Australia's cardiovascular risk study find?

Published in September in the Medical Journal of Australia, the observational study examined primary care records for adults aged 45–74 without established cardiovascular disease. Researchers compared Australia's updated assessment with its predecessor. The intermediate-risk share increased from 11.6% to 26.4%, while the high-risk share fell from 17.6% to 9.7%. [Published study](https://onlinelibrary.wiley.com/doi/10.5694/mja2.70280).

These shifts describe changes in estimated risk and classification. The study did not test whether prescribing additional medicines prevented events. It also did not apply the guideline's discretionary reclassification step, which allows clinicians to consider additional risk factors. Consequently, the findings support closer assessment rather than automatic prescribing. [Study methods and limitations](https://onlinelibrary.wiley.com/doi/10.5694/mja2.70280).

When should statins and blood pressure medicines be considered?

The Australian guideline defines intermediate risk as a predicted cardiovascular-event probability of 5% to less than 10% over five years; high calculated risk begins at 10%. Blood pressure-lowering and cholesterol-lowering medicines are recommended for high-risk patients unless contraindicated or clinically inappropriate. At intermediate risk, clinicians should discuss expected benefits, possible harms and patient preferences before deciding on treatment. Statins are an appropriate first choice for lowering cholesterol. [Australian treatment guidance](https://www.cvdcheck.org.au/managing-cvd-risk).

Assessment combines several influences rather than relying on one cholesterol reading. The updated calculator incorporates information including smoking, blood pressure, diabetes, atrial fibrillation and existing cardiovascular medicines. Clinicians may refine the resulting category using factors such as kidney function and a family history of premature cardiovascular disease. For someone near a treatment threshold, this fuller assessment can materially affect the recommendation. These thresholds belong to the Australian system; they should not be substituted directly into another country's calculator. [Australian guideline summary](https://www.mja.com.au/journal/2024/220/9/2023-australian-guideline-assessing-and-managing-cardiovascular-disease-risk).

How can patients balance preventive benefits and side effects?

The expected absolute benefit of preventive treatment generally increases as baseline cardiovascular risk rises. This helps explain why the same medicine may be strongly recommended for one person and optional for another. Smoking cessation, physical activity and healthy eating remain part of care at every risk level. For intermediate-risk patients who do not start preventive medicines, Australian guidance generally recommends reassessment after two years, or sooner if risk factors worsen or the estimate approaches the high-risk threshold. [Risk-based management recommendations](https://www.cvdcheck.org.au/managing-cvd-risk).

Follow-up helps identify problems that can often be addressed by adjusting treatment. New muscle pain during statin treatment warrants discussion with the prescriber; serious muscle damage is rare, and changing medicines may help. Blood pressure medicines have different adverse-effect profiles: some can cause dizziness, while ACE inhibitors can cause a dry cough or changes in potassium and kidney function. Patients should have a clear plan for reviewing symptoms, treatment response and any necessary tests. [NHLBI cholesterol follow-up advice](https://www.nhlbi.nih.gov/health/blood-cholesterol/living-with), [Healthdirect blood pressure medicine guidance](https://www.healthdirect.gov.au/medicines/blood-pressure-medicines).