Cardiovascular disease remains Australia's leading cause of death. Here's what the evidence says about prevention, testing, and emerging therapies.
Cardiovascular disease, which includes heart attacks and strokes, is still the leading cause of death in Australia. It accounts for about one in four deaths, according to the Australian Institute of Health and Welfare. That is more than any other single cause, including cancer. The good news is that much of this burden is preventable, and the evidence for what works is strong. The challenge is that most of it happens quietly, over decades, without symptoms. This article explains what the evidence says about prevention, what testing can tell you, and where new therapies fit.
The Scale of the Problem
Heart disease is not a niche concern. In 2021, it was the underlying cause of death for over 40,000 Australians. That is roughly the population of a small town, every year. Stroke adds another 8,000 or so. These are not abstract numbers; they are parents, partners, and friends.
What is often missed is that heart disease is not a sudden event. It is a process. Atherosclerosis, the buildup of plaque in artery walls, starts decades before any symptom appears. By the time someone has a heart attack, the disease has usually been progressing for years. This is why prevention matters, and why early detection is so valuable.
What the Evidence Says Works
The evidence for preventing cardiovascular disease is remarkably consistent. It comes down to a few core areas: blood pressure, cholesterol, smoking, blood sugar, and physical activity. These are not glamorous, but they are proven.
Blood pressure: High blood pressure is one of the strongest predictors of heart attack and stroke. Lowering it, even by a modest amount, reduces risk significantly. The evidence is clear that controlling blood pressure saves lives.
Cholesterol: Elevated LDL cholesterol is a major driver of atherosclerosis. Statins, which lower LDL, have been shown in large trials to reduce heart attacks and strokes. Lifestyle changes, such as diet and exercise, also help.
Smoking: Quitting smoking is one of the single most effective things a person can do. The risk of heart disease drops quickly after quitting.
Blood sugar: Diabetes is a strong risk factor. Managing blood sugar, through lifestyle and medication, reduces complications.
Physical activity: Regular exercise, even brisk walking, lowers cardiovascular risk. The evidence is robust.
These are the foundations. They are not new, but they are often underused. The challenge is execution, not knowledge.
The New Frontier: GLP-1–Based Cardiometabolic Medicine
GLP-1–based medicines have rapidly evolved from glucose-lowering therapies for type 2 diabetes into an important new category in obesity and cardiometabolic care. These treatments can improve glycaemic control, support clinically meaningful weight loss, and—among appropriately selected patients—help reduce the risk of serious cardiovascular events.
A significant recent development is the FDA’s expanded indication for Mounjaro (tirzepatide), a dual GIP/GLP-1 receptor agonist. It is now approved to reduce the risk of major adverse cardiovascular events—including cardiovascular death, non-fatal heart attack, and non-fatal stroke—in adults with type 2 diabetes who are at high cardiovascular risk. This reflects an increasingly important shift: treatment decisions are no longer focused solely on blood glucose or body weight, but on a patient’s broader cardiometabolic risk profile.
Cardiovascular outcome evidence has also been strengthened by landmark trials of related incretin therapies. In the SELECT trial, semaglutide reduced major adverse cardiovascular events by 20% compared with placebo in adults with overweight or obesity and established cardiovascular disease, without diabetes. This outcome represents a meaningful advance: intentional pharmacological weight management can be paired with demonstrated cardiovascular-risk reduction in a carefully defined patient population.
These therapies are prescription medicines, not universal wellness treatments. Benefits must be weighed against potential adverse effects, contraindications, treatment burden, cost, and the individual’s overall cardiovascular and metabolic risk. Their use should form part of a medically supervised plan that also addresses nutrition, physical activity, sleep, blood pressure, lipids, smoking status, and other evidence-based cardiovascular risk factors.
Testing: What Can You Do?
If you are concerned about your heart health, there are tests that can provide useful information. These are not for everyone, but they can be valuable for people with risk factors or a family history of heart disease.
Advanced blood work: Beyond the standard lipid panel, tests like ApoB and Lp(a) give a more detailed picture of cholesterol-related risk. ApoB is a measure of the number of atherogenic particles, and Lp(a) is a genetic risk factor that is not often measured.
Coronary calcium score: This is a CT scan that detects calcium in the coronary arteries. It is a direct measure of plaque burden and is a strong predictor of future events. It is particularly useful for people at intermediate risk.
Angiogram: This is an invasive test that directly visualizes the coronary arteries. It is typically reserved for people with symptoms or known disease, not for screening.
These tests are not for everyone. They are tools to be used selectively, based on risk. The decision to do any of them should be made with your doctor.
What This Means for You
Here is the takeaway. Heart disease is common, but it is not inevitable. The evidence is clear that lifestyle changes and, when appropriate, medications can dramatically reduce risk. The key is to know your numbers, understand your risk, and act on it.
If you are over 40, have a family history of heart disease, or have risk factors like high blood pressure or diabetes, it is worth having a conversation with your doctor. That conversation might include a risk assessment, some testing, and a plan. It is not about fear; it is about agency.
A Note on Emerging Therapies
There is a lot of excitement about new therapies, including GLP-1 receptor agonists and other emerging therapies (clinical governance required). These are promising, but they are not magic. They work best when combined with the basics: diet, exercise, sleep, and stress management. And they are not for everyone. Whether they are right for you is a decision to make with your doctor.
Frequently Asked Questions
What is the best test for heart disease risk?
There is no single best test. A combination of blood pressure, cholesterol, and blood sugar is a good start. For some people, a coronary calcium score adds useful information. Your doctor can help decide what is appropriate.
Can heart disease be reversed?
Atherosclerosis can be slowed or stabilised, and in some cases, plaque can regress with aggressive risk factor control. But the term "reversal" is misleading. The goal is to prevent events, not to erase the disease.
Are these new medications safe?
GLP-1 receptor agonists have been studied extensively. They are generally safe, but they have side effects, including gastrointestinal issues. They are not suitable for everyone. A doctor can assess the risks and benefits.
Should I get a coronary calcium score?
It depends on your risk profile. It is most useful for people at intermediate risk, where the result might change treatment decisions. It is not recommended for everyone.
The Bottom Line
Cardiovascular disease is the leading cause of death in Australia, but it is largely preventable. The evidence is strong for lifestyle changes and, when needed, medications. New therapies, like GLP-1 receptor agonists, offer additional options for high risk patients. The first step is to know your risk. That starts with a conversation with your doctor.
General information, not individual medical advice. Speak to your own doctor.
