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 coronary heart disease and stroke, remains one of Australia’s leading causes of death and disability. In 2022, it was the underlying cause of around 45,000 deaths, representing almost one in four deaths nationally. Coronary heart disease remains the leading single cause of death in Australia.
The encouraging news is that a substantial proportion of cardiovascular disease is preventable, and the evidence for reducing risk is strong. The challenge is that cardiovascular disease often develops quietly over decades. Atherosclerosis, the gradual build up of fatty plaque within artery walls, can begin long before symptoms appear. By the time a person has a heart attack or stroke, the underlying disease process may have been progressing for years.
This does not mean people should be fearful. It means prevention, early risk assessment and sustained action matter.
The Scale of the Problem
Heart disease is not a niche concern. It affects individuals, families and communities across Australia.
Cardiovascular disease is a broad term that includes coronary heart disease, stroke, heart failure, atrial fibrillation and peripheral arterial disease. Coronary heart disease accounts for the largest share of cardiovascular deaths, while stroke is also a major contributor.
It is easy to think of a heart attack or stroke as a sudden event. Often, however, these events are the end result of years of accumulated risk. High blood pressure, elevated cholesterol, smoking, diabetes, inactivity and other factors can cause damage gradually, even when a person feels entirely well.
That is why prevention is so important. The goal is not simply to respond after disease becomes obvious. It is to understand risk early enough to change the trajectory.
What the Evidence Says Works
The evidence for cardiovascular prevention is remarkably consistent. It is less about finding one perfect supplement, test or health trend and more about addressing the major drivers of risk over time.
Blood Pressure
High blood pressure is one of the strongest risk factors for heart attack, stroke, heart failure and kidney disease. It is common, often has no symptoms and can cause harm over many years.
Identifying and managing high blood pressure is one of the most effective ways to reduce cardiovascular risk. Depending on the individual, this may involve improving diet, reducing salt intake, increasing physical activity, moderating alcohol, improving sleep, losing excess weight where appropriate and using prescribed treatment.
Cholesterol and Lipoproteins
Low density lipoprotein cholesterol, often called LDL cholesterol, plays a central role in atherosclerosis. It is not the only factor that matters, but it is a major modifiable driver of cardiovascular risk.
Diet, physical activity, weight management and smoking cessation can improve cholesterol related risk. In people at sufficient cardiovascular risk, lipid lowering medicines can reduce the likelihood of heart attack and stroke.
A standard lipid profile is a useful starting point. In selected people, additional tests may provide helpful information. ApoB reflects the number of atherogenic lipoprotein particles in the bloodstream, while lipoprotein(a), or Lp(a), is a largely inherited risk factor that can contribute to premature cardiovascular disease.
Smoking
Stopping smoking is one of the most powerful actions a person can take for their heart and blood vessels. Smoking accelerates atherosclerosis, increases clotting risk and damages blood vessels throughout the body.
The benefits of quitting begin sooner than many people realise. Cardiovascular risk falls after stopping and continues to improve over time.
Blood Sugar and Metabolic Health
Type 2 diabetes and insulin resistance are closely linked to cardiovascular risk. High blood glucose can damage blood vessels over time, while excess abdominal fat, high blood pressure, abnormal lipids and fatty liver disease often occur together.
Improving metabolic health may involve nutrition, physical activity, resistance training, better sleep, weight management where appropriate and prescribed treatment. The right approach differs from person to person, but the principle is consistent. Treating cardiometabolic risk early can help prevent later complications.
Physical Activity and Fitness
Regular physical activity reduces cardiovascular risk, improves blood pressure and insulin sensitivity, supports mental health and helps maintain strength and function with age.
You do not need to become an endurance athlete for movement to matter. Brisk walking, cycling, swimming, playing sport, using stairs and resistance training can all contribute. Consistency matters more than finding the perfect exercise plan.
For most people, a combination of aerobic activity and strength training is a sensible long term goal.
Where Newer Therapies Fit
GLP-1 based medicines have evolved from glucose lowering treatments for type 2 diabetes into an important area of obesity and cardiometabolic medicine. In appropriately selected patients, they can improve glycaemic control, support meaningful weight loss and, in defined higher risk populations, reduce serious cardiovascular events.
The SELECT trial was an important development in this field. It studied semaglutide in adults with overweight or obesity and established cardiovascular disease, but without diabetes. Participants receiving semaglutide experienced a 20% relative reduction in major adverse cardiovascular events compared with placebo. Major adverse cardiovascular events, often shortened to MACE, include cardiovascular death, nonfatal heart attack and nonfatal stroke.
Another important trial, called SURPASS CVOT, compared tirzepatide with dulaglutide in more than 13,000 people with type 2 diabetes and established atherosclerotic cardiovascular disease. Major adverse cardiovascular events occurred in 12.2% of those receiving tirzepatide and 13.1% of those receiving dulaglutide. Tirzepatide met the trial’s prespecified criterion for noninferiority, meaning its cardiovascular outcomes were at least comparable with dulaglutide within the trial’s statistical framework. It did not demonstrate statistically significant superiority over dulaglutide for reducing major adverse cardiovascular events.
These findings are important, but they need to be interpreted carefully.
These are prescription therapies, not universal wellness treatments or substitutes for the foundations of prevention. Their potential benefits must be balanced against adverse effects, contraindications, treatment burden, cost and a person’s broader health circumstances. They should be considered as part of a medically supervised plan that also addresses nutrition, physical activity, sleep, blood pressure, lipids, smoking and other established cardiovascular risk factors.
Regulatory approvals, funded access and prescribing indications vary between countries, including Australia.
Testing: What May Be Useful?
There is no single best test for heart disease risk. The most useful assessment combines your personal history, family history, blood pressure, cholesterol, blood sugar, smoking status, age and other risk factors.
For many people without known cardiovascular disease, a formal risk calculation is a sensible place to start. In Australia, cardiovascular risk assessment is generally recommended for adults from midlife onwards, and earlier for people with diabetes, First Nations people and others with important risk factors.
Blood Tests
A standard assessment may include cholesterol, blood glucose or HbA1c, kidney function and other tests depending on the person’s circumstances.
ApoB and Lp(a) may be helpful in selected people. Lp(a) is particularly worth discussing if there is a family history of premature heart disease, a personal history of cardiovascular disease at a younger age or uncertainty about an individual’s overall risk.
Coronary Artery Calcium Score
A coronary artery calcium score is a CT scan that measures calcified plaque in the coronary arteries. It may be useful when a person’s cardiovascular risk is uncertain and the result could alter decisions about prevention.
It is not a general screening test for everyone. It is generally not needed for people who are already known to have cardiovascular disease or who are already clearly at high risk, because preventive treatment may be appropriate regardless of the result.
CT Coronary Angiography and Invasive Angiography
CT coronary angiography and invasive coronary angiography are not routine screening tests for people without symptoms.
They may be considered when symptoms, clinical assessment or other findings raise concern about coronary artery disease. The decision should be made in consultation with an appropriately qualified clinician, based on the individual’s circumstances.
What This Means for You
Heart disease is common, but it is not inevitable.
The first step is not necessarily an advanced scan, an expensive panel of tests or a new medication. It is understanding your overall cardiovascular risk and focusing on the factors that are most likely to change your future health.
A useful conversation with your doctor may include your blood pressure, cholesterol and other relevant blood tests, blood sugar and diabetes risk, smoking status, physical activity and fitness, nutrition, alcohol and sleep, family history of premature cardiovascular disease, and whether additional tests would genuinely change management.
For many Australians, a cardiovascular risk assessment is particularly relevant from midlife onwards, or earlier where there is diabetes, a strong family history, elevated blood pressure, high cholesterol, smoking or other risk factors.
The purpose is not fear. It is agency. Small, sustained improvements in the things that matter most can add up to a meaningful reduction in long term cardiovascular risk.
Frequently Asked Questions
What Is the Best Test for Heart Disease Risk?
There is no single best test for everyone. A cardiovascular risk assessment usually begins with your medical history, blood pressure, cholesterol, blood sugar, smoking status and family history. For selected people, a coronary artery calcium score can provide additional information when the result would affect decisions about prevention.
Can Heart Disease Be Reversed?
The term reversal can be misleading. Atherosclerosis can often be slowed and stabilised with sustained risk factor management. In some circumstances, plaque may regress to some degree. The main goal is to prevent heart attacks, strokes and other cardiovascular events.
Are GLP-1 Based Medicines Safe?
These medicines have been studied extensively and can be appropriate for some people. They can also cause side effects, particularly gastrointestinal symptoms, and they are not suitable for everyone. Decisions about their use require an individual discussion about potential benefits, risks, alternatives and practical considerations.
Should I Get a Coronary Artery Calcium Score?
It depends on your individual risk profile. It can be useful when your risk is uncertain and the result may change prevention decisions. It is not recommended as a routine test for everyone and is not usually needed when cardiovascular disease or high cardiovascular risk is already established.
The Bottom Line
Cardiovascular disease remains a major cause of death and disability in Australia, but much of its burden can be reduced.
The evidence is clear on the fundamentals. Do not smoke, manage blood pressure and cholesterol, address diabetes and metabolic health, stay physically active, maintain strength, eat well and assess cardiovascular risk early enough to act.
Newer treatments may offer important options for carefully selected people. They do not replace the basics, but they are part of an increasingly sophisticated approach to cardiometabolic risk.
The most valuable first step is to understand your cardiovascular risk and focus on the factors most likely to improve your long term health.
General information, not individual medical advice. Speak to your own doctor.
