Preventive Cardiology
Written by Dr Tashi Zhaxiduojie FRACP PhD · Updated June 2025
The best time to treat heart disease is before it develops. Preventive cardiology identifies your personal risk profile, targets modifiable risk factors, and deploys evidence-based therapies to prevent heart attack, stroke and heart failure.
Overview
What is preventive cardiology?
Preventive cardiology focuses on identifying and reducing cardiovascular risk before a heart attack, stroke or heart failure occurs. It combines comprehensive risk assessment, optimisation of lifestyle and risk factors, and targeted medical therapies to prevent or delay the onset of cardiovascular disease (CVD).
CVD remains the leading cause of death in Australia, accounting for approximately 25% of all deaths. The majority of cardiovascular events are preventable with appropriate identification and treatment of modifiable risk factors.
Primary vs Secondary Prevention
Primary Prevention
Preventing a first cardiovascular event. Focus on identifying and modifying risk factors in asymptomatic individuals with elevated cardiovascular risk.
Secondary Prevention
Preventing further events after an established diagnosis (post-MI, post-stroke, heart failure). Involves intensive risk factor modification and cardioprotective medications.
Calculating Your Risk
Cardiovascular risk calculation
The Australian Absolute Cardiovascular Disease Risk (CVD) Calculator estimates 5-year risk of a fatal or non-fatal CVD event. Risk categories guide treatment intensity:
Low risk: <10%
Lifestyle advice. Consider medical therapy if risk factors persist.
Intermediate risk: 10–15%
Lifestyle + consider lipid-lowering and BP-lowering therapy.
High risk: >15%
Lifestyle + lipid-lowering + BP-lowering + antiplatelet therapy.
Risk-enhancing factors beyond the calculator
- Elevated Lipoprotein(a) ≥50 mg/dL
- Familial hypercholesterolaemia
- South Asian ethnicity
- Inflammatory conditions (RA, SLE, psoriasis)
- Preeclampsia or gestational hypertension history
- HIV
- Non-alcoholic steatohepatitis (NASH)
- ApoB ≥130 mg/dL or non-HDL-C ≥4.2 mmol/L
Modifiable Risk Factors
Elevated LDL-C
Primary atherogenic driver. Each 1 mmol/L reduction in LDL-C reduces major CV events by ~22%.
Elevated Lp(a)
Genetic, independent ASCVD risk factor. Present in ~20% of the population. Not lowered by statins or lifestyle.
Hypertension
Each 10 mmHg reduction in systolic BP reduces CV events by 20–25%.
Diabetes
2–4 fold increase in CV risk. SGLT2 inhibitors and GLP-1 agonists provide direct cardioprotection.
Smoking
Doubles CV risk. Even 1–2 cigarettes/day significantly increases risk. Cessation rapidly reduces risk.
Obesity
BMI >30 increases CV risk independently. Abdominal obesity (waist >102 cm men, >88 cm women) is particularly harmful.
Physical inactivity
Regular moderate aerobic exercise reduces CV mortality by ~35%.
Diet
Mediterranean diet associated with 30% reduction in major CV events (PREDIMED trial).
Investigations
- Fasting lipid profile (including Lp(a)): Essential baseline. Lp(a) should be measured at least once in all adults.
- Coronary artery calcium score (CAC): CT-based quantification of calcified plaque. A CAC of 0 confers very low event risk over 5–10 years. High CAC (>300) identifies those requiring aggressive preventive therapy.
- Echocardiogram: Assesses for subclinical LV dysfunction, hypertensive heart disease, or valve disease.
- CTCA: Can identify non-calcified (soft) plaque and stenoses in intermediate-risk patients.
- HbA1c and fasting glucose: Prediabetes and diabetes are both significant CV risk factors.
- Ankle-brachial index (ABI): Identifies peripheral arterial disease — confirms very high CV risk.
Evidence-Based Interventions
Lifestyle interventions
- Mediterranean or DASH diet
- 150 min/week moderate aerobic exercise + 2× resistance training
- Smoking cessation — most effective single intervention
- Alcohol reduction
- Weight management — even 5% weight loss improves CV risk profile
- Adequate sleep (7–8 hours/night)
Medical therapies
- Statins: Cornerstone of lipid-lowering. Proven benefit in both primary and secondary prevention.
- PCSK9 inhibitors: For high-risk patients not at LDL-C target on maximal oral therapy.
- Antihypertensives: ACE inhibitors/ARBs, CCBs, thiazide diuretics guided by risk profile.
- SGLT2 inhibitors: Direct cardiac and renal protection independent of glucose-lowering. Consider in diabetes, heart failure, CKD.
- GLP-1 receptor agonists: CV outcome benefit in type 2 diabetes and high-risk CVD patients.
- Low-dose aspirin: Only recommended for secondary prevention (established CVD). Not routinely recommended for primary prevention due to bleeding risk.
See a specialist cardiologist in Perth
HeartWise Cardiology — GP referral required.