What’s new in the 2009 New Zealand
Cardiovascular Guidelines Handbook?
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Full colour PDF of the pages as they appeared in ‘best practice’.
Printer friendly PDF.Powerpoint presentation of main points
Key reviewer: Dr Michael Crooke, Chemical Pathologist, Wellington Hospital and Aotea Pathology
The New Zealand Guidelines Group has recently released their updated Cardiovascular Guidelines Handbook.
Topics covered in the handbook include:
- Cardiovascular risk assessment and diabetes screening
- Cardiovascular risk factor management
- Smoking cessation
- Atrial fibrillation
- Coronary heart disease
- Stroke and transient ischaemic attack
- Rheumatic fever (new)
- Prevention of infective endocarditis (new)
- Heart failure
The following article details the changes to the handbook that may affect day-to-day practice.
Cardiovascular Risk charts
There are two main differences in the cardiovascular risk charts:
- Ages bands on the risk charts now state an age range (i.e. 55–64 years), instead of choosing the age closest to the patient (i.e. 60 years)
- Only systolic blood pressure is required for the calculation of risk
| In practice: Less ambiguity for both age and blood pressure making the charts easier to use |
Non-fasting blood tests may be used in some circumstances
Initial assessment using fasting blood tests remains recommended practice. When a fasting blood sample is not possible non fasting bloods may be used as follows:
- Cholesterol HDL ratio: fasting status has little effect on total and HDL cholesterol (Although fasting bloods are still required for management, as triglycerides are used to calculate LDL cholesterol)
- HbA1c: HbA1c can be used for initial screening for diabetes. Result ≥ 6% indicates the need for fasting plasma glucose
| In practice: Rather than lose an opportunity for CVD risk assessment, non fasting bloods may be used. |
Renal disease recognised as contributing to cardiovascular risk
eGFR has become well accepted as a means of assessing renal function, therefore the handbook recommends that both ACR (albumin : creatinine ratio) and eGFR have roles in assessing renal function, and in guiding further management of those with diabetes or renal disease.
People with an eGFR <60ml/min/1.73m2 should begin having CVD risk assessments at age 35 years for men and age 45 years for women.
| In practice: Start CVD risk assessment for people with an eGFR <60ml/min/1.73m2 at age 35 years for men and age 45 years for women |
Lipids targets lower
Optimal targets for lipids for people with CVD, diabetes or a calculated CVD risk greater than 15% are lower than in the previous handbook.
The target for:
- LDL cholesterol is now less than 2.0mmol/L (down from 2.5 mmol/L)
- Total cholesterol/HDL ratio is now less than 4.0 (down from <4.5)
- Total cholesterol remains at less than 4.0 mmol/L
| In practice: Be aware of new optimal targets for lipid lowering, more aggressive treatment may be required |
New blood pressure target people with chronic kidney disease
The handbook now recommends more aggressive management of blood pressure for people with chronic kidney disease, setting a target of less than 125/75 mmHg.
| In practice: Be aware of new optimal targets for blood pressure in people with chronic kidney disease, more aggressive treatment may be required. |
Change in the recommended frequency of CVD risk assessment
The new handbook recommends frequent CVD risk assessments for people with a CVD risk of between 10–15%. These people should have a CVD risk assessment every two years.
| In practice: Update your recalls for people with a CVD risk of 10–15% |
Metabolic syndrome no longer recognised as a separate risk factor
The definition of metabolic syndrome as an entity remains contentious, and there is no clear evidence of its importance as a risk factor, aside from the other recognised risk factors for CVD.
See BPJ 18 (December 2008) “Metabolic Syndrome: Useful or not?”
Universal BMI target
Separate BMI’s for Māori and Pacific peoples have been omitted; the handbook now includes one BMI table. A BMI of less than 25kg/m2 is considered desirable. This level may be lower for people of Asian descent.
Advice on diabetes management has been removed.
Advice on diabetes management has been removed pending a full revision of the Type 2 Diabetes Management Guideline due in 2010.
New Zealand Cardiovascular Guidelines Handbook 2009 Edition. Available from:
www.nzgg.org.nz (downloadable online version plus order form for hard copy). |
