Pharmacists should be expected to advise on how medicines and lifestyle impact heart health, writes Louis Roller

Cardiovascular disease continues to have a major effect on the health of Australians in terms of prevalence, mortality, morbidity, burden of disease and expenditure and it  remains Australia’s major cause of death.

Despite improvements over the last few decades, it remains one of the biggest burdens on our economy.

Coronary heart disease, stroke, heart failure and peripheral vascular disease are the major contributors to the burden of CVD.

Cardiovascular disease:

  • Includes heart, stroke and blood vessel diseases.
  • Kills one Australian every 12 minutes.
  • Affects one in six Australians or around 4 million people.
  • Was the main cause more than 500,000 hospitalisations in 2014/15 and played an additional role in another 700,000 hospitalisations.
  • Claimed the lives of about 45,000 Australians (30% of all deaths) in 2015—deaths  that are largely preventable.
  • Lower socioeconomic groups, Aboriginal and Torres Strait Islander people and those living in remote areas had the highest rate of hospitalisation and death resulting from CVD in Australia.

Coronary heart disease or heart disease:

  • Affects around 1.5 million Australians.
  • Is the single leading cause of death in Australia.
  • Claimed the lives of about 20,000 Australians (13% of all deaths) in 2015.
  • Kills 54 Australians each day, or one Australian every 27 minutes.

Heart attack:

  • It is estimated over 350,000 Australians have had a heart attack at some time in their lives.
  • Each year, around 54,000 Australians suffer a heart attack. This equates to one heart attack every nine minutes.
  • Heart attack claimed nearly 9,000 lives in 2015, or on average, 24 each day.

The major preventable risk factors for CVD are tobacco smoking, high blood pressure, high blood cholesterol, insufficient physical activity, overweight/obesity, poor nutrition and diabetes. There is also some evidence that certain personality types when combined with anger is also a risk factor.

Additionally, loneliness has been shown to be a possible further risk factor.

The Australian Cardiovascular Risk Calculator provides absolute risk assessment based on gender, diabetes, smoking, blood pressure and cholesterol for risk of having a stroke or myocardial infarction in the next five years.

An interactive calculator can be downloaded for use by pharmacists when counselling patients. This is a powerful visual tool which can be shared with patients to show the effect on cardiovascular risk by modifying risk factors such as smoking, blood pressure, etc.

Pharmacists and lifestyle intervention advice to patients

Avoid smoking. Assess for nicotine dependence and offer counselling, support services and pharmacotherapy as appropriate.

Observe a well-balanced diet. Diet should be low in saturated fat and refined carbohydrates. Advise patients to limit salt intake by choosing foods normally processed without salt, foods labelled ‘no added salt’ or ‘low salt’ (or ‘reduced salt’ products when other options are unavailable).

Advise patients to eat a diet that includes predominantly plant-based foods (fruits, vegetables, pulses and a wide selection of wholegrain foods, moderate amounts of low-fat or reduced-fat dairy products), moderate amounts of lean unprocessed meats, poultry and fish, moderate amounts of polyunsaturated  monounsaturated fats (e.g. olive oil, canola oil, reduced-salt margarines).

Avoid sugar as much as possible. Recent evidence indicates carbohydrates and sugars can have significant effects on weight and health. Avoid sugary drinks.

Moderate alcohol:  Two alcohol–free days per week. Moderate drinking can increase blood pressure, while binge drinking appears to increase the risk of hypertension. The Heart Foundation recommends that patients with hypertension limit their alcohol intake to a maximum of two standard drinks per day and one standard drink per day respectively for men and women.

Regular physical activity:  At least 30 minutes of moderate intensity on at least five days a week

Maintain appropriate body weight. Advise patients with hypertension how to achieve and maintain a healthy body weight (BMI < 25 kg/m2). Waist circumference is more likely a better predictor of risk.  Measures of 102cm or more in males and 88cm or more in females indicates substantially increased risk.

Investigate for sleep apnoea. If the person reports excessive daytime sleepiness or the partner complains of snoring, refer on.

Medications that significantly delay the onset of clinical events such as heart attack and stroke include antiplatelet, lipid-lowering, antihypertensive agents and optimum diabetes management.

Pharmacists are expected to counsel patients on each medication and advise on lifestyle issues.

www.heartfoundation.org.au

Therapeutic Guidelines Cardiovascular version 6, 2012.

Australian Medicines Handbook 2017.

Associate Professor Louis Roller, from the Faculty of Pharmacy and Pharmaceutical Sciences Monash University, was the 2014 recipient of the PSA Lifetime Achievement Award.