Risk treatment thresholds for initiating cardiovascular disease pharmacotherapy: Synthesis of international evidence to support guideline recommendations

Background A new Australian guideline for cardiovascular disease (CVD) risk assessment and management was published in 2023, including new risk treatment thresholds. Objective This article summarises the published peer-reviewed global evidence that informed guideline recommendations on risk treatment thresholds for initiating blood pressure- and lipid-lowering therapy for CVD primary prevention. Discussion Evidence from 13 meta-analyses, randomised controlled trials and modelling studies involving more than 515, 700 patients showed that preventive pharmacotherapy reduced the number of CVD events at all risk levels. Findings informed the new risk treatment thresholds outlined in the 2023 Australian CVD risk assessment and management guideline, which recommends blood pressure- and lipid-lowering pharmacotherapy for people at high five-year risk (≥10% based on the new risk calculator) and consideration of therapy for those at intermediate risk (5% to <10%) and generally does not recommend preventive pharmacotherapy for those at low risk (<5%).