High levels of preventable chronic disease, injury and mental health problems: cardiovascular disease (CVD) as a priority health issue, including the nature, extent and risk factors

Cardiovascular disease (CVD) is a collective term for diseases of the heart and blood vessels. It remains Australia's single leading cause of death and a top three contributor to disease burden, despite a decades-long decline in age-adjusted mortality. The HSC syllabus expects you to know the nature, extent, and risk factors of CVD, and to be able to apply the five priority criteria to explain why CVD is a National Health Priority Area.

The nature of CVD

The syllabus expects you to distinguish the three main forms.

Coronary heart disease is the narrowing or blockage of the coronary arteries that supply the heart muscle, usually from atherosclerosis (fatty plaque buildup). When a coronary artery is partially blocked, the patient may experience angina. When it is fully blocked, the heart muscle downstream dies (myocardial infarction, the heart attack). Coronary heart disease is the largest cause of cardiovascular death in Australia.

Stroke (cerebrovascular disease) is the death of brain tissue caused either by a blockage in a brain artery (ischaemic stroke, around 85% of cases) or a burst artery causing bleeding (haemorrhagic stroke, around 15%). Strokes kill quickly but also leave large numbers of survivors with long-term disability, so the morbidity burden of stroke is large.

Heart failure is a chronic condition in which the heart cannot pump effectively to meet the body's demands. It typically follows years of damage from coronary heart disease, hypertension, or other CVD. Heart failure is a leading driver of hospital admission for older Australians.

Other CVD conditions that get less HSC attention but exist in the syllabus include peripheral vascular disease, atrial fibrillation, and rheumatic heart disease (which disproportionately affects Aboriginal and Torres Strait Islander communities and is itself a priority area).

The extent of CVD in Australia

Three numbers to lock in:

1. Mortality. Ischaemic heart disease is the single leading cause of death in Australia (around 17,500 deaths per year, ABS Causes of Death). Cerebrovascular disease is also in the top five. Roughly 1 in 4 Australian deaths is from CVD.

2. Prevalence. Around 4 million Australians, or 1 in 6, live with one or more cardiovascular conditions (AIHW 2024). Prevalence rises sharply with age: more than 60% of Australians aged 75 and over have CVD.

3. Cost. CVD accounts for roughly 10% of total health system expenditure (around $14 billion in direct costs, AIHW Health Expenditure Australia) and roughly 10% of total disease burden (DALYs).

There is one important trend: age-adjusted CVD mortality has fallen sharply since the 1970s, driven by smoking decline, better acute treatment, and statin uptake. But the absolute number of Australians living with CVD is rising because the population is growing and ageing. So CVD is simultaneously a public health success story and an ongoing priority.

Risk factors

Risk factors are conventionally split into modifiable and non-modifiable.

Modifiable risk factors

• Smoking. Roughly halves age-standardised cardiovascular risk when stopped. Adult smoking has fallen from 25% in 1995 to around 10% in 2023 (AIHW), saving an estimated tens of thousands of lives.
• High blood pressure (hypertension). Roughly 1 in 3 Australian adults. Strongest single modifiable risk factor for stroke.
• High blood cholesterol (specifically high LDL). Roughly 1 in 3 Australian adults.
• Physical inactivity. Roughly half of Australian adults do not meet the 150 minutes moderate-intensity per week guideline.
• Overweight and obesity. Roughly 2 in 3 Australian adults are overweight or obese (ABS National Health Survey).
• Poor diet, in particular high saturated fat, high salt, low fruit and vegetable intake.
• Harmful alcohol use.
• Diabetes. A risk factor for CVD, though also a chronic disease in its own right.

Non-modifiable risk factors

• Age. CVD risk rises sharply from age 45 onwards.
• Sex. Men have higher CVD mortality before age 65; the gap narrows after menopause.
• Family history and genetics. Familial hypercholesterolaemia and other inherited conditions elevate risk.
• Aboriginal or Torres Strait Islander status. Indigenous Australians experience CVD at younger ages and higher rates, driven by interacting modifiable and social determinants.

Why CVD is a priority

Apply the five priority criteria from the previous dot point and CVD scores on all five:

• Social justice: Indigenous Australians, low SES Australians, and rural and remote Australians experience higher CVD rates and worse outcomes (equity violation).
• Priority groups: affects every named priority group disproportionately.
• Prevalence: 1 in 6 Australians.
• Prevention potential: at least 80% of premature CVD is preventable by addressing modifiable risk factors (WHO).
• Costs: 10% of health system expenditure plus enormous indirect costs through premature death and disability.

CVD therefore sits at the centre of the National Preventive Health Strategy and is a core target of programs like the Heart Foundation, the Stroke Foundation, and the NSW Get Healthy Service.