Risk Summaries

High Risk

Greater than 15% risk of CVD within the next five years (includes clinically determined high risk) (PP)
Moderate Risk

10-15% risk of CVD within the next five years (PP)
Low Risk

Less than 10% risk of CVD within the next five years (PP)

Provide frequent and sustained lifestyle advice, support and follow-up (CBR)

Diet

Physical Activity

Commence BP + lipid lowering therapy unless contraindicted or clinically inappropriate (EBR: Grade B)

BP Lowering Therapy

Lipid Lowering Therapy

Monitor individual risk factor response to treatment (PP)

Review absolute risk according to clinical context (PP)

*EBR: Evidence-based recommendation (Graded A-D)
*CBR: Consensus-based recommendation
*PP: Practice point.

Go to Risk Calculator

High risk management summary table

Use the table below to develop a management plan for your patients.

CVD risk	Lifestyle	Pharmacotherapy	Targets	Monitoring
High risk Clinically determined or calculated using FRE as > 15% absolute risk of CVD events over 5 years.	Frequent and sustained specific advice and support regarding diet and physical activity. Appropriate advice, support and pharmacotherapy for smoking cessation. Advice given simultaneously with BP and lipid lowering drug treatment.	Treat simultaneously with lipid lowering and BP lowering unless contraindicated or clinially inappropriate. Aspirin not routinely recommended. Consider withdrawal of therapy for people who make profound lifestyle changes.	BP: < 140/90 mmHg in general or people with CKD; < 130/80 mmHg in all people with diabetes; < 130/80 mmHg if micro or macro albuminuria (UACR > 2.5 mg/mmol in men and > 3.6 mg/mmol in women).	Review response 6-12 weekly until sufficient improvement or maximum tolerated dose achieved. Adjust medication as required. Review of absolute risk according to clinical context.

CVD risk

Lifestyle

Pharmacotherapy

Targets

Monitoring

High risk

Clinically determined or calculated using FRE as > 15% absolute risk of CVD events over 5 years.

Frequent and sustained specific advice and support regarding diet and physical activity.

Appropriate advice, support and pharmacotherapy for smoking cessation.

Advice given simultaneously with BP and lipid lowering drug treatment.

Treat simultaneously with lipid lowering and BP lowering unless contraindicated or clinially inappropriate.

Aspirin not routinely recommended.

Consider withdrawal of therapy for people who make profound lifestyle changes.

BP:

< 140/90 mmHg in general or people with CKD;

< 130/80 mmHg in all people with diabetes;

< 130/80 mmHg if micro or macro albuminuria (UACR > 2.5 mg/mmol in men and > 3.6 mg/mmol in women).

Review response 6-12 weekly until sufficient improvement or maximum tolerated dose achieved.

Adjust medication as required.

Review of absolute risk according to clinical context.

Provide lifestyle advice and support (CBR)

Diet

Physical Activity

Is one of the following present?

BP persistently ≥ 160/100 mmHG
Family history of premature CVD
South Asian, Middle Eastern, Maori or Pacific Islander peoples

Yes

Calculate risk level using FRE (EBR Grade B)

Identify all other risk factors

Continue with lifestyle intervention (CBR) (Diet) Physical Activity Treat BP and/or Treat Lipids

Monitor response (PP)

No

Monitor and review risk at 3-6 months (CBR)

Has risk improved?

Yes

Continue with lifestyle intervention (CBR) (Diet) Physical Activity

No

Consider treating for BP, or Lipid Lowering

Monitor response (PP)

Review absolute risk in 6-12 months (PP)

*EBR: Evidence-based recommendation (Graded A-D)
*CBR: Consensus-based recommendation
*PP: Practice point.

Go to Risk Calculator

Moderate risk management summary table

Use the table below to develop a management plan for your patients.

CVD risk	Lifestyle	Pharmacotherapy	Targets	Monitoring
Moderate risk Calculated using FRE as 10-15% absolute risk of CVD events over 5 years.	Appropriate, specific advice and support regarding: Diet ⁽¹⁾ Diet ⁽²⁾ Physical activity Appropriate advice, support and pharmacotherapy for: Smoking cessation Lifestyle advice given in preference to drug therapy.	Not routinely recommended. Consider: BP lowering and/or lipid lowering in addition to lifestyle advice if 3-6 months of lifestyle intervention does not reduce risk or: BP persistently > 160/100 mmHg Family history of premature CVD Specific population where the FRE underestimates risk e.g. ASTSI peoples, South Asian, Maori and Pacific islander, Middle Eastern. Consider withdrawal of therapy for people who make profound lifestyle changes.	Lipids: TC < 4.0 mmol/L; HDL-C ≥ 1.0 mmol/L; LDL-C < 2.0 mmol/L; Non HDL-C < 2.5 mmol/L; TG < 2.0 mmol/L. Lifestyle: Smoking cessation (if smoker); Consumes diet rich in vegetables and fruit, low in salt and saturated and trans fats; At least 30 mins of physical activity on most or preferably every day of the week; Limit alcohol intake.	Review response 6-12 weekly until sufficient improvement or maximum tolerated dose achieved. Adjust medication as required. Review absolute risk every 6-12 months.

CVD risk

Lifestyle

Pharmacotherapy

Targets

Monitoring

Moderate risk

Calculated using FRE as 10-15% absolute risk of CVD events over 5 years.

Appropriate, specific advice and support regarding:

Diet ⁽¹⁾ Diet ⁽²⁾ Physical activity

Appropriate advice, support and pharmacotherapy for:

Smoking cessation

Lifestyle advice given in preference to drug therapy.

Not routinely recommended.

Consider:

BP lowering and/or lipid lowering

in addition to lifestyle advice if 3-6 months of lifestyle intervention does not reduce risk or:

BP persistently > 160/100 mmHg
Family history of premature CVD
Specific population where the FRE underestimates risk e.g. ASTSI peoples, South Asian, Maori and Pacific islander, Middle Eastern.

Consider withdrawal of therapy for people who make profound lifestyle changes.

Lipids:

TC < 4.0 mmol/L;
HDL-C ≥ 1.0 mmol/L;
LDL-C < 2.0 mmol/L;
Non HDL-C < 2.5 mmol/L;
TG < 2.0 mmol/L.

Lifestyle:

Smoking cessation (if smoker);
Consumes diet rich in vegetables and fruit, low in salt and saturated and trans fats;
At least 30 mins of physical activity on most or preferably every day of the week;
Limit alcohol intake.

Review response 6-12 weekly until sufficient improvement or maximum tolerated dose achieved.

Adjust medication as required.

Review absolute risk every 6-12 months.

Provide lifestyle advice and support (CBR)

Diet

Physical Activity

Is BP persistently ≥ 160/100mmHg?

Yes

Treat BP (CBR)

Continue with lifestyle advice (CBR) (Diet) Physical Activity

Monitor response (PP)

No

Review absolute risk in 6-12 months (PP)

*EBR: Evidence-based recommendation (Graded A-D)
*CBR: Consensus-based recommendation
*PP: Practice point.

Go to Risk Calculator

Low risk management summary table

Use the table below to develop a management plan for your patients.

CVD risk	Lifestyle	Pharmacotherapy	Targets	Monitoring
Low risk Calculated using FRE as < 10% absolute risk of CVD events over 5 years.	Brief, general lifestyle advice regarding diet and physical activity. Appropriate advice, support and pharmacotherapy for smoking cessation.	Not routinely recommended. Consider BP lowering therapy in addition to specific lifestyle advice if BP persistently ≥ 160/100 mmHg. Consider withdrawal of therapy for people who make profound lifestyle changes.	Lipids: TC < 4.0 mmol/L; HDL-C ≥ 1.0 mmol/L; LDL-C < 2.0 mmol/L; Non HDL-C < 2.5 mmol/L; TG < 2.0 mmol/L. Lifestyle: Smoking cessation (if smoker); Consumes diet rich in vegetables and fruit, low in salt and saturated and trans fats; At least 30 mins of physical activity on most or preferably every day of the week; Limit alcohol intake.	Review response 6-12 weekly until sufficient improvement or maximum tolerated dose achieved. Adjust medication as required. Review of absolute risk every 2 years. Blood rest results within 5 years can be used.

CVD risk

Lifestyle

Pharmacotherapy

Targets

Monitoring

Low risk

Calculated using FRE as < 10% absolute risk of CVD events over 5 years.

Brief, general lifestyle advice regarding diet and physical activity.

Appropriate advice, support and pharmacotherapy for smoking cessation.

Not routinely recommended.

Consider BP lowering therapy in addition to specific lifestyle advice if BP persistently ≥ 160/100 mmHg.

Consider withdrawal of therapy for people who make profound lifestyle changes.

Lipids:

TC < 4.0 mmol/L;
HDL-C ≥ 1.0 mmol/L;
LDL-C < 2.0 mmol/L;
Non HDL-C < 2.5 mmol/L;
TG < 2.0 mmol/L.

Lifestyle:

Smoking cessation (if smoker);
Consumes diet rich in vegetables and fruit, low in salt and saturated and trans fats;
At least 30 mins of physical activity on most or preferably every day of the week;
Limit alcohol intake.

Review response 6-12 weekly until sufficient improvement or maximum tolerated dose achieved.

Adjust medication as required.

Review of absolute risk every 2 years.

Blood rest results within 5 years can be used.

Risk Summaries

High Risk

Moderate Risk

Low Risk

Provide frequent and sustained lifestyle advice, support and follow-up (CBR)

Commence BP + lipid lowering therapy unless contraindicted or clinically inappropriate (EBR: Grade B)

Monitor individual risk factor response to treatment (PP)

Review absolute risk according to clinical context (PP)

High risk management summary table

CVD risk

Lifestyle

Pharmacotherapy

Targets

Monitoring

High risk

Provide lifestyle advice and support (CBR)

Is one of the following present?

Yes

Calculate risk level using FRE (EBR Grade B)

No

Has risk improved?

Yes

No

Review absolute risk in 6-12 months (PP)

Here's the Management Table

Moderate risk management summary table

CVD risk

Lifestyle

Pharmacotherapy

Targets

Monitoring

Moderate risk

Provide lifestyle advice and support (CBR)

Is BP persistently ≥ ​​​​​​​ 160/100mmHg?

Yes

No

Review absolute risk in 6-12 months (PP)

Low risk management summary table

CVD risk

Lifestyle

Pharmacotherapy

Targets

Monitoring

Low risk

Is BP persistently ≥ 160/100mmHg?