Earlier cardiovascular screening needed for Indigenous adults

ABORIGINAL and Torres Strait Islander adults should undergo cardiovascular disease (CVD) risk factor screening from the age of 18 years at the latest, according to the authors of a consensus statement published by the MJA. The authors also recommended that Indigenous people from the age of 30 years at the latest should be assessed for diabetes, renal disease and other cardiovascular risk factors, with use of an Australian cardiovascular risk factor algorithm, as part of an annual health check “or opportunistically”. Indigenous individuals with type 2 diabetes with microalbuminuria, moderate to severe chronic kidney disease, systolic blood pressure of 180 mmHg or greater or diastolic pressure of 110 mmHg or greater, familial hypercholesterolaemia, or total cholesterol greater than 7.5 mmol/L are automatically considered to be at high absolute risk of a future CVD event. The authors explained that since the development of the three commonly used guidelines that inform Aboriginal and Torres Strait Islander absolute CVD risk assessment and management, “evidence has … emerged to support lowering the age at which to commence CVD risk assessment in Aboriginal and Torres Strait Islander adults” and that therefore there was “a demonstrable need for agreement on a consistent age to begin CVD risk assessment in the Aboriginal and Torres Strait Islander population”. “Although age-standardised CVD mortality has fallen by 40% over the past few decades, CVD still accounts for a quarter of Aboriginal and Torres Strait Islander deaths overall and 21% of all premature years of life lost. CVD events and CVD-related mortality in the Aboriginal and Torres Strait Islander population occur, on average, about 10–20 years earlier than in non-Indigenous Australians. Taken together, these findings indicate the need to assess and manage risk at an earlier age in Aboriginal and Torres Strait Islander adults. According to the current risk assessment algorithm, Aboriginal and Torres Strait Islander adults aged 25–34 years have an absolute CVD risk similar to non-Indigenous Australians aged 45–54 years. It also highlights that over three-quarters of this population have at least one vascular risk factor that would prompt screening for all relevant CVD risk factors before the age of 30 years under existing [National Aboriginal Community Controlled Health Organisation/Royal Australian College of General Practitioners] guidelines, and that all individuals aged under 30 years deemed to be at high risk were classified based on clinical criteria, [such as diabetes with renal impairment].”

Gaps in HIV diagnosis and treatment for migrants and overseas-born gay and bisexual men

Burnet Institute-led research published in PLOS Medicine has identified significant gaps in the rates of human immunodeficiency virus (HIV) infection diagnosis and treatment in Australia among migrant populations and overseas-born gay and bisexual men, compared with non-migrants. The research shows that while Australia is on track to meet UNAIDS global HIV testing, treatment, and viral suppression targets, the rates of testing and treatment of migrants reporting male-to-male HIV exposure, migrants from South-East Asia, and migrants who are Medicare-ineligible is lagging. The data show Australia meets the UNAIDS 90-90-90 targets in 2020 – with at least 90% of people estimated to be living with HIV knowing their HIV status, 90% of these people receiving treatment, and 90% of those on treatment experiencing viral suppression. “The problem is that since 2012, we’ve had an average of 1000 new infections in Australia every year,” the authors wrote. “While the trend is going down, it is not going down as fast as our progress towards the UNAIDS 90-90-90 targets. If we are reaching 90-90-90 that fast, shouldn’t we be seeing a significant decline in new HIV infections already? We took a closer look at these key subpopulations and what we found confirmed our thinking, that migrants had lower rates of testing, diagnosis and treatment, exposing a big gap in the HIV prevention cascade resulting in fewer migrants living with HIV who have suppressed virus.” One of the starkest differences is between migrant and non-migrant gay and bisexual men. In 2018, only 66% of migrants reporting male-to-male HIV exposure achieved viral suppression compared with 85% of non-migrants reporting male-to-male HIV exposure.

NHMRC announces annual Research Excellence Awards

Professor Stuart Tangye from the University of New South Wales has been named as the 2019 National Health and Medical Research Council (NHMRC) Peter Doherty Investigator Grant Award (Leadership) winner. Professor Tangye heads the Immunity and Inflammation Research Theme at the Garvan Institute of Medical Research. His research focuses on the biology of the human immune system and discovering mechanisms whereby genetic defects cause clinical features of immunodeficiencies. Professor Tangye aims to increase understanding of the requirements for generating an effective immune response and translating these insights into better diagnoses, treatments and outcomes for patients with debilitating immune dysregulatory diseases. Associate Professor Eric Chow is a sexual health epidemiologist and the Head of the Health Data Management and Biostatistics Unit at the Melbourne Sexual Health Centre, Alfred Health and the Central Clinical School, Monash University. He was named the 2019 NHMRC Peter Doherty Investigator Grant Award (Emerging Leadership) winner. Professor Naomi Wray holds joint appointments at the Institute for Molecular Bioscience and the Queensland Brain Institute at the University of Queensland. She was named the 2019 NHMRC Elizabeth Blackburn Investigator Grant Award (Leadership in Basic Science) winner. Professor Glenda Halliday, from the University of Sydney and renowned internationally for her research on neurodegeneration, was named as the 2019 NHMRC Elizabeth Blackburn Investigator Grant Award (Leadership in Clinical Medicine and Science) winner. Professor Jo Salmon, Co-Director of the Institute for Physical Activity and Nutrition at Deakin University, was named the 2019 NHMRC Elizabeth Blackburn Investigator Grant Award (Leadership in Public Health Research) winner. Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research at Macquarie University’s Australian Institute of Health Innovation, won the 2019 NHMRC Elizabeth Blackburn Investigator Grant Award (Leadership in Health Services Research) award. Dr Phillippa Taberlay, a descendent of Mannalargenna and proud Tasmanian Aboriginal woman, is based at the Tasmanian School of Medicine, College of Health and Medicine. She was named the 2019 NHMRC Sandra Eades Investigator Grant Award winner. Dr Adam Wheatley, from the University of Melbourne’s Department of Microbiology and Immunology, was named the 2019 NHMRC Frank Fenner Investigator Grant Award winner. Dr Olivia Smibert, from the University of Melbourne, hopes to increase understanding of the mucosa-associated microbiome and infectious and immunological outcomes after bone marrow and solid organ transplantation. She was given the 2019 NHMRC Gustav Nossal Postgraduate Scholarship Award. Professor Mark Willcox, from the University of NSW, specialises in ocular and oral microbiology, particularly understanding how bacteria adhere to surfaces and cause disease. He was named the 2019 NHMRC Marshall and Warren Ideas Grant Award winner. Associate Professor James St John, Head of the Clem Jones Centre for Neurobiology and Stem Cell Research at Griffith University, won the 2019 NHMRC Marshall and Warren Innovation Award. Professor Erica Wood, head of the Transfusion Research Unit at Monash University and a consultant haematologist at Monash Health, won the 2019 NHMRC Fiona Stanley Synergy Grant Award. Associate Professor Jaquelyne Hughes from the Menzies School of Health Research won the 2019 NHMRC Clinical Trials and Cohort Studies Award.

What’s new online at the MJA

Podcast: Associate Professor Chelsea Bond, Principal Research Fellow within the School of Social Science at the University of Queensland, talks about whether Closing the Gap is fit for Indigenous purpose … OPEN ACCESS permanently

Consensus statement: Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement
Agostino et al; doi: 10.5694/mja2.50529
A consistent approach to cardiovascular disease risk assessment and management from an early age will support further improvements in Aboriginal and Torres Strait Islander health … OPEN ACCESS permanently

Narrative review: Antidepressant-induced sexual dysfunction
Rothmore; doi: 10.5694/mja2.50522
Antidepressant-induced sexual dysfunction is common and distressing for many patients, and is associated with a high risk of medication non-adherence … FREE ACCESS for 1 week


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