Cardiovascular disease is increasingly preventable and treatable – but too many Australians are still being missed. From identifying hypertension earlier to navigating new medicines, community pharmacists can help to improve cardiovascular care.
Cardiovascular disease (CVD) accounted for almost 1 in 4 deaths in Australia in 2024 and around 12% of the nation’s total disease burden.¹ It’s an area with which community pharmacists are very familiar, with almost 113 million Pharmaceutical Benefits Scheme (PBS) prescriptions for cardiovascular medicines dispensed in 2024–25, or 34% of all PBS prescriptions.¹
Yet there is a striking gap between the treatments available and the number of Australians whose cardiovascular risk is adequately controlled. One in three Australian adults – around 6.8 million people – has hypertension, according to the National Hypertension Taskforce. About half don’t know they have it, and only 32% have their blood pressure controlled to less than 140/90 mmHg.²
The Taskforce wants that figure to reach at least 70% by 2030, which would give Australia the best control rate in the world. Its 2024 roadmap focuses on prevention, detection and effective treatment – with pharmacists part of the multidisciplinary approach needed to get there.²
‘Multidisciplinary teams linking general practitioners, pharmacists and nurses can significantly improve blood pressure control, and have formed the cornerstone of international successes,’ the roadmap states.
For Natalie Raffoul MPS, Senior Manager, Healthcare Programs and Clinical Strategy at the Heart Foundation, finding people at risk before a cardiovascular event is one of the biggest opportunities for pharmacists.
‘Although CVD is one of our leading causes of death in Australia, it doesn’t have a structured program for screening, unlike bowel cancer, breast cancer or many other cancers,’ she says.
‘We wait for people to show up to their general practitioner and voluntarily have a check-up for their heart.’
Community pharmacists can help close that detection gap, Ms Raffoul says. A blood pressure check can open the door to a wider assessment of cardiovascular risk – including cholesterol and diabetes – and a referral for a Heart Health Check or GP review where appropriate.
‘Every community pharmacy right now could run very simple cardiovascular risk factor screening clinics,’ Ms Raffoul says. ‘They have the facilities, the means and the skills.
‘In future, there may be more comprehensive clinical cardiovascular risk assessment occurring in a community pharmacy setting. That would really close the loop around management of cardiovascular risk. But right now, blood pressure is a very simple and important cardiovascular risk factor that often motivates people to do more about their cardiovascular health.’
Queensland is already testing a broader role for community pharmacists. Under its Community Pharmacy Chronic Conditions Management Pilot, participating pharmacists can provide structured care through a CVD Risk Reduction Program covering type 2 diabetes, hypertension
and dyslipidaemia.
The aim is to provide an ‘accessible, community-based healthcare service to identify and improve outcomes for patients at high risk of CVD’.³ Pharmacists conduct risk assessments, develop and implement management plans that include pharmacological and non-pharmacological measures, and refer or collaborate with other healthcare professionals where appropriate.
Beyond ‘eat less salt’
Community pharmacists can also counsel patients on a small dietary change that has the potential to make a big difference.
Excess sodium and inadequate potassium both contribute to raised blood pressure, with high sodium intake alone attributed to 1.9 million deaths globally each year.⁴ This is particularly relevant in Australia, where average salt intake is 9.6 g per day – almost twice the World Health Organization recommendation. Potassium intake is also below recommended levels.⁴
A 2026 position statement from Hypertension Australia and the Hypertension Taskforce notes that population efforts to reduce sodium intake have had limited success.⁴ Instead, it recommends ‘novel strategies’ for people with hypertension who add salt to food, including replacing regular salt one-for-one with potassium-enriched salt containing approximately 75% sodium chloride and 25% potassium chloride.
Research cited in the statement shows potassium-enriched salt can lower blood pressure and reduce the risk of stroke, major cardiovascular events and premature death.⁴ However, it’s not suitable for everyone, and before recommending it pharmacists should consider factors that increase the risk of hyperkalaemia. Reducing salt overall, choosing lower-salt foods and increasing potassium through fruit and vegetables remain the core dietary advice.
In New South Wales, researchers are planning to pilot a pharmacy-based model recommending potassium-enriched salt as part of routine hypertension services. They estimate that replacing regular salt with potassium-enriched salt could prevent around 10,000 cardiovascular events and 3,000 deaths each year in Australia.
Community pharmacy ‘presents an untapped, high-reach, equitable platform for preventive cardiovascular care,’ the researchers say. Consumers are willing to switch, particularly when potassium-enriched salt is recommended by a healthcare professional, while pharmacists themselves report a strong willingness to recommend it. The intervention could be incorporated into existing services such as blood pressure monitoring, medication reviews and lifestyle counselling.
Medicines crossing disease boundaries
Alongside preventative interventions, cardiovascular treatment itself is becoming more complex as medicines increasingly cross traditional disease boundaries.
Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors are now used across type 2 diabetes, chronic kidney disease and heart failure, while glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have a growing role in cardiometabolic care. The Heart Foundation’s 2026 consensus statement on obesity and CVD notes positive cardiovascular outcomes with newer incretin-based therapies, including in people with established CVD.⁵
Adam Livori, lead pharmacist in cardiology at Grampians Health, says the practical challenge for community pharmacists is understanding why a medicine is being used.
‘The utilisation of these agents across multiple conditions … is extraordinary,’ he says. ‘People using these medications may have multiple indications for these therapies. It is important for pharmacists to appreciate that the streamlined authority code use does not always dictate the sole indication, and some digging may be required to get this history.’
He gives the example of a patient prescribed semaglutide and an SGLT2 inhibitor. GLP-1 RAs are not PBS-subsidised in combination with an SGLT2 inhibitor for type 2 diabetes, except where the SGLT2 inhibitor is prescribed for another indication such as heart failure or kidney disease and other PBS criteria are met.
The message for pharmacists is not to assume an unfamiliar combination is an error. Establishing the patient’s diagnoses and intended indications may reveal deliberate cardio-renal-metabolic treatment. As medicines regimens become more complex, Home Medicines Reviews (HMRs) can help pharmacists establish the full treatment picture. HMRs provide an opportunity to identify adherence problems, duplication and uncertainty about why a medicine is being used – particularly when patients have cardiovascular, kidney and metabolic conditions.
Vaccination as cardiovascular care
Vaccination is also emerging as part of the cardiovascular care toolkit, particularly for patients already at increased risk of heart attack or stroke.
Respiratory infection can trigger cardiovascular events through inflammatory and prothrombotic pathways.⁶ Emerging Australian data suggests that 8.7% of all acute myocardial infarction events may be attributable to respiratory viral triggers.⁷
Professor Raina MacIntyre, head of the Biosecurity Program at the University of NSW’s Kirby Institute, says the evidence is strongest for influenza. In a person with pre-existing coronary plaque, infection can create an inflammatory and hypercoagulable state that can contribute to plaque disruption and acute clot formation. ‘These are events that are potentially preventable by vaccination,’ she says.
The evidence changes how pharmacists can frame vaccination for people with cardiovascular risk. ‘Pharmacists can say to their patients that having a vaccine is like taking your statins or your blood pressure medication, or stopping smoking,’ Prof MacIntyre says. ‘It’s another way to prevent the risk of having a heart attack or stroke.’
A paper she co-authored reported estimates of 15–45% for the efficacy of influenza vaccination in preventing acute myocardial infarction, comparable to several established prevention measures.⁶
There is also growing evidence of cardiovascular protection from COVID-19 vaccination. For patients concerned about vaccine-associated myocarditis or pericarditis, Prof MacIntyre says pharmacists should put the known vaccine risk in the context of the cardiovascular risks associated with COVID-19 infection itself.
Practical watch-outs
New technology and changing treatment recommendations create other opportunities for community pharmacists.
Smartwatches can improve detection of atrial fibrillation, Mr Livori says, but patient-generated data needs clinical context. He has seen patients become anxious about normal heart-rate variation and reduce exercise because of fear of tachycardia. ‘As clinicians it is about balancing insight into symptoms and not contributing to anxiety,’ he says.
Antiplatelet therapy is another area where a simple medicines check can matter. Mr Livori says some patients continue dual antiplatelet therapy beyond the intended duration, while aspirin can be missed during medicines reconciliation because it doesn’t require a prescription.
Both examples point to the same issue: pharmacists need to know not only what a patient is taking or measuring, but what the plan is. That becomes harder when information doesn’t follow the patient. Mr Livori argues that hospital discharge summaries should be shared with the patient’s nominated community pharmacy as well as their GP, so pharmacists can see treatment indications, intended duration and follow-up.
But the greatest opportunity for community pharmacists is earlier in the cardiovascular pathway. Australia already has effective medicines, increasingly sophisticated cardiovascular risk assessment and new ways to reduce risk. And community pharmacists are among the health professionals most likely to encounter people before they think of themselves as cardiovascular patients at all.
A blood pressure check can trigger risk assessment and referral; a medicines conversation can uncover an adherence problem or unclear indication; and vaccination can become part of cardiovascular prevention. The challenge is to turn those everyday contacts into action before the first cardiovascular event.
References
- Australian Institute of Health and Welfare. Heart, stroke and vascular disease: Australian facts. 2026. At: www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/summary
- Schutte AE, Bennett B, Chow CK, et al. National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030. Med J Aust. 2024;221(3):126-134.
- Queensland Government. Queensland Community Pharmacy Chronic Conditions Management Pilot Cardiovascular Disease (CVD) Risk Reduction Program – hypertension. Clinical protocol. At: www.health.qld.gov.au/__data/assets/pdf_file/0015/1451103/cvd-hypertension-protocol.pdf
- Xu X, Land MA, James S, et al. Potassium-enriched salt for patients with hypertension: a Hypertension Australia and National Hypertension Taskforce of Australia Position Statement. J Hypertens. 2026;44(1):1-5.
- Heart Foundation of Australia. Obesity and cardiovascular disease. 2026. At: www.heartfoundation.org.au/for-professionals/obesity-cvd-consensus-statement
- MacIntyre CR, Mahimbo A, Moa AM, et al. Influenza vaccine as a coronary intervention for prevention of myocardial infarction. Heart. 2016;102:1953–1956.
- Nguyen TQ, Zhao E, Weinman AL, et al. Respiratory viral contribution to acute myocardial infarction: a time series and spatiotemporal analysis in Victoria, Australia 2010–2022. medRxiv. 2026. doi:10.64898/2026.01.30.26345252.
- Pharmaceutical Benefits Scheme. PBS restriction changes for antihypertensive dual therapy fixed dose combinations. 2026. At: www.pbs.gov.au/reviews/pbs-restriction-changes-for-antihypertensive-dual-therapy-fixed-dose-combinationsi
- Raffoul N, Brims K, Knight J, et al. Targeted cardiovascular risk screening through an SMS programme (Text to Detect) in general practice: a three-arm, parallel group, randomised controlled trial. Lancet Prim Care. 2025;1(5):100043. At: www.thelancet.com/journals/lanprc/article/PIIS3050-5143(25)00043-3/fulltext
