The Centre of Research Excellence (CRE) to Reduce Inequality in Heart Disease focuses on improving the heart health and outcomes of groups and communities i.e. Regional Australians, Indigenous Australians and International Health

Regional Australians

Theme Leader

Associate Professor Melinda Carrington


RegionalAustralians.jpg - largeAmid improvements in cardiovascular disease (CVD) related mortality, risk factors remain high in adult Australians. Age-adjusted case fatality rates from CVD have fallen from 55% of all deaths in the late 1960s to 34% in 2007 [1]. This is attributable to better CVD prevention, detection and clinical management. Nevertheless, CVD (notably coronary heart disease) ranks second highest in healthy years of life lost, representing 16% of the overall disease burden [1]. Inevitably, the burden of CVD will inexorably rise within Australia’s ageing population [2]. Despite some encouraging trends in respect to the declining prevalence of major risk factors [1, 3], there are equally cautionary data in respect to sustained, and in some cases increasing levels of hypertension [4, 5], dyslipidaemia [1, 6] and metabolic risk factors (e.g. physical inactivity/sedentary behaviour[1] and obesity [3, 7 ]). When coupled with increasing longevity, it is therefore imperative that heart health be improved by mitigating elevated risk factors [8] through pharmacological and/or non-pharmacological recommendations embedded within evidence-based guidelines [9-15].


Any focus on reducing cardiovascular risk levels has to consider higher risk populations. People living in regional, rural or remote locations consistently fare worse than their metropolitan counterparts [5, 15,16] with mortality rates rising in accord with remoteness [17]. Unfortunately, reliable (measured) population data, especially for biomedical health risk factors, are over 10 years old and limited in respect to regional data. This extends to the AusDiab Study [18] with specific studies examining those living beyond metropolitan regions few and far between [19,20]. Moreover, the distribution of traditional health care services do not match the needs of regional/rural dwelling Australians [21].


Led by Associate Professor Melinda Carrington (supported by an NHMRC of Australia Career Development Award), the CRE to Reduce Inequality is leading a number of projects to achieve the following:

  1. Accurately estimate the burden of risk (including metabolic disorders) and established heart disease in regional Australia;
  2. Develop innovative and cost-effective health care programs to deliver state-of-the art prevention and disease management strategies to reduce cardiac events in regional communities;
  3. Translate these (and other) innovative strategies into sustainable health services to meet the additional needs of those living in Regional Australia.

List of Projects


Royal Flying Doctors Service (RFDS)

Healthy Hearts Beyond City Limits

Protecting Healthy Hearts

The WHICH? II Trial



  1. Australian Institute of Health and Welfare. Australia's health 2010. Canberra, ACT, Australia: AIHW cat. no. AUS 122; 2010.
  2. Australian Institute of Health and Welfare. Cardiovascular disease mortality: Trends at different ages. Canberra, ACT, Australia: Cat. no. 47; 2010.
  3. Australian Bureau of Statistics. National Health Survey: Summary of Results. Canberra, ACT, Australia: ABS cat. no. 4364.0; 11 May 2008.
  4. Barr ELM, Magliano DJ, Zimmet PZ, et al. AusDiab 2005: the Australian Diabetes, Obesity and Lifestyle Study. Melbourne: International Diabetes Institute; 2006.
  5. Carrington MJ, Jennings GL, Stewart S. Pattern of blood pressure in Australian adults: results from a national blood pressure screening day of 13,825 adults. Int J Cardiol 2010; 145:461-467.
  6. Carrington M, Stewart S. Australia's cholesterol crossroads: An analysis of 199,331 GP patient records. Melbourne, Australia: Baker IDI Heart and Diabetes Institute; 2011.
  7. Bennett SA, Magnus P. Trends in cardiovascular risk factors in Australia. Results from the National Heart Foundation's Risk Factor Prevalence Study, 1980-1989. Med J Aust 1994; 161:519-527.
  8. AIHW: O’Brien K. Living dangerously: Australians with multiple risk factors for cardiovascular disease. Canberra: AIHW: Bulletin No. 24. AIHW Cat. No. AUS 57; 2005.
  9. Department of Health and Ageing. Choose Health: Be Active: A physical activity guide for older Australians. Canberra: Commonwealth of Australia and the Repatriation Commission; June 2008.
  10. National Health and Medical Research Council. Dietary Guidelines for Australian Adults. Canberra, ACT, Australia: National Health & Medical Research Council; 2003.
  11. National Heart Foundation of Australia (National Blood Pressure and ascular Disease Advisory Committee). Guide to management of hypertension 2008.
  12. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults. Canberra, ACT, Australia: National Health & Medical Research Council; 2003.
  13. National Health and Medical Research Council. National evidence based guidelines for the management of type 2 diabetes mellitus. Canberra, ACT, Australia: National Health & Medical Research Council; 2005.
  14. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra, ACT, Australia: National Health & Medical Research Council; 2009.
  15. Tonkin A, Barter P, Best J, et al. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Position statement on lipid management--2005. Heart Lung Circ 2005; 14:275-291.
  16. Australian Institute of Health and Welfare. Prevention of cardiovascular disease, diabetes and chronic kidney disease: Targeting risk factors. Canberra, ACT, Australia; 2009.
  17. Department of Health. Victorian population health survey report 2008. Melbourne, Victoria: Department of Health; 2008.
  18. Australian Bureau of Statistics. Population by Age and Sex, Regions of Australia, 2009. Canberra, ACT, Australia.
  19. Chen L, Magliano DJ, Balkau B, et al. AUSDRISK: an Australian Type 2 Diabetes Risk Assessment Tool based on demographic, lifestyle and simple anthropometric measures. Med J Aust 2010; 192:197-202.
  20. Janus ED, Bunker SJ, Kilkkinen A, et al. Prevalence, detection and drug treatment of hypertension in a rural Australian population: the Greater Green Triangle Risk Factor Study 2004-2006. Intern Med J 2008; 38:879-886.
  21. Carrington MJ, Jennings G, Stewart S. Pattern of blood pressure in Australian adults: Results from a national blood pressure screening day of 13,825 adults. Int J Cardiol 2010; 145:461-67
  22. Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event: The Cardiac Accessibility and Remoteness Index for Australia (ARIA) Project. Circulation. 2012;125(16):2006-2014.