Emily Banks

Background: As cancer survival improves, cardiovascular disease (CVD) has emerged as a major competing cause of death. However, population‐level evidence on the burden of pre‐existing and post‐cancer CVD remains limited. This study aims to quantify pre‐existing and post‐cancer newly documented major CVD and their association with mortality outcomes among people with cancer. Methods: Major CVD was identified using linked hospital records among 344,336 adults registered with primary invasive cancer in the New South Wales Cancer Registry from 2006 to 2016. The cohort was followed up until 31 December 2021. Fine‐Grey modelling estimated sub‐distributional hazard ratios (sHR) for cancer and cardiovascular mortality, and Cox proportional hazard modelling estimated hazard ratio for mortality from any cause across 20 common cancers. Results: Overall, 18% ( n = 62,675) of participants had pre‐existing CVD within 5 years before cancer diagnosis, varying by age (3% for age < 50 vs. 40% for ≥ 80). Of those without pre‐existing CVD ( n = 281,661), 27% ( n = 76,924) had post‐cancer newly documented CVD, with the highest age‐standardised incidence rates in pancreatic cancer (716 per 10,000 person‐years), followed by lung (657). The median follow‐up period was 6.8 years with an interquartile range: 2.1–10.3 The sHR of pre‐existing CVD for cancer mortality ranged from 0.99 (95% CI: 0.85–1.13) in cancer of kidney to 1.81 (95% CI = 1.71–1.91) in lymphoma, and for cardiovascular mortality, 1.98 (1.78–2.18) in lymphoma to 4.74 (4.39–5.09) in pancreatic cancer. The sHR of post‐cancer newly documented CVD for cancer mortality, ranging from 0.87 (95% CI: 0.69–1.05) in liver cancer to 2.33 (95% CI = 2.04–2.62) in cervical cancer and cardiovascular mortality, ranging from 1.45 (95% CI: 1.18–1.72) in myeloma to 3.39 (95% CI = 2.90–3.88) in liver cancer. Conclusion: CVD is prevalent both before and after cancer diagnosis, with strong relations to increased cancer, cardiovascular and all‐cause mortality. Population‐based strategies to strengthen holistic survivorship care and address key risk factors are essential to improve both cancer and cardiovascular outcomes.

In Australia, despite overall declines in cardiovascular disease (CVD)-related mortality, Aboriginal and Torres Strait Islander women develop heart disease earlier and experience more than twice the rate of related morbidity and mortality compared with non-Indigenous women. This study explores Aboriginal women's understandings of the factors that shape their heart health and lived experiences of CVD. We spoke with 28 Aboriginal women aged ≥18 years-15 semistructured interviews and two yarning circles with an additional 13 Aboriginal women-with/without pre-existing CVD, and 10 healthcare professionals (HCPs) working with Aboriginal communities in the Perth metropolitan region, between May 2024 and April 2025. Data were analysed thematically using a combination of inductive and deductive strategies. Five major themes emerged from the data: (i) understanding heart health and CVD, (i) experiences of living with and seeking care for CVD, (iii) caregiving responsibilities and cardiovascular health, (iv) achieving a healthy heart, and (v) culturally grounded approach to ways moving forward. Participants' accounts revealed how caregiving dynamics, together with systemic constraints and life circumstances, influenced efforts to build and sustain Aboriginal women's heart health. Aboriginal women emphasized the importance of holistic, community- and Aboriginal-led approaches to strengthen heart health-related care and their overall wellbeing. Incorporating the perspectives of Aboriginal women and HCPs is essential to addressing the disproportionate burden of CVD among Aboriginal women. Limited access to heart health-related information and the structural issues impacting Aboriginal women's lives on a daily basis underscore the urgent need for tailored, targeted, and community-driven strategies to improve their cardiovascular health.

Universal telehealth aims to support access to timely coordinated chronic disease care. Large-scale evidence on the extent to which this occurs to guide telehealth policy is limited. To examine temporal changes in uptake and timeliness of general practitioner chronic disease management (GP-CDM) services in Australia following universal telehealth introduction (March 2020) and removal of subsidized telephone (but not video) GP-CDM services (July 2021). Whole-of-population cohort study of linked national claims and death data, 2018-2022. Interrupted time-series analyses quantified temporal changes in GP-CDM service uptake and timeliness following telehealth policy changes. From 2018 to 2022, each month an average of 568 858 GP-CDM services were delivered, with 25-43 users and 44-76 services per 1000 population aged 45-<85 per month. After universal telehealth introduction, GP-CDM uptake remained stable, with similar trends pre- and early-pandemic. Monthly uptake decreased substantially following the removal of telephone GP-CDM services [decrease of 4.0 users (95%CI -6.3, -1.7) and 6.9 services (-10.5, -3.3) per 1000 population]. In the first month of telehealth, 38.7% of people using GP-CDM services used telehealth (37% telephone, 1.7% video), declining to 2.2-5.4%/month after removal of telephone GP-CDM services. Small improvements in GP-CDM timeliness stalled once telephone services were no longer available. Patterns were similar across population subgroups. Telehealth policies in Australia sustained access to chronic disease care during the pandemic. Limiting access to these services to video alone was associated with a greater than expected decline in use had the pandemic and introduction of telehealth not occurred.

Contemporary tobacco and nicotine products, particularly e-cigarettes, are deliberately designed, marketed, and distributed to maximize youth appeal, uptake, dependence, and use. Youth uptake is a predictable outcome of systems designed to maximize product availability, appeal, and addictiveness.

Introduction: Despite reductions in tobacco smoking among Aboriginal and Torres Strait Islander peoples since 2004, particularly among youth, smoking remains elevated in Indigenous communities —highlighting the importance of understanding why some Aboriginal and Torres Strait Islander people never take up smoking. Methods: Taking a strength-based approach and using data from 473 Aboriginal and Torres Strait Islander youth aged 16–24 years joining the Next Generation Youth Wellbeing Study (Western and Central Australia, New South Wales), 2018–2020, age-, sex-, and family-adjusted prevalence ratios (PRs) for never-smoking relative to sociodemographic, health, social, and other factors across socioecological levels were estimated through Poisson regression. Results: Overall, 45% of participants had never smoked tobacco; 31% reported current daily/weekly/monthly smoking, indicating a normative shift. Among those who ever smoked, mean initiation age was 15. Never-smoking was greater with: younger age [16–17-years (PR = 1.9; 95% Confidence Interval = 1.5–2.5), 18–20 (1.3;1.0–1.8)]; completing ≥Year 10 (1.8;1.1–3.0); no interaction with (1.9;1.5–2.5) or being charged by police (2.3;1.5–3.3); never being imprisoned (2.5;1.2–4.8); not having friends imprisoned (1.7;1.3–2.2); having non-smoker friends (1.8;1.4–2.2); never vaping (5.7;3.2–10.1) or smoking marijuana (7.9;4.9–12.8), never having tried alcohol (2.4;2.0–3.0); higher physical activity (1.4;1.1–1.7); and lower psychological distress (1.3;1.1–1.6), never being diagnosed with depression (1.5;1.1–2.1) or anxiety (1.7;1.2–2.4), and having “good-to-excellent” perceived health (1.5;1.1–2.1), compared with not having these attributes. Conclusions: These findings highlight the importance of strengthening family, community, and social environments that protect against smoking initiation and support smoking cessation, and call for sustained structural and policy reforms to address systemic drivers of tobacco use. Implications: Preventing smoking uptake and long-term use among Aboriginal and Torres Strait Islander youth will continue to reinforce a tobacco-free norm and improve long-term tobacco-related outcomes for the total Indigenous population. Ongoing investment in tobacco control and effective smoking cessation initiatives and new initiatives that build on the strengths of Aboriginal and Torres Strait Islander youth are warranted. Tailored approaches should enable protective factors at population-, community-, and individual-levels. Initiatives may include programs to delay initiation, further promotion of youth-friendly, culturally appropriate cessation support, and a holistic focus on wellbeing embedded in Aboriginal and Torres Strait Islander culture.

New and innovative measures are needed to combat tobacco industry marketing strategies and reduce the harm caused by tobacco products. This rapid review aimed to identify and synthesize global evidence relating to dissuasive tobacco product measures, defined as unappealing colours and/or messages directly applied to individual tobacco products to discourage uptake and motivate cessation. Scopus, PubMed, Ovid, and Google were systematically searched from January 2000 to September 2024 to capture all published evidence relating to dissuasive measures, regardless of study design and tobacco product investigated. ‘Forward’ and ‘backward’ citation searching was also conducted. Studies were assessed for quality using JBI critical appraisal tools. Forty-seven eligible publications from 6011 titles/abstracts were included, all relating to conventional cigarettes: 37 peer-reviewed journal articles, including 2 reviews, 29 empirical studies (19 quantitative, 9 qualitative, 1 mixed-methods) and 6 commentaries, 8 government publications, 1 market research report and 1 doctoral thesis. Evidence largely related to perceptions of dissuasive products and their likely impacts. No empirical evidence regarding the relation of dissuasive measures to tobacco control outcomes was located. When compared with standard cigarettes, darker coloured cigarettes—often brown and green—were perceived to be less appealing, whilst cigarettes with messages related to the impact of smoking on finances, others, mortality, and life expectancy were viewed as novel and effective, and capable of inciting behavioural change. The available evidence is generally supportive of dissuasive cigarettes as a tobacco control measure, although a lack of empirical evidence on tobacco control outcomes limits the findings.

Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women—particularly Indigenous women—whose CVD needs differ in terms of symptom presentation, healthcare access, receipt of guideline-recommended care and sociocultural roles. This review aims to summarize the effectiveness of CVD prevention interventions in Indigenous women in the USA, Canada, New Zealand and Australia. Umbrella review of systematic reviews and randomized and non-randomized interventions examines the effectiveness of pharmacological and nonpharmacological interventions in reducing CVD risk in target countries in Indigenous adult studies with ≥50% women. Systematic searches were conducted across six electronic databases between January and February 2024 (update: February 2025). Quality assessment applied standard methods and evidence was synthesized qualitatively. The protocol was PROSPERO registered (CRD42024575310). Six systematic reviews and 16 primary studies (7 randomized and 9 non-randomized; 11,473 participants; 50%–100% women) in Indigenous participants were included. Evidence was limited and generally of low certainty. Four randomized studies were exclusively in Indigenous women (Australia and USA). Only one pharmacological study was identified, investigating vitamin D in reducing blood pressure. Non-pharmacological interventions demonstrated potential to improve CVD risk factors, primarily adiposity, blood pressure, lipids, and glucose. Participant involvement was generally limited and continuation was problematic. This first umbrella review on CVD risk reduction in Indigenous women suggests an urgent need for high-quality evidence to inform and make CVD prevention accessible and equitable for them. Future studies should employ consumer-led, innovative, and context-specific strategies to ensure inclusive recruitment and sustain participant engagement.

Objective: Australian guidelines on cardiovascular disease (CVD) risk assessment and management, including risk prediction algorithms, were updated in 2023. We quantified CVD risk using the 2023 algorithm, compared this to the previous 2012 algorithm, and considered implications for preventive pharmacotherapy. Design: Comparative analysis. Setting, participants: Data from 115,873 people aged 45-74 years without existing CVD from MedicineInsight, a longitudinal primary-care database covering 8% of Australian general practices. Main outcomes: We applied 2023 and 2012 risk algorithms to estimate and categorise individual-level CVD risk into low, intermediate, and high. Risk re-classification in accordance with the 2023 algorithm was not possible. Cohen’s kappa and Bland-Altman plots assessed agreement and concordance. Results: Using the 2023 CVD risk algorithm and revised thresholds, 9.7% of participants were high (≥10% 5-year risk or clinically-determined high risk); 26.4% were intermediate (5-<10% 5-year risk), and 63.9% were low CVD risk (15% 5-year risk or clinically-determined high risk); 11.6% intermediate (10-15% 5-year risk); and 70.8% low risk (<10% 5-year risk). Differences in proportions at high risk were largely driven by changes to clinically-determined high risk criteria. Overall, there was moderate-to-substantial agreement (kappa=0.62) and concordance (Kendall’s tau-b=0.74) between the algorithms. Conclusion: Proportions estimated at low risk and not routinely recommended pharmacotherapy align with international standards and were similar between guidelines. Although fewer people would be recommended pharmacotherapy on the basis of high risk under the updated versus previous guidelines, this reflects better estimates of contemporary risk using the 2023 equation and does not account for re-classification. Pharmacotherapy is considered for those at intermediate risk depending on clinical context under the 2023 guidelines. To ensure continued reduction of the CVD burden across the population, we emphasise the application of re-classification factors and benefits of pharmacotherapy for those at intermediate risk. Summary box: The known: Australian CVD prevention guidelines were updated in 2023, replacing 2012 guidelines. They recommend preventive pharmacotherapy for people at high 5-year CVD risk (≥10%) and considering it for intermediate risk (5-<10%). The new: 9.7% of participants were classified as high, 26.4% as intermediate, and 63.9% as low CVD risk under the 2023 guidelines, using large-scale primary-care data. This compares with 17.6% high, 11.6% moderate and 70.8% low risk under 2012 guidelines. The implications: Updated CVD risk algorithms more accurately reflect contemporary risk. Pharmacotherapy should be discussed systematically with people at intermediate CVD risk under the 2023 guidelines.