Coronary heart disease is no longer Australia's leading cause of death

In 1968, coronary heart disease caused close to half (44.5%) of all premature deaths in Australia among both men and women under 70 years. 

But this year, for the first time, coronary heart disease is not the leading cause of death in the country. This change matters because coronary heart disease is mostly preventable, and it shows Australia’s health policies are saving lives. 

 What is coronary heart disease? 

Heart disease is a general term for a range of conditions that can affect how the heart and blood vessels function. 

But, put simply, if someone has a heart attack, it is because they have coronary heart disease. These conditions, including coronary heart disease, stroke, and heart failure, are a major public health concern.

The most common type of heart disease in Australia is coronary heart disease.  

Australia’s success in reducing coronary heart disease deaths shows that comprehensive health policies can save lives. The trend is clear: in 1980, the age-standardised death rate for men and women was 414 and 209 per 100,000 people, respectively. By 2022, deaths from coronary heart disease fell to 72 and 35 per 100,000 people. 

The number of Australians prematurely dying from coronary heart disease is at a historic low. 

The Packer Whacker 

The chance of surviving a heart attack depends on how quickly blood flow is restored. Defibrillators—external devices that deliver an electrical shock to the heart to restore normal heart rhythm—can increase the chances of surviving a heart attack by 60-70%.

But until the 1990s, it wasn’t standard for were not standard equipment ambulances to carry them. This meant that surviving a heart attack was based mainly on luck; a responding ambulance might have a portable defibrillator, or it might not. 

Through a simple twist of fate, Kerry Packer was one of the lucky ones. In 1990, the media mogul and billionaire suffered a heart attack while playing polo. The ambulance that responded was fitted with a defibrillator, and Packer survived. 

Following his recovery, Packer donated $2.5 million so that all NSW ambulances could be equipped with defibrillators, which became known as “packer whackers”.

Other states and territories followed the lead, transforming emergency care for heart attack victims. The decision to invest in this proven technology through public ambulance systems has saved countless lives. 

Prevention strategies 

While defibrillators helped, the sustained decline of deaths has really been driven by the prevention of heart disease in the first place. 

In 2008, the Commonwealth Government established a national preventive health strategy to enhance Australia’s capacity to implement health policies focused on early detection, risk reduction, education and nationwide interventions to tackle known risk factors, such as smoking. 

The introduction of heart health checks improved the identification of those at risk, particularly those aged 45 and over, and indigenous populations.  

But the really big change has been the decline in rates of smoking. Smoking is among the strongest risk factors for coronary heart disease. Australia was the first country in the world to introduce strict tobacco laws, which took considerable political will. 

This approach allowed Australia to reduce smoking-related harm and demonstrated the effectiveness of basing health policy on science and evidence.  

Complacency would be a policy failure 

But Australia is at risk of undermining this success. The illegal tobacco market has grown rapidly. Since 2013, the sale of illicit tobacco products has increased by 280% while legal tobacco sales have fallen by 29%. This unregulated, growing market now operates largely outside Commonwealth oversight, which means we could be unaware of how prevalent smoking has become. 

Furthermore, despite decades of progress, the main drivers of coronary heart disease remain widespread. High blood pressure is the most important risk factor for heart disease. 

One in three Australian adults has high blood pressure, but many people are unaware that they have a problem until they experience a stroke or a heart attack. 

Lifestyle factors such as poor diet, excess alcohol consumption, and physical inactivity continue to push blood pressure higher across Australia. 

Between 2021-22, high blood pressure cost an estimated $1.2 billion to treat, $7.3 billion of which was subsidised by Medicare and the Pharmaceutical Benefits Scheme.

This is money that could be saved if the Commonwealth Government strengthened preventative policies to improve lifestyle factors known to contribute to high blood pressure. 

The decline in coronary heart disease deaths in Australia is a major achievement. But victory is not guaranteed. Heart disease is still a significant cause of premature death, and nearly 10% of direct healthcare spending is still spent on treating it. This is why policy should focus on regulation, early intervention, and access to lifesaving care.