Warrnambool and south-west leading the state for three major chronic diseases

After feeling a "cold pain" in his chest Mr Auld was referred for an angiogram in Geelong to check the blood flow around his heart. He asked the doctor whether he'd be able to head home that day.

"He said: "You can go home if you want, but you won't be coming back alive.'"

After emergency quintuple bypass surgery, Mr Auld is back on his bike, but a glance down at his chest is a daily reminder of his brush with the silent killer of heart disease.

In the south-west he's not alone. The region leads the state in deaths from heart disease and sits well above the state average for our other major chronic conditions: kidney disease and diabetes. Experts said this was no surprise, with all three conditions sharing nearly identical risk factors - smoking, obesity, poor diet and physical inactivity - all areas where the south-west punched well above its weight.

Heart disease is the number one killer nation-wide, with 1.5 million Australians at risk of suffering a heart attack or stroke in the next five years. Warrnambool and the south-west sit at an even higher risk, recording heart disease mortality 20 per cent above the state average and a heart stopping 55 per cent above inner Melbourne.

"That's a massive variance," Heart Foundation director of heart health Bill Stavreski said.

"That shows the risk factors within the community are very high."

Mr Stavreski said many of these risk factors were lifestyle related.

"They are things that seem simple, like eating fresh fruits, vegetables and whole grains, not smoking and getting the recommended daily exercise," he said. But he acknowledged that these simple steps often presented a challenge.

"Eight in 10 people aren't getting enough exercise and the diet numbers are similar."

Mr Stavreski said the best advice was to set realistic, achievable goals.

"It's not about overhauling your life, even a small change can make a big difference."

But he also said the two biggest risk factors for heart disease - high blood pressure and high cholesterol - often had nothing to do with our lifestyle. He said the secret to managing these key risk factors was to get tested to find out whether you had them.

"The evidence says the best way to manage your risk of heart disease is to have it assessed with a heart health check," Mr Stavreski said.

"If it turns out you are at high risk you can take key medications to keep your cholesterol and blood pressure under control, which can lower your risk by 50 per cent."

Gerard Auld had always been active, healthy and fit, but that didn't stop him coming within a whisker of a deadly heart attack.

"My heart was in mint condition but the pipework was finished," he said.

The doctors said the four main arteries around Mr Auld's heart were between 85 and 95 per cent blocked. They said the cause was hereditary high cholesterol.

"After that my five brothers all got checked, because of the family risk, and I told my children, especially the boys, they needed to check their blood pressure and cholesterol carefully," Mr Auld said.

But heart disease isn't the only silent condition where regular checks are essential.

Take chronic kidney disease: nine out of 10 people with kidney disease don't even know they have it.

"It's a very silent disease," South West Healthcare kidney specialist Dr Muhammad Javaid said.

So silent, Dr Javaid said, that by the time most patients come to see him their illness has already progressed to the advanced stage.

"By the time they walk through my door, the boat has already sailed."

Dr Javaid said kidney disease was often worse in regional and remote areas and that rates were very high in Warrnambool and the south-west.

The latest data from the Australian Institute of Health and Welfare shows hospitalisations for dialysis - a treatment used for patients with kidney failure - are a staggering 56 per cent higher in Warrnambool than the rest of Victoria.

Despite huge advances in the medical treatment of kidney disease, rates have been rising steadily over the years, with the disease now accounting for one in six hospital visits and one in nine deaths.

Dr Javaid said this was partly a matter of lifestyle factors, but it also showed the lack of screenings that might reveal the illness before it became serious or irreversible.

"The main function of the kidneys is cleaning the body of its waste products, toxins, poisons and excess water, as well as regulating blood pressure," Dr Javaid said.

He explained that because of their many functions, if the kidneys stopped working properly it often caused problems in other organs.

"Everything is interlinked with these diseases. Many of the risk factors are the same, but having one disease also raises your risk of developing the others.

"Kidney disease is itself a risk factor for heart disease and vice versa."

This was also the case the third "silent" chronic condition, diabetes. Recent mortality data showed heart disease was a factor in 42 per cent of diabetes deaths, and kidney disease was a factor in 39 per cent.

Diabetes is another condition where the south-west sits uncomfortably above the average for the rest of the state, with cases of type 2 diabetes 24 per cent higher than the rest of the state.

Award-winning diabetes educator Ann Morris said this figure was an improvement on a decade ago, when Warrnambool led the state for diabetes cases. She agreed with Mr Stavreski and Dr Javaid that lifestyle changes were an important part of avoiding and managing the condition, but also said it was important to resist the idea that people had "somehow caused their condition".

"We have to undo the belief that people have caused their condition or should have been able to avoid it," she said

"This pushes people into denial and avoidance and people need to talk to their GPs about risk factors and get checked."

Ms Morris said the most important part of dealing with and surviving a chronic illness was managing it.

"Active management is the key, having the information and resources to manage the condition and live a long, normal life."

But Dr Javaid said more could be done by health services to ensure that patients with chronic conditions got the best possible outcomes.

"There is too much of a boundary between primary and secondary care, so the GP often doesn't refer a patient early enough, but the specialist also doesn't get enough contact with the patient once they have treated them," he said.

"The emphasis for chronic disease management needs to shift from just acute care to longer term care, with more interaction with GPs and community health workers."

He has started a four-days-a-week public outpatient clinic at Warrnambool Base Hospital to treat patients with conditions such as chronic kidney disease, kidney infections, and kidney failure. He said he was also eager to start education sessions for GPs as well as a community screening program, but said this would require more resources.

Dr Javaid said that if the south-west was going to bend the chronic disease curve, it would be a matter of preventing, rather than treating, heart disease, kidney disease and diabetes.

"We can manage acute illness, but what about prevention?"

Since his surgery, Mr Auld said he gets regular blood pressure and cholesterol checks to make sure everything is under control. "It's all about managing it, preventing the next one" he said.

Earlier in the year he gave his heart its biggest test since the bypass, diving with sharks in South Australia.

"Up came the dorsal fin and they started loading us into the cage. I got a bit worried and had to check with them. They said nah, you'll be right, and started lowering us down into the water. You've still got to take a few risks I suppose."