Prevention is undoubtedly the best strategy to adopt to reduce the incidence of cardiovascular disease! Cardiovascular diseases can, at least in part, be prevented by implementing a series of behavioural measures (quitting smoking, changing eating habits, doing physical activity) and therapeutic measures (reducing high blood pressure, high cholesterol, controlling diabetes). Adopting these tips means doing prevention.
Risk factors are characteristics that increase the likelihood of disease onset, have been identified and risk reversibility has been demonstrated, therefore cardiovascular disease is now preventable.
The general objective of the prevention of cardiovascular diseases is to reduce the frequency of cardiovascular diseases, delay their onset and/or reduce the severity and disabling consequences, through actions aimed at delaying the natural evolution of the underlying diseases and/or removing risk factors both at an individual and community level. In adults, therefore, prevention measures are aimed not only at preventing acute events in the population at risk, but also at limiting any complications, slowing the process of chronic disease and promoting recovery from heart disease. The awareness of the high frequency of the disease and the high cost both in economic and social terms has led to the creation of guidance documents at European level for different countries to undertake effective plans to combat cardiovascular disease. Reducing the impact of cardiovascular diseases, protecting the health of citizens and improving the quality of life through the prevention of early mortality and disability is the primary objective of cardiovascular prevention enshrined and summarized in the European Charter for Heart Health, drawn up with the support of the European Commission and the World Health Organization, the European Heart Network and the European Society of Cardiology, with the aim of implementing strategies and measures agreed in the policy documents signed by the European Union. The measures adopted must be implemented at European, national and regional level. As indicated by the diagnostic and intervention guidelines in cardiovascular prevention developed over a decade by the European Interassociative Task Force (European Society of Cardiology, European Society of Atherosclerosis, General Medicine and Behavioural Medicine), preventive interventions must be directed as a priority to:
- Patients with previous coronary and/or vascular disease.
- Asymptomatic subjects at high risk for the presence of diabetes mellitus, for the high level of individual risk factors or for the coexistence of several risk factors such as to configure a high absolute cardiovascular risk.
- First-degree familiarity of individuals with early onset of cardiovascular disease.
Health professionals from all countries of the European Union are therefore called upon to take an active part in the planning and implementation of Community programmes and health policy at national and international level. Awareness in government, the attention of relevant Ministries, Health Departments and Non-Governmental Organisations should be more focused on finding resources to be allocated to heart health programmes. Therefore, the implementation at national and regional level of cardiovascular prevention measures, invoked by technical-scientific and political bodies (guidelines and European Charter for Heart Health), must find application in Italian Cardiology as it represents a strategic point in the global management of cardiovascular diseases.
Through the integrated networks of services in the cardiovascular field, gradual and widespread preventive actions can more easily be provided with the aim of identifying and treating individuals at high cardiovascular risk.
The tasks of cardiovascular prevention are:
- reduce the risk of subsequent cardiovascular events
- delay the progression of the atherosclerotic process, underlying heart disease and clinical deterioration
- reduce morbidity and mortality.
These objectives can be pursued through two main types of actions:
inform and motivate:
- informing individuals at risk of cardiovascular disease, teaching them to recognize the symptoms of acute coronary artery disease and the procedures to be implemented in the event of a coronary attack
- inform patients with cardiovascular disease about the symptoms of recurrence, the correct use of drugs, the importance of adherence to therapy and the diagnostic and therapeutic paths of follow-up
- motivate at-risk individuals to change unhealthy lifestyles. In this regard, motivational counseling techniques can facilitate the construction of a helpful relationship that facilitates overcoming behavioral ambivalence towards lifestyle changes relevant to one’s health
identify and process:
- stratify the risk in patients with acute coronary syndrome and/or those undergoing coronary revascularization in order to direct resources and guide follow-up
- identify and modify risk factors, in particular the pre-clinical phase of atherosclerosis, through the recognition of biochemical or instrumental markers with prognostic value and monitor their progression
- recognize the risk factors for early heart failure and identify individuals with asymptomatic left ventricular dysfunction (pre-symptomatic or pre-clinical phase, stage A and B of heart failure) through the promotion of screening or predictive models of the risk of heart failure.
Similarly, it is important to prevent cognitive decline on a vascular basis, which is very frequent after a stroke (to reduce the impact of the epidemic of “dementia” produced by the progressive aging of the population), as well as functional limitations secondary to arteriopathy of the lower limbs (which often culminate in amputations), renal failure due to arterial stenosis and rupture of the aortic aneurysm.
Each cardiovascular prevention structure, in the philosophy of an integrated cardiological network, must develop, in parallel with the clinical attention to the individual patient and his/her care, a strong orientation towards non-invasive instrumental diagnostics and epidemiology, or effective functional links with diagnostic laboratories and reference epidemiological structures through which to carry out:
- systematic follow-up of patients
- your own database
- periodic process and result analyses in order to assess needs in relation to the population of their area of use, and to monitor quality.
General criteria to identify high cardiovascular risk.
- Presence of clinically known cardiovascular disease (including transient clinical pictures such as transient cerebral ischemic attack and angina pectoris)
- Peripheral vascular disease
- Renal vascular disease
- Silent stroke
- Asymptomatic left ventricular dysfunction
- Subjects with asymptomatic atheromasia, for example:
- Carotid atheromastic stenosis
- Aortic aneurysm, even if not of atheromastic origin
- Renal artery stenosis, etc. (particularly if with signs of malignant progression, such as vulnerable plaques)
- Multiple risk factors that lead to an increase in 10-year absolute global cardiovascular risk ≥20%, or between 4% and 19% if the patient has a higher risk factor not estimated by the risk chart of the Higher Institute of Health
- Type 2 diabetes
- Type 1 diabetes associated with microalbuminuria
- Significantly higher levels of individual risk factors, especially when associated with target organ disease
- Familial hyperlipoproteinemia
- Thrombophilic diatheses and other conditions of very high genetic and/or metabolic risk
- Individuals with Familiarity for Early Cardiovascular Disease in Family Members