Background and objectives: Previous epidemiological studies have identified a group of heart diseases (here called heart diseases of uncertain etiology-HDUE) whose characteristics were rather different from cases classified as coronary heart disease (CHD), but frequently confused with them. This analysis had the purpose of adding further evidence on this issue based on a large population study. Materials and Methods: Forty-five Italian population samples for a total of 25,272 men and 21,895 women, free from cardiovascular diseases, were examined with measurement of some risk factors. During follow-up, CHD deaths were those manifested as myocardial infarction, other acute ischemic attacks, and sudden death of probable coronary origin, after reasonable exclusion of other causes. Cases of HDUE were those manifested only as heart failure, chronic arrhythmia, and blocks in the absence of typical coronary syndromes. Cox proportional hazards models were computed separately for CHD and HDUE, with 11 risk factors as possible predictors. Results: During an average of 7.4 years (extremes 1-16) there were 223 CHD and 150 HDUE fatal events. Male sex, age, smoking habits, systolic blood pressure, serum cholesterol, and plasma glucose were significantly and directly related to CHD events, while high density lipoprotein (HDL) cholesterol was so in an inverse way. The same risk factors were predictive of HDUE events except serum cholesterol and HDL cholesterol. Multivariable hazards ratio of serum cholesterol (delta = 1 mmol/L) was higher in the CHD model (1.24, 95% CI 1.11-1.39) than in the HDUE model (1.03, 0.5% C.I. 0.89-1.19) and the difference between the respective coefficients was statistically significant (p = 0.0444). Age at death was not different between the two end-points. Conclusions: CHD and HDUE are probably two different morbid conditions, only the first one is likely bound to gross atherosclerotic lesions of coronary arteries and linked to blood lipid levels. We reviewed the problem in epidemiological investigations and addressed inflammation as a potential cofactor to differentiate between CHD and HDUE.

Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project. Mean of BMI and prevalence of obesity (BMI > =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee. In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively. Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025. Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.

Results confirm how important is to produce standardised measures, also to adjust and correct SR height and in order to have a reliable picture of in the population. At present obesity is still a priority in public health and is one of the main indicator to plan community actions for chronic disease prevention in the population.

Diego Vanuzzo1, Clara Pinna2, Simona Giampaoli3, Lorenza Pilotto1, Giorgio Brianti4, Nora Coppola5, Andrea Di Lenarda6, Francesco Antonini-Canterin7, Giancarlo Miglio8, Loris Zanier9, Luigi Canciani10, Romano Paduano11, Doriano Battigelli12, Fabio Samani13, Silvio Brusaferro14 1Centro di Prevenzione Cardiovascolare, AAS 4 “Friuli Centrale”, Udine 2Dipartimento di Prevenzione, AAS 2 “Bassa Friulana Isontina”, Palmanova (UD) 3Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma 4Dipartimento di Prevenzione, AAS 4 “Friuli Centrale”, Udine 5Area Promozione della Salute e Prevenzione, Direzione Centrale Salute Friuli Venezia Giulia, Trieste 6Centro Cardiovascolare, AAS 1 “Triestina” e Università degli Studi, Trieste 7Cardiologia Preventiva e Riabilitativa, AAS 6 “Friuli Occidentale”, Pordenone e Sacile 8AAS 3 “Alto Friuli-Collinare-Medio-Friuli”, San Daniele del Friuli, già Epidemiologia, ASS 4 “Medio Friuli”, Udine 9Servizio di Epidemiologia e Flussi Informativi, Direzione Centrale Salute Friuli Venezia Giulia, Udine 10Medico di Medicina Generale, Responsabile Nazionale Area Prevenzione della Società Italiana di Medicina Generale, Codroipo (UD) 11Medico di Medicina Generale, FIMMG Regionale Friuli Venezia Giulia, Trivignano Udinese (UD) 12Medico di Medicina Generale, Formatore Centro Regionale di Formazione per l’Area delle Cure Primarie, Trieste 13Già Direttore Generale, ASS 6 “Friuli Occidentale”, Pordenone, Vicepresidente Nazionale di Federsanità ANCI 14Struttura Accreditamento, Valutazione del Rischio Clinico e Valutazione delle Performance Sanitarie, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Udine

Background Italy has a long tradition of cardiovascular surveys. Due to the decline in the participation rates, in the OEC/HES new exams such as bone densitometry were added; more attention was put to select and train the fieldwork staff; possibility to change the appointment was offered. Methods The OEC/HES was conducted in May 2008-July 2012; 220 men and women aged 35-79 years per 1.5 million persons were randomly selected for a …

Introduction and Aims: Change in estimated GFR (eGFR) is frequently used to track CKD progression in clinical practice, trials and cohort studies but its association with mortality has not been studied extensively.Methods: Change in eGFR was estimated as % change from the first to last eGFR (CKD-EPI creatinine) in a 2-year baseline period.We modeled the hazard ratios (HRs) of subsequent mortality as a spline function of % change in eGFR after adjusting for age, sex, race, first eGFR, and co-morbid conditions.We used random effects meta-analyses to combine results stratified by first baseline eGFR (<60 & ≥60) across studies.Results: Mortality follow-up of 1,597,723 participants from 32 cohorts for a mean of 3.7 years after the 2-year baseline period showed 101,120 deaths for baseline eGFR <60 (n=395,394) and 57,472 deaths for baseline eGFR ≥60 (n=1,202,329).Change in eGFR had a non-linear association with mortality (Figure for eGFR<60).A decline in eGFR was consistently associated with higher subsequent mortality risk (adjusted HR for -30% vs. 0% change in eGFR were: 1.8 at eGFR <60; and 1.6 at eGFR ≥60; p<0.001).Similar results were obtained for a 1-or 3-year change in eGFR.Hazards ratios were largely similar for those with eGFR ≥60 or when stratified by ACR levels.Conclusions: Declines in eGFR are strongly and consistently associated with subsequent risk of mortality adjusted for the first eGFR and covariates.These findings support using smaller changes than -57% (equivalent to doubling of serum creatinine) in clinical research.

Objective: As excess sodium and inadequate potassium intake are causally related to hypertension and cardiovascular disease, the MINISAL-GIRCSI Program aimed to provide reliable estimates of dietary sodium and potassium intake in representative samples of the Italian population.Design and methods: Random samples of adult population were collected from 12 Italian regions, including 1168 men and 1112 women aged 35-79 yrs. Electrolyte intake was estimated from 24 hour urine collections and creatinine was measured to estimate the accuracy of the collection. Anthropometric indices were measured with standardised procedures.Results: The average sodium excretion was 189 mmol (or 10.9 g of salt/day) among men and 147 mmol (or 8.5 g) among women (range 27-472 and 36-471 mmol, respectively). Ninetyseven % of men and 87% of women had a consumption higher than the WHO recommended target of 5g/day. The 24 h average potassium excretion was 63 and 55 mmol, respectively (range 17-171 and 20-126 mmol), 96% of men and 99% of women having an intake lower than 100 mmol/day (European and American guideline recommendation). The mean sodium/ potassium ratio was 3.1 and 2.8 respectively, i.e. over threefold greater than the desirable level of 0.85. The highest sodium intake was observed in Southern regions. Sodium and potassium excretion were both progressively higher the higher the BMI (p < 0.0001).Conclusions: These MINISAL preliminary results indicate that in all the Italian regions thus far surveyed dietary sodium intake was largely higher and potassium intake lower than the recommended intakes. They also highlight the critical association between overweight and excess salt intake. (C) 2012 Elsevier B.V. All rights reserved.

Il Progetto cuore e nato nel 1998 ed e coordinato dall’Istituto Superiore di Sanita. E' stato finanziato dal 1% del Fondo Sanitario Nazionale come Progetto cuore - Epidemiologia e prevenzione delle malattie ischemiche del cuore e come Progetto cuore II – Risk assessment individuale, di struttura e dei percorsi prognostico terapeutici per le malattie cardiovascolari. Dal 2005 partecipa alle attivita del Centro nazionale per la prevenzione e il controllo delle malattie (CCM), Ministero della Salute

Objective: To assess the seasonality of cardiovascular risk factors (CVRFs) in the general population. Methods: Cross-sectional data from subjects aged 35 - 80 years from 10 population-based studies from 7 countries: Belgium (N=21,128); Denmark (N=15,664); France (N=1,626); Italy (N=18,370); Norway (N=25,532); Russia (N=9,359) and Switzerland (N=15,411). Results are expressed as difference between annual and monthly average. Within each study, all data were multivariately adjusted for age, gender and current smoking (yes/no). For blood pressure, lipids and glucose levels, further adjustment on body mass index and drug treatment (yes/no) was performed. Results: Relative to the annual average, CVRF levels tended to be higher in winter (January - February) and lower in summer (June – August), see table. This pattern was observed for most study sites. The amplitude of the CVRF yearly change (maximum – minimum) was 3.5 mm Hg for SBP and 0.24 mmol/L for total cholesterol. Table 1. Seasonal pattern of CVRFs Results are expressed as pooled differences (95% CI) between annual and monthly averages. §Log-transformed data. Conclusion: Some CVRFs show a seasonal pattern with higher levels in winter and lower levels in summer. This pattern is comparable in magnitude to the effect of combined genetic markers and could contribute to the seasonal pattern (higher levels in winter and lower levels in summer) of CV deaths.

Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise.

Ippolito, R.; Donfrancesco, C.; Noce, C. L.O.; Russo, O.; Palmieri, L.; Vanuzzo, D.; Galletti, F.; Giampaoli, S.; Strazzullo, P.Author Information

Background Uncertainties persist about the magnitude of associations of diabetes mellitus and fasting glucose concentration with risk of coronary heart disease and major stroke subtypes. We aimed to quantify these associations for a wide range of circumstances.Methods We undertook a meta-analysis of individual records of diabetes, fasting blood glucose concentration, and other risk factors in people without initial vascular disease from studies in the Emerging Risk Factors Collaboration. We combined within-study regressions that were adjusted for age, sex, smoking, systolic blood pressure, and body-mass index to calculate hazard ratios (HRs) for vascular disease.Findings Analyses included data for 698 782 people (52765 non-fatal or fatal vascular outcomes; 8.49 million person-years at risk) from 102 prospective studies. Adjusted HRs with diabetes were: 2.00 (95% CI 1.83-2.19) for coronary heart disease; 2.27 (1.95-2.65) for ischaemic stroke; 1.56 (1.19-2.05) for haemorrhagic stroke; 1.84 (1.59-2.13) for unclassified stroke; and 1.73 (1.51-1.98) for the aggregate of other vascular deaths. HRs did not change appreciably after further adjustment for lipid, inflammatory, or renal markers. HRs for coronary heart disease were higher in women than in men, at 40-59 years than at 70 years and older, and with fatal than with non-fatal disease. At an adult population-wide prevalence of 10%, diabetes was estimated to account for 11% (10-12%) of vascular deaths. Fasting blood glucose concentration was non-linearly related to vascular risk, with no significant associations between 3.90 mmol/L and 5.59 mmol/L. Compared with fasting blood glucose concentrations of 3.90-5.59 mmol/L, HRs for coronary heart disease were: 1.07 (0.97-1.18) for lower than 3.90 mmol/L; 1.11 (1.04-1.18) for 5.60-6-09 mmol/L; and 1.17 (1.08-1.26) for 6.10-6.99 mmol/L. In people without a history of diabetes, information about fasting blood glucose concentration or impaired fasting glucose status did not significantly improve metrics of vascular disease prediction when added to information about several conventional risk factors.Interpretation Diabetes confers about a two-fold excess risk for a wide range of vascular diseases, independently from other conventional risk factors. In people without diabetes, fasting blood glucose concentration is modestly and nonlinearly associated with risk of vascular disease.

Background. The CUORE Project, an Italian longitudinal study, and the SCORE Project use similar methodology in data collection of cardiovascular risk factors and events. The aim of this study was to build the CUORE Project risk charts for the assessment of cardiovascular mortality and to compare them with the SCORE charts. Methods. Random population samples enrolled between 1980 and 1990 in Italy were included in the analysis: 7520 men aged 35-69 years without previous cardiovascular events with a mean follow-up period of 10 years for cardiovascular disease. ICD-9 codes of death certificates similar to those of the SCORE Project were considered in the analysis when they appear as first cause of death. Gender stratified Cox proportional hazard models were used to assess cardiovascular mortality, including age, systolic blood pressure, total cholesterol (or total-to-HDL cholesterol ratio) and smoking habit as risk factors. Results. Results from gender stratified analysis considering total cholesterol showed that all risk factors included in the cardiovascular mortality Cox model of the CUORE Project were statistically significant. The correspondent area under the ROC curve was 0.822 (95% confidence interval 0.800-0.844) for men. The CUORE Project charts were quite similar to the correspondent charts of the SCORE Project: Lin’s concordance coefficient was 0.964. Risk range of non-smoker men was 0-17% for the CUORE cardiovascular mortality risk chart (0-14% for the SCORE chart); risk range of smokers was 0-25% for the CUORE cardiovascular mortality risk chart (0-26% for the SCORE chart). Similar results were observed for the chart with total-to-HDL cholesterol ratio. Conclusions. The comparison between the CUORE and SCORE mortality risk charts demonstrates that the SCORE charts reflect quite well Italian cardiovascular mortality and, correspondingly, Italian cohorts of the CUORE Project are quite representative of European countries with a low risk of cardiovascular mortality.

Background: The Italian register of cardiovascular diseases is a surveillance system of fatal and nonfatal cardiovascular events in the general population aged 35–74 years. It was launched in Italy at the end of the 1990s with the aim of estimating periodically the occurrence and case fatality rate of coronary and cerebrovascular events in the different geographical areas of the country. This paper presents data for cerebrovascular events. Methods: Currentevents were assessed through record linkage between two sources of information: death certificates and hospital discharge diagnosis records. Events were identified through the ICD codes and duration. To calculate the number of estimated events, current events were multiplied by the positive predictive value of each specific mortality or discharge code derived from the validation of a sample of suspected events. Attack rates were calculated by dividing estimatedevents by resident population, and case fatality rate at 28 days was determined from the ratio of estimated fatal to total events. Results: Attack rates were found to be higher in men than in women: mean age-standardized attack rate was 21.9/10,000 in men and 12.5/10,000 in women; age-standardized 28-day case fatality rate was higher in women (17.1%) than in men (14.5%). Significant geographical differences were found in attack rates of both men and women. Case fatality was significantly heterogeneous in both men and women. Conclusions: Differences still exist in the geographical distribution of attack and case fatality rates of cerebrovascular events, regardless of the north-south gradient. These data show the feasibility of implementing a population-based register using a validated routine database, necessary for monitoring cardiovascular diseases.