The Silent Threat: Cardiometabolic Risk in Italy

Cardiovascular diseases remain a leading cause of mortality worldwide, and Italy is no exception. A important portion of the population faces preventable risks. Recent data indicates that a staggering 50.1% of Italians aged 40-69, without prior cardiovascular events, are at medium-to-high risk of heart attack or stroke within the next decade. This translates to a greater than 5% chance of experiencing a life-threatening event.

Though, experts emphasize that approximately 80% of cardiovascular-related deaths could be avoided through proactive primary prevention strategies, as highlighted in the European Society of Cardiology (ESC) guidelines issued in 2021.

A Proactive Approach: Targeted Screening for At-Risk Individuals

To combat this growing concern, a collaborative effort led by The European House Ambrosetti, in conjunction with a panel of health experts, has proposed a strategic screening program aimed at identifying and managing cardiometabolic risk factors in the Italian population. The core of the initiative involves a straightforward screening process for individuals aged 40 to 69, encompassing approximately 18 million people.

The Screening Process: Simple, Affordable, and Effective

The proposed screening program is designed to be accessible and efficient, incorporating several key components:

• Lifestyle Questionnaire: A extensive assessment of lifestyle habits, including diet, exercise, and smoking.
• Blood Pressure Measurement: A standard procedure to identify hypertension, a major risk factor for cardiovascular disease.
• Blood Tests: A panel of blood tests to evaluate critical markers, including:
  • Blood sugar and glycated hemoglobin (HbA1c) levels, providing insights into long-term blood sugar control and diabetes risk.
  • Lipid profile, assessing cholesterol levels (including LDL, HDL, and triglycerides).
  • Lipoprotein(a) [Lp(a)], a genetically resolute type of cholesterol that substantially elevates cardiovascular risk, independent of other risk factors. Elevated Lp(a) affects approximately 20% of the global population, making it a crucial marker to assess.
• Electrocardiogram (ECG): Recommended for individuals aged 65-69 to detect underlying heart conditions.

Economic Benefits: A Sound Investment in Public Health

The program’s cost-effectiveness is a key consideration. The estimated cost per participant is relatively low, with approximately two euros for the initial invitation letter and an additional 27 to 60 euros for the necessary tests.Even when factoring in the potential costs associated with preventive therapies for individuals identified as high-risk (e.g., medications for diabetes, hypertension, or hypercholesterolemia), the screening program remains economically viable.

Simulations suggest that the investment would be recouped if at least 70,000 Italians participate in the screening. In a balanced scenario, for every euro invested in the program, a return of 60 cents could be expected, demonstrating a positive impact on both public health and the sustainability of the healthcare system.

Expert Endorsement: Prioritizing Prevention

The challenge of cardiovascular prevention passes through the recognition of the risk condition of patients and from the intervention before an ischemic event develops. In absolute terms the greatest number of events develops precisely in those who are not aware of the disease below or has not had previous events. For this reason Sic supports the “Prevent The first Event” approach,prevailing the first event,focusing not only on the campaigns to promote correct lifestyles but also on the screening activity to intercept early those who are at risk, emphasizes Pasquale Perrone Filardi,president of the Italian Cardiology Society.

The hope is that a cardiometabolic screening program like the one proposed can be implemented to make a tangible difference in the lives of countless individuals.