KICK-OFF MEETING CVrisk-IT

Integrated approaches for personalized cardiovascular prevention:
the CVRISK-IT study

“On June 14 and 15, the CVRISK-IT study will be officially presented, an important study wanted by the Italian Parliament and sponsored by the Ministry of Health, which will involve 30,000 healthy people. This is a large primary prevention study that we will present in all its features, as well as presenting the Cardiology Network as an actor and main performer in the study.

There are 17 IRCCSs entering the study, and this is the first time that IRCCSs in the Cardiology Network are producing such an important infrastructure to improve cardiovascular prevention.“

“The presentation will feature subject matter experts and leading experts, who will share the task of analyzing the various systems, the various means of prevention according to clinical differences.”

“From this study we expect to improve prevention, and to make the population aware in an important way.”

CONTEXT

Cardiovascular diseases are among the leading causes of death, as well as the first source of healthcare spending. In our country, according to ISTAT data, in 2021 these diseases accounted for 30.8 percent of all deaths (27.7 percent in men and 33.7 percent in women). And ischemic heart disease remains the leading cause of death for men and women over 65, with rates of about 673 and 400 deaths per 100,000 inhabitants, respectively.

Numbers like these, among other things, jeopardize the future sustainability of an already hard-pressed health care system.

According to the latest available EUROSTAT data, referring to the year 2021, cardiovascular diseases accounted for more than 32 percent of all deaths on our continent, followed by oncological diseases (22 percent). Yet, awareness of the risk-cancer is often higher than that for heart attack, stroke, and other potentially fatal cardiovascular events. Moreover, more than half of Italians (54 percent) think they are not at risk for cardiovascular disease. And those who are least aware are women and younger groups.

To identify those at greatest risk and target preventive interventions, effective primary prevention strategies are essential. And the more precise and personalized they are, the more effective they will prove to be.

Obviously, the main cardiovascular and modifiable risk factors are apolipoprotein-B-containing lipoprotein in the blood (of which low-density lipoprotein LDL is the most abundant), elevated blood pressure, cigarette smoking, and diabetes mellitus. Risk prediction models, such as SCORE2 and SCORE2-OP, which estimate the overall risk of disease by taking into account these individual modifiable and non-modifiable factors, are critical for the prevention of cardiovascular disease.

But in addition to the risk factors included in the risk tables, under certain circumstances, the Clinical Guidelines also recommend taking into account other factors called: “risk modifiers.” Indeed, early evidence suggests that elements such as genetic and imaging data as additional information on cardiovascular risk may improve personalized interventions and adherence to physician advice on lifestyle and treatment. Among these, the polygenic risk score has shown some potential for improving heart risk prediction as a function of increasingly personalized primary prevention.

Da questo punto di vista, anche il punteggio del calcio coronarico (calcium score) può riclassificare il rischio cardiovascolare verso l’alto o verso il basso in aggiunta ai fattori di rischio convenzionali e può quindi essere preso in considerazione in uomini e donne con rischi calcolati intorno alle soglie decisionali. Simile considerazione può essere fatta per quanto riguarda la valutazione della placca carotidea mediante ultrasonografia, che può essere considerata un modificatore di rischio nelle persone a rischio intermedio quando il calcium score non è fattibile.

Per una prevenzione efficace, occorre aumentare nella popolazione la consapevolezza del rischio e delle misure necessarie a ridurlo. Occorre, cioè un’azione completa di comunicazione-disseminazione, il coinvolgimento di vasti strati della popolazione e la promozione di una relazione sostenuta nel tempo. Un obiettivo ambizioso, ma necessario se si vuole aumentare la portata e l’efficacia dei programmi di educazione/prevenzione nel campo delle malattie cardiovascolari