2.1. Cardiovascular disease

Cardiovascular diseases are one of the leading causes of morbidity, invalidity and mortality. One important piece of information is that, over the past 40 years, total mortality has been more than halved (the total standardised mortality rate dropped by 53% between 1970 and 2008) and the contribution of cardiovascular diseases is the factor that has most influenced the downward mortality trend (over the same period mortality for cardiovascular disease dropped by 63%). Cardiovascular diseases are to a great extent avoidable by adopting healthy lifestyles, particularly a healthy diet, regular exercise and abstinence from smoking and therefore over the years, the increase in the medical and surgical options for the treatment of diseases has been accompanied by a growing awareness of the importance of initiatives that prevent or delay their onset.

In 2008, cardiovascular diseases were responsible for 224,482 deaths (97,952 men and 126,530 women), equal to 38.8% of total deaths. As regards ischaemic heart disease (myocardial infarction, other acute and subacute forms of ischaemic heart disease, prior myocardial infarction, angina and other forms of chronic ischaemic heart disease) there were 75,046 deaths (37,827 men and 37,219 women), equal to about 33% of all cardiovascular deaths.

Longitudinal studies conducted as part of the CUORE project enrolling more than 21,000 men and women aged 35-74 years, starting in the mid-1980s with a mean follow-up of 13 years, showed incidence rates for coronary events (in men 6.1/1,000/year with fatality at 28 days of 28%, in women 1.6/1,000/year with a fatality of 25%) to be higher than for cerebrovascular diseases (2.7/1,000/year for males, 1.2/1,000/year for females) in both sexes, except for the last decade of life in women, where the incidence of cerebrovascular events was higher. Since 1980, the age-adjusted coronary death rates have dropped from 267.1 to 141.3 per 100,000 in men and from 161.3 to 78.8 in women aged 25-84 years, producing 42,930 fewer coronary deaths in 2000 (24,955 in men, 17,975 in women). Approximately 40% of this drop was due to specific treatments, particularly for decompensated heart failure (14%) and secondary prevention treatment following myocardial infarction or a revascularisation procedure (6%). On the other hand, about 55% is due to changes in the main cardiovascular risk factors in the Italian population, primarily the drop in arterial pressure (25%) and in total cholesterolaemia (23%). This demonstrates the efficacy of the schemes designed to promote lifestyle changes, even among the elderly population, in maintaining the increases in healthy life years recorded in recent years over time. In cases of high overall cardiovascular risk, in addition to “heart-saving” life styles, medicinal products, specifically antihypertensives and fat-lowering medicinal products, of documented preventative efficacy exist.