Risk factors are those characteristics resulting from incorrect habits and lifestyles, environmental and biological factors, which, if present in a person free of clinical manifestations of the disease, predict the probability of falling ill over a certain period of time. They are mainly caused by unhealthy diet, smoking habits, physical inactivity. Arterial hypertension, hypercholesterolemia, diabetes and obesity are the main factors that increase the risk of cardiovascular disease.

 

Since the 1980s, data on the distribution of risk factors, the frequency of risk conditions and the prevalence of cardiovascular disease have been collected and analysed using standardized procedures and methodologies.

The data collected can be consulted through the online platform CuoreData, the data query system of the Cuore Project. In addition to the data included in the questionable platform, data on migrants and menopausal women can also be consulted.

 

Blood pressure - Blood pressure is measured, before taking the blood sample, in a sitting position, in the right arm, after 4 minutes of rest, with a mercury sphygmomanometer for investigations prior to 2018 and with automatic equipment from 2018 onwards. Between the first and second measurement the pulse rate was recorded in one minute. The persons examined were grouped into hypertensive and normotensive according to blood pressure values and possible pharmacological treatment.

 

Anthropometric measurements - The weight and height were measured to person wearing underwear only: for the height the wall statimeter was used, for the weight a tilt scale was used. The body mass index (BMI = weight in kg divided by height in square meters) was calculated using the weight and height values. The waist circumference was measured using a tailoring meter, person standing, halfway between the lower edge of the costal arch and the upper edge of the iliac crest during the expiratory phase; the hips circumference was measured at the height of the maximum circumference at the level of the buttocks.

 

Laboratory tests - Blood samples were taken in persons who had been fasting for at least 12 hours; the sample, divided into the various components, was frozen and transferred to a centralized laboratory for the determination of total cholesterol, HDL, LDL, triglyceridemia and glycaemia.

 

Habits and lifestyles

Cigarette smoking habit, physical activity, regular use of medicines were collected through a standardized questionnaire:

• cigarette smoking habit concerns the habitual or past consumption of cigarettes per day and is classified into three categories: current, former and never smoker
• the level of physical activity is expressed in 4 categories of increasing order (sedentary, light, moderate, heavy), separately for work and leisure time; each person had to indicate which category best identified own physical activity. In the data analysis, only physical activity during leisure time was considered and was classified into sedentary and non-sedentary, the latter including the light, moderate and heavy physical activity categories
• pharmacological treatments include cholesterol-lowering, antihypertensive, antidiabetic, aspirin for preventive purposes for cardiovascular diseases, contraceptive or hormone replacement therapy in menopause

Sodium and potassium

Sodium chloride (table salt) is the main source of sodium in the diet. The available scientific evidence on the negative effects on health, deriving from excessive salt consumption, is indisputable, especially with regard to the risk of cardio and cerebrovascular diseases, digestive tract, cancer, osteoporosis, gastritis and kidney disease. Oms recommends a daily salt consumption of less than 5 grams (about 2 grams of sodium). Excessive salt consumption is often associated with insufficient potassium intake, well below the levels recommended by Oms (≥ 3.510 mg), mainly due to low consumption of vegetables, fruits and legumes. Within the CUORE project surveys, the determination of sodium salt and potassium consumption in the general Italian adult population was estimated through the urinary excretion of sodium and potassium carried out through the 24 hour urine collection.

 

Risk conditions and lifestyles: definitions

Hypertension: systolic blood pressure ≥140 or diastolic ≥90 mmHg or specific treatment

 

Hypertension - awareness and adequate medication treatment: hypertensive persons were classified into those who were not aware to be hypertensive (persons who had never been told by a doctor or other health care professional that they had high blood pressure), untreated, not adequately treated (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg), and adequately treated (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg).

 

Hypercholesterolemia (threshold at 240 mg/dl): total cholesterolemia ≥240 mg/dl or specific treatment

 

Hypercholesterolemia (threshold at 200 mg/dl): total cholesterolemia ≥200 mg/dl or specific treatment

 

Hypercholesterolemia - awareness and adequate pharmacological treatment: persons with a total cholesterolemia ≥240 mg/dl or under pharmacological treatment were hypercholesterolemic. Hypercholesterolemic persons, who had never been told by a doctor or another health care professional that they had high total cholesterolemia, were defined unaware; persons who, despite drug therapy, had values ≥240 mg/dl were defined not adequately treated; treated persons presenting total cholesterolemia<240 mg/dlwere defined adequately treated.

 

Low HDL-Cholesterolemia: HDL-cholesterolemia≤40 mg/dl in men and ≤50 mg/dl in women

 

High LDL-Cholesterolemia: HDL-cholesterolemia≥115mg/dl

 

Hypertriglyceridemia: triglyceridemia ≥150 mg/dl

 

Hyperglycaemia: fasting glycaemia between 110 and 125 mg/dl and not under specific treatment

 

Diabetes: fasting blood glycaemia ≥126 mg/dl or specific treatment

 

Diabetes: persons with a previous clinical diagnosis of diabetes or with fasting blood glycaemia > 126 mg/dl or under specific pharmacological treatment were diabetic

 

Diabetes - awareness and adequate pharmacological treatment: diabetic persons were classified into: unaware (persons who had never been told by a doctor or other health care professional that they had diabetes), aware untreated, not adequately treated (persons who despite the pharmacological therapy had blood glucose > 126 mg/dl), adequately treated (persons who were treated and had blood glucose values < 126 mg/dl

Smoking habit: person smoking even one cigarette per day, per week or per month is considered a “current smoker”; "never smokers" and "ex-smokers" are respectively those who have never smoked or who quitted smoking for at least a year

 

Overweight: Body mass index (BMI) between 25.0 and 29.9 Kg/m²

 

Obesity: Body mass index (BMI) ≥ 30 Kg/m²

 

Sedentariness: describes sedentariness during leisure time and at work

 

Cardiovascular risk after 10 years

For those without a previous cardiovascular event and aged 35-69 years, the CUORE project cardiovascular risk score was applied to assess the probability of falling ill from a major cardiovascular event (myocardial infarction or stroke) in the following 10 years; the individual risk score, specific for men and women, includes age, systolic blood pressure, antihypertensive therapy, total and HDL cholesterolemia, presence of diabetes, cigarette smoking habit. Prevalence for risk ranges of less than 5%, between 5 and 9.9%, between 10% and 14.9%, between 15 and 19.9%, and 20% or more was identified.

 

Diagnostic criteria for cardiovascular diseases

The following cardiovascular diseases were considered in the assessment of prevalence: previous myocardial infarction, stroke, angina pectoris, intermittent claudication, atrial fibrillation, left ventricular hypertrophy, previous coronary artery bypass surgery or revascularization, transient ischemic attack (TIA).

 

The diagnostic criteria of the previous heart attack are based on the combination of ECG, read according to the Minnesota code, and medical history; angina pectoris and claudication intermittent were diagnosed using the Rose's questionnaire from the London School of Hygiene and Tropical Medicine; the Minnesota code was considered to identify left ventricular hypertrophy and atrial fibrillation; the medical history was considered to detect previous stroke and TIA.

 

Standardization

The statistics were compiled using the following standardizations by age and sex: age distribution relative to the study design of the survey (study pop.), Age distribution relative to the ISTAT data of the central year of the survey (Italian pop.), age distribution relative to the standard European population 2013 (European pop.).