Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari
Epidemiologia e prevenzione delle malattie cerebro e cardiovascolari
Acute myocardial infarction (or heart attack)
Death of part of the cardiac muscle caused by the narrowing or obstruction of a coronary artery or one of its branches; the flow of blood, and therefore of oxygen, to the cardiac muscle becomes insufficient. The typical symptom is a sudden pain in the middle of the chest, described as oppressive and constrictive (a crushing sensation), which may spread higher up to the mandible and along the left arm. More seldom, the pain may be felt in the upper part of the abdomen.
A pain in the chest, arms or mandible due to a temporary imbalance between the oxygen requirement by the cardiac muscle and the ability of coronary arteries to transport blood; it usually occurs when the oxygen requirement increases due to an effort or stress. Angina pectoris may be stable and unstable. Stable angina is the most frequent form. The pain appears when the heart works more intensively and requires more oxygen, for example as a consequence of physical effort, stress, when it is too warm or too cold, during exercise, even if light, after a meal. Generally, the pain disappears after rest. In unstable angina, pain attacks are more frequent, tend to last longer and are triggered by efforts which become less and less intensive, until they also occur when the person is at rest.
Technique used to treat the narrowing or obstruction of a blood vessel. A catheter (flexible tube), with a small inflatable balloon on its end, is introduced in the injured vessel. The balloon is inflated, thus “crushing” the atherosclerotic plaque which obstructs the vessel, expanding it and allowing the blood flow to resume normally. The catheter and balloon are then removed.
A new technique, on the contrary, instead of using the balloon, is based on the introduction in the injured vessel of a “stent”, an expandable hollow pipe. The stent is introduced by means of a catheter, then permanently positioned in the restricted area of the vessel.
Antihypertensive therapy (or antihypertensive treatment)
Drug treatment aimed at reducing the blood pressure.
It occurs when arterial walls become thick and loose elasticity due to lipid deposits; this causes a reduction of the vessel lumen and, subsequently, of the blood flow. Arteriosclerosis is one of the major causes of cerebro and cardiovascular disease. It develops slowly over a person’s lifetime and is non-symptomatic: when the symptoms appear, the cardiovascular disease has already reached an advanced stage.
Atherosclerosis
The narrowing of the arteries is due to the formation of plaques inside their inner lining. The plaques mainly consist of fat deposits from blood circulation and are found most frequently among individuals with a high cholesterolemia. The following risk factors increase the likelihood for atherosclerosis to occur: male gender, habitual cigarette smoking, high blood pressure, high cholesterolemia, overweight or obesity, physical inactivity, family history. Moreover, the risk of atherosclerosis increases with age.
Atrial fibrillation is a dysrhythmia (abnormal cardiac rhythm) occurring when the atria (upper cavities in the heart) beat irregularly and very rapidly.
The sum of new episodes and recurrences (patients who survived an episode but experienced another) in a given population over a given period of time. It is usually expressed as the number of new cases every 100,000 individuals of the same gender and age per year. It differs from incidence because it takes into account recurrences as well as new cases. Usually, incidence is estimated in populations at risk.
Surgical technique used to “cross over” the obstruction or narrowing of a section of a blood vessel. Segments taken from a patient’s artery or vein (usually a vein in the leg) or vessels made of synthetic material are connected to one point above and one below the obstruction; in this way an alternative path for the blood flow is obtained.
They include diseases of the heart and blood vessels. The most common are those of atherosclerotic origin, in particular ischaemic coronary heart disease, which includes acute myocardial infarction and angina pectoris, and cerebrovascular diseases, including stroke.
The number of persons with a disease who die within a given period of time. It is expressed as a percentage.
They include pathologies of the cerebral vascular system, such as stroke; the most common are those of atherosclerotic origin.
Sudden rupturing or obstruction of a blood vessel inside the brain which might cause a haemorrhage or local interruption of the blood flow. Depending on the position of the injured blood vessel, haemorrhage may be intra-cerebral, subarachnoid or extradural.
The term cohort is used in epidemiological studies to indicate a group of people which is followed over a given period of time.
Coronaries
Arteries which ensure blood flows to the heart.
Death due to a cardiac cause, myocardial infarction, chronic ischaemic heart disease, heart failure.
Coronary diseases
They include coronary diseases mainly due to arteriosclerosis.
Coronary events
Coronary events include: acute myocardial infarction in its narrowest sense, acute coronary syndrome, sudden death and terminal events after a previous infarction.
Early cardiovascular disease familiarity
Early cardiovascular disease familiarity refers to cases of individuals whose parents, siblings or offspring have experienced a cardiovascular event before the age of 55 for men and of 65 for women.
Family dyslipidemia
Family dyslipidemias are genetically-based diseases characterised by high levels of some lipid fraction and by serious and early insurgence of arteriosclerosis.
Observation, during a given period of time, of an individual, group or population whose specific characteristics have been previously assessed, to check whether there have been changes (and, if so, which ones) in the health condition and how these may be related to the characteristics considered.
Global absolute cardiovascular risk
It is an indicator which allows to assess the likelihood of experiencing a major cardiovascular event over the following years when the level of eight risk factors is known (age, sex, smoking habit, diabetes, total cholesterol, HDL, systolic blood pressure, antihypertensive treatment).
Heart attack
see Acute myocardial infarction.
Indicates the number of new cases of disease (for example coronary heat disease) in a given population at risk over a given period of time. It is usually expressed as the number of new cases per 100.000 individuals of the same age and gender every year.
Disease characterised by pain in one or both legs which appears when walking and become less intense when the person is at rest. Intermittent claudication is caused by the occlusion or narrowing of the leg arteries due to atherosclerosis. The pain appears because the muscle no longer receives sufficient oxygen and nourishment from the arterial flow, thus accumulating toxic substances.
Insufficient supply of blood to part of the body. Generally speaking, ischaemia is caused by the presence of atherosclerosis in the blood vessels.
Ischaemic heart disease (or coronary heart disease or coronary artery disease)
The generic term ischaemic heart disease refers to a group of heart diseases characterised by the reduction of the blood flow to the cardiac muscle subsequent to the narrowing or obstruction of the coronary arteries. For this reason, it is also known as coronary heart disease or coronary artery disease. The main clinical signs of ischaemic heart disease are: myocardial infarction, angina pectoris, chronic ischaemic heart disease.
Longitudinal study (or cohort or follow-up study)
Epidemiological study which foresees the enrolment of a cohort and its follow up for a given period of time, with the aim of assessing the relationship between risk factors and the development of the disease.
This definition is generally used to refer to myocardial infarction, acute coronary syndrome and stroke.
The disease trend among populations. It may be measured using incidence and prevalence estimates.
The number of persons in a given population who die over a given period of time. It is generally expressed in multiples of 10,000 per year. If all causes are taken into consideration it is defined as total mortality; if, on the contrary, only specific causes are considered, for instance cardiovascular disease, it is called cause-specific mortality.
Number of individuals suffering from a disease, or other condition, in a population at a given moment in time. Prevalence is generally expressed in 1000 (or multiples) for the disease and in 100 (or multiples) for risk conditions.
Primary prevention
The total sum of measures undertaken to avoid disease in individuals free from any previous event.
Revascularization interventions
They include by-pass and angioplasty.
A characteristic (related to personal behaviour, lifestyle, environmental exposure or genetic) which, if present in an individual without clinical signs of a disease, predicts the probability of its occurring over a given period of time.
Secondary prevention
The total sum of measures taken in individuals who have survived an event in order to avoid its recurrence or death.
Injury to part of the brain, deprived of oxygen and nutrition because of the reduction or interruption of the blood flow to a brain artery. This causes a reduction in sensitivity, movement and in the function controlled by the impaired area. About 80% of strokes are due to the presence of a blood clot which partially or totally obstructs the cerebral arteries causing ischaemia; this situation is known as ischaemic stroke. The haemorrhagic stroke, which account for around 20% of cases, involves the rupturing of a cerebral artery.
Death occurring within less than one hour from the onset of the symptoms or without any of these, in individuals who have no history of coronary disease. In most cases sudden death among adults is a complication and, often, the first clinical sign of myocardial infarction.
Transient ischaemic attack (TIA)
Brief interruption of the blood flow in a part of the brain. An event typically lasts for a few minutes or, at the most, for a few hours; if the attack lasts more than 24 hours it is defined as a stroke. Even though the person recovers completely, a TIA can be an alarming sign of an impending stroke.
Method used to describe a pathological event, for example a coronary or cerebrovascular event, using rigorous standardized epidemiological criteria that allow for a reliable classification, regardless of factors linked to the specific circumstances in which the event occurs or is treated. The method guarantees comparability of results over time between genders and among different areas and age groups.
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