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Istituto Superiore di Sanità
EpiCentro - L'epidemiologia per la sanità pubblica
Istituto Superiore di Sanità - EpiCentro


Risk Tables for Myocardial Infarction in Italy from Progetto CUORE

Simona Giampaoli, Istituto Superiore di Sanità, Roma

Marco Ferrario, University of Insubria, Varese

Paolo Chiodini, University of Insubria, Varese

Luigi Palmieri, Istituto Superiore di Sanità, Roma

Salvatore Panico, University Federico II, Napoli

Diego Vanuzzo, Regional Health Agency of Friuli Venezia Giulia, Udine

 

Progetto CUORE (Project Heart) began in 1998 with the objectives of creating a register of cardiovascular and cerebrovascular events, describe the distribution of risk factors for these conditions, and evaluate cardiovascular risk in the Italian population. As part of this latter objective, data from 17 cohorts were assembled in a single data base. The cohorts, which had used comparable methods, included approximately 17,000 men and 22,000 women enrolled from North, Central, and Southern Italy.These populations were clinically followed through the end of 1998, with the recording and validation of information on fatal and non-fatal myocardial infarctions.

 

Using these data, the risk of having a myocardial infarction among persons 40-69 years of age with no previous history of cardiovascular disease was estimated. Predictive weights of single risk factors and mathematical functions that predicted disease risk were developed. For men, the probability of having an infarct within the next 10 years was calculated; for women, the probability calculated referred to a 5-year period.

 

Italy has a lower frequency of myocardial infarcts than does Northern Europe. For this reason, the risk categories conventionally used in Europe were redefined based on the mean risk of illness in the Italian population as identified in the cohorts of Progetto CUORE. In particular, for men, the levels of infarction risk within the next 10 years divided into six risk groups: CRI (carta rischio infarto; infarct risk table) I: <5%, CRI-II between 5% and 10 %, CRI-III between 10% and 15%, CRI-IV between 15% and 20%, CRI-V between 20% and 30% and CRI-VI > 30%. For the women, the categories were: CRI-I <1%, CRI-II between 1% and 3%, CRI-III between 3% and 5%, CRI-IV between 5% and 7%, CRI-V between 7% and 10%, CRI-VI > 10%. The mean risk in the Italian population corresponded the the lower limit of the category CRI-II in men (5.8% at 10 years) e and the upper limit of CRI-I in women (0.9% at 5 years). Separate tables are presented for males and females, stratified further by diabetic and non-diabetic status.

 

The tables are available at the website www.cuore.iss.it; to determine the category in which an individual falls, the following information is necessary: age, systolic blood pressure, cholesterol level, smoking history, and diabetes history. It is also possible to calculate individual risk, which requires knowledge of the above factors, plus levels of HDL cholesterol and whether the person is being treated for hypertension. In both cases, the risk factors need to be measured according to standardized methods described on the website.

 

The tables are a highly visual way of describing the category of risk to which a person belongs, while the individual point system provides more precise information about a given individual’s risk Both tools, in addition to identifying those at high risk, provide the possibility of measuring over time, in an objective manner, the benefits obtained through modifications in life style or pharmacologic management and to evaluate the cost-benefit ratio of such interventions. Further tables are planned that will allow the identification and quantification of risks for other cardiovascular conditions.

 

It is important to remember that the risk of myocardial infarction increases with age, but it is possible to lower the risk by controlling modifiable risk factors through life-style changes. In this regard, the following activities are suggested:

  • Avoid smoking. Both active and passive smoking are harmful.

  • Eat a healthy and balanced diet, with a wide range of foods. Decrease fat consumption, especially saturated fats of animal origin and foods high in calories. It is also important to increase the consumption of foods rich in fiber, amides, vitamins, and minerals such as fruits, vegetables, legumes, and grains. Consumption of fish should be increased, and consumption of red meats decreased.

  • Keep weight under control; body mass index should be less than 25 kg/m2. To maintain an appropriate body weight, in addition to a balanced diet, persons should engage in regular physical activity that takes into account the physical condition as well as health status of the individual.

Figure (www.cuore.iss.it)

Figure 1. Risk of myocardial infarction within 5 years for diabetic women (non-fumatrici = non-smokers, fumatrici = smokers, pressione = systolic blood pressure in mm Hg, and colesterolemia = blood cholesterol level in mmol/l).

Figure 2. Risk of myocardial infarction within 5 years for non-diabetic women (non-fumatrici = non-smokers, fumatrici = smokers, pressione = systolic blood pressure in mm Hg, and colesterolemia = blood cholesterol level in mmol/l).

Figure 3. Risk of myocardial infarction within 5 years for diabetic men (non-fumatori = non-smokers, fumatori = smokers, pressione = systolic blood pressure in mm Hg, and colesterolemia = blood cholesterol level in mmol/l).

Figure 4. Risk of myocardial infarction within 5 years for diabetic men (non-fumatori = non-smokers, fumatori = smokers, pressione = systolic blood pressure in mm Hg, and colesterolemia = blood cholesterol level in mmol/l).