CREMONA – In contrasting cardiovascular diseases, the rigid distinction between primary and secondary prevention must be overcome. It is increasingly necessary to evaluate the conditions and functionality of the organs that are the “target” of the main risk factors. A new indispensable approach to improve medical-health assistance towards pathologies that cause, every year only in Italy, more than 900,000 hospital admissions. They also cause 232 thousand deaths and cost our country a total of 21 billion euros (16 for direct costs and 5 for indirect ones).
The invitation to the institutions and the medical-academic world is contained in a document drawn up by the Council of Scientific Societies for the reduction of Cardio-Vascular Risk (www.consulta-scv.it). The alliance brings together 16 different Scientific Societies and presents its work in the context of a workshop entitled “Focus on three major issues for the NHS: Reflections and Proposals of the SCV Consulta”.
“Cardio-vascular diseases represent the first cause of death throughout the planet – says the professor Joseph Manchapresident of the Consulta-SCV, Professor Emeritus of the Milano Bicocca University and President of the European Society of Hypertension Foundation -. Their prevention remains by far the best strategy at our disposal to limit their overall impact on the NHS. The prevention can be primary and involve interventions on lifestyles and other risk factors. Or secondary and therefore aimed at the eavoid recurrences in people already affected by a cardiovascular event. This subdivision has had, and continues to have, numerous positive effects on clinical practice. However, it has limitations, which can be overcome thanks to more accurate diagnostic tests. Today they have been finalized biomarkers of organ damage and new instrumental investigations such as bio-images. Compared to a few years ago it is therefore possible quantify and qualify the structural and functional damage to the cardiovascular system. For example, the most advanced ultrasound and tomographic techniques allow early identification of lesions, even very slight ones, to the vascular system of the heart or kidneys or other organs. All this inevitably leads to important clinical-therapeutic repercussions and opportunities for early intervention for all patients. This greater diagnostic precision allows a timely identification of organ damage and a consequent adequate quantification of the risk. The classic paradigm with which we classify patients, interpret our guidelines and give therapeutic recommendations will therefore have to be reviewed in the light of the new role assigned to the organ damage, the real new “silent killer”.
“Updating work must also be done for the fragile patient – solines Professor Giovanni Corrao, Director of the Interuniversity Healthcare Research and Pharmacoepidemiology Center -. The Consulta-SCV has in fact proposed setting up an interdisciplinary working group to study this issue. In fact, every person affected by a cardiovascular pathology has different levels of frailty, which depend on various factors such as clinical complexity, biological susceptibility and even social vulnerability. These are all elements that must be translated into an individualized care plan which then takes into account the individual aspects of each patient. This is especially true in the clinical and healthcare management of chronicity, a condition that affects a growing number of patients”.
HERE THE SCIENTIFIC COMPANIES
At the Rome Workshop, the Consulta also presents a third document, dedicated to theperipheral arterial disease of the lower limbs. “It is a decidedly neglected pathology even if it can affect up to 10% of the adult population – continues la Professor Adriana Visonà, Director of UOC Angiology, Local Health Unit 2, Marca Trevigiana Veneto Region-. It is characterized by one severe reduction in blood supply and oxygen to the arteries of the lower extremities, due to blockage or narrowing of blood vessels. The disease also does not always present with specific symptoms. A patient with PAD has a sixfold increased risk of cardiovascular events, including heart attack and stroke. It is estimated that peripheral arterial disease of the lower limbs will increase significantly over the next 20 years, also due to the general aging of the population”.
“Fortunately, there are different types of therapies capable of effectively counteracting it – he adds Dr. Walter Marrocco, Scientific Responsible of the Italian Federation of Family Doctors/FIMMG and Coordinator of the Consulta-SCV-. However, as a Consulta we are absolutely convinced that arterial disease can also be defeated thanks to new awareness campaigns that increase awareness among the population. Finally, the multidisciplinary and multiprofessional collaboration of all the medical personnel involved in the treatment process must be made systematic”.
