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Cardiovascular diseases remain the leading cause of mortality and disability in developed countries. Therefore, it is necessary to increase a policy of primary prevention. The most recent European guidelines recommend the use of the absolute risk profile as a tool to identify high-risk individuals, but also underline the need for interventions on the whole population. They also mentioned the concept of opportunistic screening for cardio- and cerebrovascular risk factors.From September 2004 to December 2008, 13 619 consecutive blood donors were evaluated to determine the absolute risk profile by using the CUORE Project score. Inclusion criteria were age between 35 and 69 years, no evidence of cardiovascular disease, 12 h fasting, and informed consent. All blood donors underwent physical examination and blood tests. The absolute risk profile system includes 8 variables: age, gender, diabetes, smoking habit, systolic blood pressure, total and HDL cholesterol, and antihypertensive therapy. The population was classified into five risk categories (5%; 5-10%; 10-15%; 15-20%;or =20%). The results were analyzed according to age and gender.The mean risk score was 2.9 +/- 3 in men and 0.8 +/- 1.04 in women. Furthermore, the proportion of subjects at low risk was high even in the most advanced age groups in both sexes, differently from the general population. In particular, in young and female subjects the risk score did not exceed 20%. The proportion of men at high risk increased in adulthood, varying between 0.5% in the 50-59 age range to 4% in subjectsor =60 years.Our results demonstrate the feasibility of a primary cardiovascular prevention program in a new opportunistic setting, not assessed previously. The implementation of this program is a valuable tool not only to identify high-risk subjects but also to maintain a favorable risk profile in low-risk subjects over time.

The Italian National Prevention plan includes 10-year cardiovascular risk (CR) assessment of the Italian general population aged 35-69 years using the CUORE Project risk score. A national training program for general practitioners (GPs) was launched by the Ministry of Health in 2003. GPs were encouraged to collect data on risk factors and risk assessment and to contribute to the CUORE Project Cardiovascular Risk Observatory (CRO). The aim of this analysis is to demonstrate the feasibility and effectiveness of risk assessment in primary care.The cuore.exe software, free of charge for GPs and easily downloadable from the CUORE Project web site (www.cuore.iss.it), is the frame for the GP data collection. The CRO provides a platform to analyze data collected on risk assessment and risk factors, and compare results at regional and national level in order to support health policy makers in their decision process.From January 2007 to April 2009, 2858 GPs have downloaded the cuore.exe software; 102,113 risk assessments were sent to the CRO based on risk factors profile of 87,556 persons (3617 persons had more than 1 risk assessment). Mean level of CR was 3.1% in women and 8.4% in men; 30% of men and 65% of women were at low risk (CR3%), 9% of men and 0.4% of women were found at high risk (CRor = 20%). Among those with at least 2 risk assessments, 8% shifted to a lower class of risk after 1 year. Mean level of systolic and diastolic blood pressure decreased by about 1% in 1 year; total cholesterol more than 2%, and prevalence of smokers decreased by about 3% in the second risk assessment.These data demonstrate that risk assessment can be included as a first step of prevention in primary care. The CUORE Project individual score is expected to become an important tool for GPs to assess their patients' CR, to promote primary prevention, and to focus attention to healthy lifestyle adoption.

Over the last decades a change in physical activity habits of the Italian population has been observed. The aim of this study was to compare occupational and leisure-time physical activity, to assess the relationship between physical activity and cardiovascular risk factors and the variation in cardiovascular risk profile measured 20 years apart in the Italian population.In two populations aged 35-69 years (MATISS 1984-1987: 2041 men, 2424 women; OEC 1998-2002: 4214 men, 4206 women) gender-specific levels of occupational (occupational physical activity [OPA]-light, OPA-moderate, OPA-heavy) and leisure-time (leisure-time physical activity [LTPA]-low, LTPA-moderate, LTPA-high) physical activity were compared. Relationship between physical activity and cardiovascular risk factors was evaluated in the two samples using logistic regression models adjusted for age, heart rate, educational level and other possible confounding variables in men and women separately. The 10-year cardiovascular risk was assessed in the two periods and in different physical activity strata using the Progetto CUORE risk score.Comparing the two studies, prevalence of OPA-low had decreased, whereas the prevalence of LTPA-low had increased. With increasing LTPA blood pressure, heart rate and glycemia decreased, whereas high-density lipoprotein-cholesterol increased with a positive effect on obesity, smoking habit and cardiovascular risk.Over the last 20 years, physical activity apparently changed: currently men and women dedicate more time to physical activity during leisure-time, and are less active at work. More active people have lower levels of major cardiovascular risk factors. Societal efforts are needed to increase physical activity levels in the population.

To evaluate 10-year cardiovascular risk, the risk chart and the individual risk score from the CUORE Project were recently introduced in Italy. These tools differ as for age range and some risk factors. Therefore, the aim of this study is to evaluate the difference between the global absolute risk assessed by the risk chart and the individual risk score using the data collected through the Osservatorio Epidemiologico Cardiovascolare (OEC).From the Osservatorio Epidemiologico Cardiovascolare sample, 6508 people aged 40-69 years without clinical manifestations of atherosclerosis were selected. Cardiovascular risk was assessed using risk chart and individual risk score and the 10-year risk was categorized in six classes (5%, 5-9%, 10-14%, 15-19%, 20-29%,or = 30%). As coefficient of agreement between risk chart and individual risk score, Cohen kappa statistic was computed using the Cicchetti-Allison weights (k(w)).From contingency tables of the two methods distribution, k(w) was 0.71 (p0.0001 and 95% confidence interval 0.70-0.72). Using the 20% risk threshold reported in Nota 13 of Agenzia Italiana del Farmaco and excluding persons who were treated for hyperlipemia refunded regardless of their chart or individual score estimation of cardiovascular risk, the differences between the two tools classification resulted in the 2.6% of the sample (1.4% were assessed as at non-high risk [20%] using the risk chart and at high risk using the individual risk score, and the opposite for 1.2%).Classification difference between risk charts and the individual risk score is quite small. Updating of predictive functions of two tools could improve their concordance also for individual evaluation, including older people and better reflecting current Italian lifestyle.