Does surveillance impact on cardiovascular prevention?

Many epidemiological projects and clinical trials on determinants of atherosclerotic cardiovascular diseases (CVDs) have been conducted to identify risk factors and demonstrate the reversibility of risk through actions directed at their reduction, both in healthy subjects and in patients with established CVDs. At the international level, the Seven Countries Study identified risk factors common to different cultures, consistent for their importance, predictive power, and frequency among the general population.1 Smoking habit, and a rich diet with consequent high levels of total cholesterol and high blood pressure, were ascertained to be partly responsible for differences in the incidence of stroke and coronary heart disease (CHD) between countries.2,3 The WHO's European Collaborative Trial of the multifactorial prevention of CHD demonstrated the reversibility of risk among European populations, through healthier lifestyles and treatment of high risk subjects.4 To this extent the North Karelia Project represents the best example of community-based primary prevention.5 In all these studies, risk factors were carefully standardized and CVD incident events and deaths validated. The scenario may be different when evaluating whole countries. In fact in most industrialized countries CHD mortality has decreased since 1960, but in others it has increased. Time trends have been described for total cholesterol, smoking habit, blood pressure, and body mass index. However, the comparability of mortality and risk factors data was poor. The MONICA-WHO Project (Monitoring Trends and Determinants in Cardiovascular Disease) was the first multinational large-scale study specifically designed to understand the wide variations in CHD and stroke mortality among different countries, … *Corresponding author. Tel: +39 0432 554449, Fax: +39 0432 554448, Email: dichiara.antonio{at}aoud.sanita.fvg.it