CUORE project: implementation of the 10-year risk score.

PURPOSE: The Italian national prevention plan 2005-2008 included 10-year cardiovascular risk (10-CR) assessment of the general population aged 35-69 years using the CUORE project risk score. General practitioners (GPs) were encouraged to collect data on risk factors and 10-CR and to contribute to the Cardiovascular Risk Observatory (CRO). The aim is to demonstrate feasibility and effectiveness of 10-CR assessment as a first step to implement primary preventive actions at the individual level. METHODS: Data were collected using CUORE.EXE software, easily and freely downloadable by GPs from the CUORE project website (www.cuore.iss.it). CRO provides a web platform to analyse and compare data on 10-CR and risk factors at regional and national levels with the aim of supporting health policy decision processes. RESULTS: From January 2007 to May 2010, 2,858 GPs downloaded cuore.exe; 139,269 CR assessments on 117,345 persons were sent to CRO. CR mean was 3.0% in women, 8.3% in men; 30% of men and 65% of women were at lower risk (CR < 3%), 9.2% of men and 0.4% of women were at high risk (CR ≥ 20%). Among those with at least two risk assessments (n = 5,948), 8% (95% CI 7-9%) shifted to a lower risk class after 1 year. Systolic blood pressure mean levels decreased by 1.6 mmHg (95% CI 1.2-2.1 mmHg), diastolic blood pressure by 0.9 mmHg (95% CI 0.5-1.3 mmHg), total cholesterol by 5.6 mg/dl (95% CI 4.3-6.8 mg/dl), and smokers prevalence by 3.5% (95% CI 2.5-4.6%); high-density lipoprotein cholesterol increased in women by 1 mg/dl (95% CI 0.5-1.4 mg/dl). CONCLUSIONS: Data demonstrate that 10-CR assessment can be the first step to implement preventive actions in primary care.

Reliable surveillance of tick-borne encephalitis in European countries is necessary to improve the quality of vaccine recommendations.

In July-November 2009, 26 European Union (EU) Member States (MSs), Norway and Iceland, participated in a survey seeking information on national tick-borne encephalitis (TBE) vaccination recommendations. Information on TBE surveillance, methods used to ascertain endemic areas, vaccination recommendations, vaccine coverage and methods of monitoring of vaccine coverage were obtained. Sixteen countries (57%) reported presence of TBE endemic areas on their territory. Vaccination against TBE was recommended for the general population in 8 (28%) countries, for occupational risk groups - in 13 (46%) countries, and for tourists going abroad - in 22 (78%) countries. Although vaccination recommendations for country residents, and for tourists always referred to endemic areas, there was no uniform, standardized method used to define endemic areas. For this reason, clear recommendations for tourists need to be developed, and standardized surveillance directed to efficient assessment of TBE risk need to be implemented in European countries.

Hepatitis B immunisation programmes in European Union, Norway and Iceland: where we were in 2009?

In January 2009 25 European Union (EU) Member States (MSs), Norway and Iceland, participated in a survey seeking information on national hepatitis B vaccination programmes. Details of vaccination policy, schedule, population groups targeted for vaccination, programme funding, vaccine coverage and methods of monitoring of vaccine coverage were obtained. Twenty (74%) countries reported that they have a universal hepatitis B vaccination programme, in addition to immunisation of at risk groups; seven (26%) countries recommend HBV for high risk groups only (with some inter-country variation on groups considered at high risk). Among countries without universal hepatitis B vaccination programmes, the major factor for non-introduction is low disease endemicity.

[Cardiovascular Risk Assessment: preliminary results]. / Osservatorio del Rischio Cardiovascolare: primi risultati.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 (CR < 3%), 9% of men and 0.4% of women were found at high risk (CR > or = 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. CONCLUSIONS: 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.