Il controllo dei fattori di rischio nella

realtà

Prof. ENRICO AGABITI ROSEI

Clinica Medica -Università of Brescia

35

40

J Hypertens 2007

15

20

25

30

35

N=40.829

0

5

10

optimal (160/>100 mmHg)

ISH (>140/

FORLIFEComparison between pressure values

at visits 1 and 3 in patients with diabetes

Visit 1

(

Cholesterol and glycemia in Italy :

changes 1998-2008

1998 : 1912 M & 1870 F

2008 : 1738 M & 1741 F

150

200

250

total cholesterol LDL cholesterol HDL cholesterol

TGD glucose

** ↑

** ↑

Giampaoli S et al. Ital Heart J 2003 and 2010

0

50

100

150

1998 2008

** ↑

* ↑

Smoke and body weight in Italy :

changes 1998-2008

1998 : 1912 M & 1870 F

2008 : 1738 M & 1741 F

40

50

60

smoke normal weight overweight obesity DM MS

** ↑** ↑

* ↑

Giampaoli S et al. Ital Heart J 2003 and 2010

0

10

20

30

1998 2008

** ↑** ↑* ↑

Hypertension in Italy :

treatment and control changes 1998-2008

1998 : 1912 M & 1870 F

2008 : 1738 M & 1741 F

40

50

60

70

HT untreated HT treated uncontrolled

HT treated controlled Normotensives

Giampaoli S et al. Ital Heart J 2003 and 2010

0

10

20

30

40

1998 2008

Prevalence of hypertension, dyslipidaemia and diabetes among men

80

30

40

50

60

70

8020-39 40-59 60-79

Menotti et al, J Hypertens 2009

0

10

20

HT survey1 HT survey 3 Dyslip

survey 1

Dyslip

survey 3

DM survey

1

DM survey

3

70 allHT untreated

Prevalence of LVH in HT patients

(%)

30

40

50

60HT untreated

HT treated uncontrolled

HT treated controlled

*

* +* +

* +

*^

*

* +

*^

0

10

20

Vobarno Pamela Gubbio (2° s)

*

* vs NT, + vs IE NT, ^ vs HT uncontrolled

Renal dysfunction and BP control _I DEMAND

87 centers/4151 pts, 92 % treated, 34 % controlled

37 % diabetics

% p

ati

en

ts * *

*

22,0

26,825,0 26,5

45,2

38,9

20

30

40

50

microalb. eGFR

EUROASPIRE III disappointments

Smoking Raised BP Over

weight

Obesity Central

Obesity

140/90 or

130/80 in DM

Survey I

1995-1996

19 58 81 22 43

Survey II 15 57 72 24 55Survey II

1999-2000

15 57 72 24 55

Survey III

2006-2007

14 63 81 29 52

EUROASPIRE III

• Lifestyle of coronary patients major cause of concern

• Adverse trends in obesity and central obesity• Adverse trends in obesity and central obesity

• No change in BP control despite use of AHT treatment

(61 % above therapeutic target 140/90mmHg)

• Improvement in lipid control with increased use of

statins

• Increasing prevalence of diabetes, self reported and • Increasing prevalence of diabetes, self reported and

undetected, and deteriorating glucose control

The Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group 2011

Mean BMI

Stemming the global tsunami of cardiovascular disease

Mean Blood Pressure Mean total cholesterol

Anand & Yusuf, Lancet 2011 (data from Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group, Lancet 2011)

Percentage growth in age-standardised diabetes

prevalence, 1980–2008, by region

M Tobies, Lancet 2011 (data from G Danaei et al, Lancet 2011)

Lancet, August 28, 2011

“Health-related research cannot be separated“Health-related research cannot be separated

from research into policies related to

agriculture, trade, education, taxation, and

urban design, and political solutions across

these sectors are needed to ensure that the

health of a nation’s people is a top priority”health of a nation’s people is a top priority”

Anand and Yusuf, Lancet 2011