Hypertension, coronary artery and cerebrovascular diseases in the population. Has epidemiology changed in the last decades?
Life expectancy has significantly increased in the last decades in many western populations, due to the fall of total and cardiovascular death rate. However, morbidity from cardiovascular diseases has decreased to a smaller extent. The overall population risk profile has improved, but it is still unsatisfactory. This is true for blood pressure control (with only 20% of hypertensive patients achieving normotension with antihypertensive drugs), hypercholesterolemia (with borderline-high serum cholesterol levels in 50% of the population), and smoking habits. Other potential causes of the poor cardiovascular prevention are: 1) a limited knowledge of the optimal blood pressure goal with antihypertensive treatment, 2) scanty information on the long term effects of antihypertensive drugs on cerebral and coronary circulation. Finally, little is being done to improve primary prevention in youth, when the slowly progressing atherosclerotic plaque formation is already on the way. To improve the cost / effectiveness of cardiovascular prevention, efforts must concentrate on the early identification of the subjects at the highest risk and on health promotion among youngsters. Large epidemiological trials conducted from the early 50s have provided convincing evidence of the multifactorial origin of cardiovascular diseases and encouraged the implementation of population based primary and secondary preventive measures, including antihypertensive treatment, as well as dietary and life-style modifications. It is now time to start asking ourselves whether or not we are satisfied with the results obtained in terms of reduced morbidity and mortality, whether these results are the direct consequence of these measures and whether or not we can do even better. The present work reviews some of the most recent comparative reports on the epidemiology of cardiovascular diseases in different populations, and some intervention trials to answer these questions and to help in identifying the most cost-effective approach to cardiovascular disease prevention in the next few years.
Pessina
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Institute of Clinical Medicine, University of Padova Medical School, Italy.
Serena
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Semplicini
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D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D015981:Epidemiologic Factors; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D012307:Risk Factors