Palmieri Luigi, Rielli Rita, Demattè Luca, Donfrancesco Chiara, La Terza Giampaolo, De Sanctis Caiola Patrizia, Dima Francesco, Lo Noce Cinzia, Giannelli Anna Maria, Brignoli Ovidio, Cuffari Alfredo, De Rosa Marisa, Addis Antonio, Laurendi Giovanna, Giampaoli Simona
Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma.
G Ital Cardiol (Rome). 2010 Feb;11(2):154-61.
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 (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.
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.
意大利国家预防计划包括使用CUORE项目风险评分对35至69岁的意大利普通人群进行10年心血管风险(CR)评估。2003年,卫生部启动了一项针对全科医生(GP)的全国培训计划。鼓励全科医生收集风险因素和风险评估数据,并为CUORE项目心血管风险观察站(CRO)做出贡献。本分析的目的是证明在初级保健中进行风险评估的可行性和有效性。
cuore.exe软件对全科医生免费,可从CUORE项目网站(www.cuore.iss.it)轻松下载,是全科医生数据收集的框架。CRO提供了一个平台,用于分析收集到的风险评估和风险因素数据,并在区域和国家层面比较结果,以支持卫生政策制定者的决策过程。
从2007年1月至2009年4月,2858名全科医生下载了cuore.exe软件;根据87556人的风险因素概况,向CRO发送了102113次风险评估(3617人有多次风险评估)。女性的CR平均水平为3.1%,男性为8.4%;30%的男性和65%的女性处于低风险(CR<3%),9%的男性和0.4%的女性处于高风险(CR≥20%)。在至少进行过两次风险评估的人群中,8%在1年后风险等级降低。收缩压和舒张压的平均水平在1年内下降了约1%;总胆固醇下降超过2%,第二次风险评估时吸烟者的患病率下降了约3%。
这些数据表明,风险评估可作为初级保健预防的第一步。预计CUORE项目的个人评分将成为全科医生评估患者CR、促进一级预防以及关注采用健康生活方式的重要工具。