Prevention Italy 2021 - An update of the 2018 Consensus document and recommendations for the prevention of cardiovascular disease in Italy

Cardiovascular prevention represents one of the most important strategies of public health, since cardiovascular diseases are the first cause of morbidity and mortality worldwide. Measures to promote a healthy lifestyle and an adequate control of risk factors need be highlighted also during the COVID-19 outbreak, which has dramatically changed the priorities and the use of available resources by the National Health Systems. Indeed, the COVID-19 pandemic and the consequent lockdown measures imposed in several countries have caused a widespread diffusion of behaviors with detrimental effects on the cardiovascular system, including inappropriate dietary habits, sedentary lifestyle and smoking. Moreover, as a consequence of the COVID-19 outbreak, a relevant number of programmed follow-up visits and screening procedures have been cancelled, and hospital admissions for severe acute pathologies, such as myocardial infarction, have been significantly reduced, with a parallel increase in fatality and complication rates. This represents a serious social issue, whose impact will last for many years, and which deserves priority attention by the scientific and healthcare communities. In such a context, cardiovascular prevention may play a key role in interrupting this vicious circle. The aim of this update of the 2018 SIPREC consensus document is to analyze and highlight the available evidence produced by medical research over the last 3 years, providing with the synergistic contribution of many scientific societies an integrated tool to support clinical practice. Indeed, important new recommendations have been introduced in the management of hypertension, dyslipidemias and type 2 diabetes, consisting in the identification of lower therapeutic targets, the promotion of combination strategies and the introduction in routine clinical practice of new effective pharmacological classes, such as sodium-glucose cotransporter-2 inhibitors for the treatment of diabetes and heart failure and proprotein convertase subtilisin/kexin type 9 inhibitors for hypercholesterolemia. Moreover, new evidence has become available for the management of antiplatelet therapy, both in primary and secondary prevention. Finally, much attention has been devoted to telemedicine, which has shown great promise to support cardiovascular prevention and care not only during the COVID-19 pandemic but also as part of routine care in the future.