It is not only a matter of age or lifestyle: educational attainment also affects the heart health of older adults. This is demonstrated by data from PreVasc (Cardiovascular Prevention), the first community-based cardiovascular screening project, whose findings were presented today at the Chamber of Deputies during the press conference “Communities Caring for Health. The PreVasc Project and Local Partnerships for Heart Health”, promoted by MP Gian Antonio Girelli and the Parliamentary Intergroup on Prevention and Risk Reduction.
The screening programme, promoted by the Italian Society of Geriatric Cardiology (SICGe) in collaboration with the Cardiothoracic and Vascular Department of Careggi Hospital in Florence, the Fondazione Longevitas ETS and the Salute e Società Association, also involved the University of Rome Tor Vergata and UniCamillus University. It was conducted among more than 2,600 people over the age of 65 in senior centres, parishes and community gathering places in Rome’s Municipality VI.
The PreVasc experience provided an opportunity to discuss the role of institutions in developing a new prevention model capable of complementing traditional healthcare pathways with community-based interventions, placing cardiovascular prevention and its dissemination across local communities at the centre of the institutional debate.
From healthcare facilities to the community: a new prevention model
“PreVasc data show that cardiovascular prevention cannot stop at the doors of healthcare facilities: it must reach people where they live, especially those who are more socially and economically vulnerable. The gap between people with lower and higher levels of education is a warning sign that Parliament cannot ignore. It means that, without targeted interventions, we risk leaving behind precisely those who are most exposed. As a Parliamentary Intergroup, our commitment is to place these findings at the centre of the political agenda, in order to transform experiences such as this one into a national model,” said MP Antonio Girelli, President of the Parliamentary Intergroup on Prevention and Risk Reduction.
Screening results
Among the 2,600 people over the age of 65 who underwent screening, with an average age of 74.7 years, 43% had hypertension, 47% dyslipidaemia, 7% diabetes, 14% were smokers and 21% former smokers. However, it is the data on cardiac function that is particularly noteworthy: 241 people, corresponding to 9.2% of the sample, had an ejection fraction below 50%, while in three cases the value fell below 30%.
The screening also identified moderate or severe valvular heart disease: aortic stenosis in 1.07% of those examined, mitral regurgitation in 4.69% and tricuspid regurgitation in 5%.
Low educational attainment and social disadvantage affect heart health in older adults
“These figures show how crucial it is to identify cardiovascular conditions and risk factors at an early stage, particularly among older people, by bringing prevention directly into the places where people live their everyday lives,” said Alessandro Boccanelli, project coordinator for the Italian Society of Geriatric Cardiology and President of the Salute e Società Association.
“What is particularly concerning is not only the clinical data themselves, but also the significant differences associated with social conditions,” Boccanelli warns. “Heart disease affects 38.6% of people with primary-level education, compared with 16% of university graduates. The relationship appears even more pronounced when considering that the average number of diseases rises from around three among people with lower levels of vulnerability to almost four among those with greater vulnerability. We are further investigating these findings by integrating clinical and sociological approaches. Fewer years of education can in fact often translate into a lower ability to understand the importance of prevention and ‘silent’ risk factors, as well as a greater risk of delayed diagnosis, as these individuals tend to seek medical attention only when the disease is already advanced.
“Compared with educational attainment, household income appears to be a relatively less important factor. Overall, the lowest income brackets show less favourable trends, particularly with regard to obesity: 27.5% among those with an annual income below €10,000 compared with 15.9% in the €30,001–€50,000 bracket, although the difference across the four income brackets is only just above the threshold for statistical significance (p=0.058). Smoking and hypertension show differences in the same direction, but these are not statistically significant.”
Prof. Francesco Vetta, President of SICGe, adds: “One of the main objectives of the Italian Society of Geriatric Cardiology is to increase awareness among both the general population and the medical community of cardiovascular diseases that occur in older age. This is necessary to highlight the fact that, despite the increase in life expectancy over recent decades, there is still insufficient attention to conditions such as valvular heart disease, heart failure and atrial fibrillation, with discriminatory attitudes on the part of physicians and resignation on the part of patients. The PreVasc study is part of this effort.”
“The University of Rome Tor Vergata, through the Department of Nursing Sciences headed by Prof. Rosaria Alvaro, made nursing staff in training available for the screening programme, awarding academic credits for their participation. This was a highly valuable educational experience for the staff, as the young professionals were able to see first-hand the importance of prevention, namely investigating the conditions that contribute to the development of disease before it manifests itself. This represents the transition from a university in the community to a university with the community, and ultimately to a university of the community, capable of training professionals while also promoting health within the community,” said Nathan Levialdi Ghiron, Rector of the University of Rome Tor Vergata.
“The involvement of the two universities is precisely one of the developments of the project. Through Third Mission activities and the Sociology of Health, scientific expertise, research and education are brought into local communities, helping to build a prevention model that does not necessarily wait for citizens to enter a healthcare facility, but is capable of reaching them within their own communities. A university specialising in health sciences cannot remain within its classrooms: it must train professionals who are able to recognise these warning signs before hospitalisation becomes necessary, especially when the patient is older and frail. This is a responsibility, not an option. PreVasc shows that it can be done, and UniCamillus will continue to do so,” emphasises Gianni Profita, Rector of UniCamillus – Saint Camillus International University of Health Sciences.
“The PreVasc experience therefore raises an issue that goes beyond the individual project: transforming community-based prevention from a local initiative into a more structured model, consolidating the partnerships that have already been tested and assessing their extension to other areas. The focus on cardiovascular prevention among older adults is also part of Fondazione Longevitas ETS’s commitment to the Structural Heart Disease (SHD) Coalition, a European alliance bringing together patient organisations, healthcare professionals, scientific societies and other stakeholders working to raise awareness of structural heart diseases and promote their early diagnosis,” concludes Eleonora Selvi, President of Fondazione Longevitas ETS.