On the occasion of the meeting “Prevention that matters to the heart. Cardiovascular disease and cholesterol in high-risk patients: acting first, intensively and effectively, to reduce mortality”, held in Milan on the eve of World Heart Day 2022 ( 29 September), the survey carried out by Swg for Sanofi was presented, in which the level of awareness and knowledge regarding cardiovascular diseases and the consequences of hypercholesterolemia is analyzed. Andrea Rizzi, Medical Head General Medicines of Sanofi Italy, poses the ’emphasis on the concrete commitment that the company puts in the work of raising awareness regarding cardiovascular diseases: “At Sanofi we are committed every day to the study of innovative therapeutic solutions and programs for improving the quality of life and survival of patients with cardiovascular diseases. At Sanofi we work alongside the associations that represent patients and the medical profession, to help drastically reduce the impact in terms of mortality and quality of life that cardiovascular diseases still have today, offering not only concrete answers in terms of treatments and therapies and management in the field of secondary prevention – with particular attention to patients high risk – but also opportunities for discussion and reflection useful for raising public awareness and information “. The data that emerged from the survey – conducted by filling in an online questionnaire by a sample of 1,202 Italian citizens aged between 45 and 74 years – represent a precious opportunity to reflect on the steps to be taken to concretely improve the health of citizens and their predisposition to prevention, since the numbers linked to the impact of cardiovascular diseases in terms of mortality are still alarming. 34.8% of deaths in our country are attributable to cardiovascular diseases and some of them could be preventable with adequate prevention and solid therapeutic adherence, as Emanuela Folco, president of the Italian Heart Foundation (Fipc) explains: “In our country, over 1 in 3 deaths is attributable to cardiovascular diseases, the leading cause of death for both men (31.7%) and women (37.7%). Anyone who survives a heart attack becomes chronically ill. The disease changes the quality of life and involves significant economic costs for society. In Italy, the prevalence of citizens living with cardiovascular disability is equal to 4.4 per thousand. This – continued Folco – is partly attributable to the increase in life expectancy, with an increasingly elderly and therefore ‘fragile’ population, as well as to the prevalence of cardiovascular risk factors, including hypercholesterolemia. After almost three years of pandemic, we still see today how the general perception is that cardiovascular diseases do not occupy the first places among the diseases to be feared, given in contrast to what we see in everyday life where mortality from cardiovascular causes occupies the very first places “.” Today is an opportunity to reiterate, once again, the importance of raising awareness among citizens and patients to take their cardiovascular health to heart starting from primary prevention, emphasizing, as always, the need to adopt correct lifestyles and a healthy diet, but also and above all secondary where there is a pathological condition that needs to be taken in charge by the specialist. Furthermore – concluded the president – therapeutic adherence represents a fundamental aspect: the patient must continue taking the drugs indicated by the specialist with care and consistency, respecting all the indications and not suspending the therapy once the first positive results have been glimpsed ” . The lack of awareness of the crucial role played by hypercoleserolemia in the onset of cardiovascular diseases is also worrying. Over 40% of the interviewees, in fact, underestimate the risks associated with high cholesterol levels, while about 1 in 3 believe that the risk of mortality associated with hypercholesterolemia should concern only those with previous heart problems. 20% of the sample does not know the risks deriving from high cholesterol levels, while for 42% the control of the cholesterol level depends only on the diet and physical activity, thus neglecting the therapeutic efficacy. And again, less than 1 in 2 (43% of the sample) know that LDL cholesterol is harmful to our health. Giuseppe Ciancamerla, president of the Conacuore Association, explains: “It is necessary to overcome the preconception that cholesterol can only be fought with diet. It is clear that this can help, but hypercholesterolemia is a pathology, it is called atherosclerosis, and must be treated with the help of a specialist. For this reason, patients need to be increasingly aware of the need to know the various types of cholesterol and their optimal values with the help of risk cards, which are easy to read, and which correct an inadequate lifestyle. Even more so if we are talking about a patient with a high cardiovascular risk, in order to maintain adherence to therapy and thus counteract mortality. A traumatic health event such as a heart attack can in fact have physical, but also emotional, devastating effects. In some cases, the specialist plays a pivotal role because he is called to evaluate the involvement of other figures, through a multidisciplinary approach, for a global management of the high-risk patient “. 92% of the interviewees affirmed that cardiovascular problems can be avoided with prevention. However, this consolidated belief does not correspond to concrete actions: only for 17% of the sample, in fact, it is advisable to periodically carry out check-ups, while only 31% underwent a cardiovascular risk assessment in the last 12 months. However, more than others, patients with high cardiovascular risk are unable to escape regular checks and represent, according to international guidelines, the real and urgent priority in the context of preventive interventions. Professor Ciro Indolfi, president of the Italian Society of Cardiology (Sic), underlines this in his speech: “The topic of prevention is of great importance for all of us, but it becomes crucial when it comes to patients with high cardiovascular risk: who has been affected from a cardiovascular event, in fact, he runs a high risk of undergoing a new heart attack or stroke in the following years. Events that could be significantly reduced – as the recent guidelines of the European Society of Cardiology recall – if secondary prevention strategies were increasingly implemented “.” Precisely in the direction of early and rapid treatment – added Indolfi – the lowering of the LDL cholesterol thresholds for access to the new anti-cholesterol drugs Pcsk9, recently published in Gu da Aifa. Scientific evidence shows that LDL cholesterol is the cause of cardiovascular diseases, not a risk factor, and how its reduction therefore represents one of the main objectives for limiting cardiovascular events such as myocardial infarction and counteracting mortality. In fact, the guidelines of the European Society of Cardiology – concluded Indolfi – suggest Ldl cholesterol levels lower than 55 mg / dl in secondary prevention and, in some particularly at risk patients, Ldl-C levels even lower and lower than 40. mg / dl. These ambitious goals can now be achieved thanks to the Pcsk9 protein inhibitors, capable of reducing the LDL cholesterol level by 60%, demonstrating a clear clinical benefit in patients with high cardiovascular risk. A change of course, the one started for the first time in Italy compared to other European countries, for the secondary prevention of cardiovascular diseases “. The patient at high cardiovascular risk has suffered one or more cardiovascular events and is a chronic patient who, as such, treaty. Although he is often on oral medications such as statins and ezetimibe, he continues to have high LDL cholesterol levels. For this reason, its management today represents one of the main complexities for national health systems, as Giuseppe Di Tano, of the National Association of Hospital Cardiologists (Anmco) points out: “For a correct and appropriate care and management of patients with cardiovascular disease note with a high risk of events, it is necessary to implement various actions, also through a more effective synergy between primary care, hospital and territory. The control of risk factors through an incisive and early pharmacological intervention, constant monitoring of clinical conditions, sensitization of the patient, of his family-social environment and of the caregiver on the importance of adherence to therapy and lifestyle norms recommended, are fundamental elements capable of counteracting the risk of facing a new cardiovascular episode “.” As in primary prevention, also in secondary prevention it is essential to promote patient engagement in the treatment path, so as to encourage greater proactivity in the management of one’s own health, in relation to the health system. Failure or inappropriate management of hypercholesterolemia leads, in fact, to a worsening of the state of health and exposure for the patient to a high risk of events, with negative repercussions not only on health but also on the NHS. A condition as silent as it is insidious like hypercholesterolemia must be treated incisively and early. This is why it must be attacked with an even more energetic approach than what was done until yesterday, so as to ensure effective risk containment. Finally, the possibility, as indicated by the guidelines, of using an objective and easily obtainable parameter such as the measurement of blood Ldl – concludes Di Tano – on which to modulate the therapy, aiming to reach the target levels required, represents an unavoidable recommendation to which adapt “.