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Background: The CardioRESET project was carried out in 2005 to evaluate the feasibility of a cardiovascular risk factor survey by general practitioners in Friuli Venezia Giulia, a north-eastern Italian region., Methods: We randomized 2701 subjects (1336 males and 1365 females), aged 35-74 years, from the general population. The family doctors surveyed the randomized population sample using the standardized methods of the Osservatorio Epidemiologico Cardiovascolare, a reference national survey., Results: The participation rate was 85.4% and all variables were recorded at least in 60% of subjects. Mean values of risk factors, prevalence of hypertension, dyslipidemia, diabetes and data on their control, smoking habits were comparable with data from the Osservatorio Epidemiologico Cardiovascolare; only the mean value of low-density lipoprotein cholesterolemia was higher in our region., Conclusions: This experience points out that in a small region it is possible to engage general practitioners to achieve a standardized surveillance of cardiovascular risk factors at a low cost.

On the basis of a critical literature review, this article deals with the concepts of global cardiovascular risk and cardiometabolic risk, pointing out their links but also their unresolved issues and discussing their usefulness in clinical practice. The global cardiovascular risk is the probability of suffering from a coronary event or stroke in a given period of time and in this sense it is an absolute risk, generally reported as percentage at 10 years. Usually risk functions are used, derived from longitudinal studies of healthy people at baseline. They consider some factors that are coherently linked with events in population analyses: among these there are some metabolic factors (total cholesterol, HDL cholesterol, fasting blood glucose), some biological factors (blood pressure) and some lifestyle factors (tobacco smoking), all modifiable beyond those non-modifiable like age and gender. The chosen factors must be independent at multivariate analysis, simple and standardized to measure, and contribute to significantly increase the risk-function predictivity. To be reliable, these risk functions must be derived from the same population where they will be later administered. For this reason the Italian Progetto CUORE, in the longitudinal study section, built a database of risk factors from longitudinal comparable studies started between the mid '80s and '90s and followed up the participants for cardiovascular mortality and morbidity to estimate the Italian global cardiovascular risk (first coronary or cerebrovascular event) for men and women. Two tools have been produced, the risk charts and a score software (see www.cuore.iss.it). The ongoing epidemics of obesity and diabetes and the fact that diabetes is associated with classical risk factors like hypertension and dyslipidemia induced the American Diabetes Association and the American Heart Association to launch a "call to action" to prevent both cardiovascular disease and diabetes. In this paper, as cardiometabolic risk factors were considered those "closely related to diabetes and cardiovascular disease: fasting/postprandial hyperglycemia, overweight/obesity, elevated systolic and diastolic blood pressure, and dyslipidemia". The association among the cardiometabolic risk factors has been known for a long time, and much of their etiology has been ascribed to insulin resistance. Also, the fact that these "metabolic" abnormalities can cluster in many individuals gave rise to the term "metabolic syndrome", a construct embraced by many organizations but questioned by other authors. From an epidemiological point of view the metabolic syndrome seems to increase modestly the cardiovascular risk, whereas in non-diabetic individuals it predicts diabetes much more efficiently. Many studies have compared the performance of the classical cardiovascular evaluation tools (the Framingham risk score, the SCORE charts, the Progetto CUORE score) and metabolic syndrome in cardiovascular disease prediction. Usually in people at high risk the presence of the metabolic syndrome does not improve the risk, whereas in people at lower risk its presence increases significantly the chances of cardiovascular disease. Many studies have shown that positive lifestyle interventions markedly reduce the rate of progression of type 2 diabetes. Also some drugs were tested for diabetes prevention, usually in people with impaired glucose tolerance. Oral diabetes drugs considered together (acarbose, metformin, flumamine, glipizide, phenformin) were less effective than lifestyle interventions, with different results among the drugs; the antiobesity drug orlistat gave similar results to lifestyle interventions. In Italy an appropriate approach to cardiovascular disease and diabetes prevention may be that of first evaluating the global cardiovascular risk using the charts or the score software of the Progetto CUORE, because high-risk subjects (> or =20%) must be treated aggressively independently of the presence of the metabolic syndrome; as a second step the metabolic syndrome may be sought, because it increases the risk; finally some attention should be paid to non-diabetic hyperglycemic individuals.

Uptake of I-131 in the pericardial area is described in an asymptomatic patient who underwent total body scan for recurrent papillary thyroid cancer. Ultrasonography demonstrated a small pericardial effusion that persisted after I-thyroxine therapy was reinstituted. Two I-131 therapeutic doses were given, and follow-up total body scans were performed during the next 6 years. Although tracer accumulation in the neck was eliminated and the serum thyroglobulin level was not elevated, I-131 uptake persisted in pericardial effusion. Despite diligent study, no neoplastic, infectious, or autoimmune etiology could be demonstrated, and we thus classified it as idiopathic pericardial effusion. This phenomenon should be considered when interpreting I-131 scans that show I-131 uptake in the region of the heart.

In order to evaluate the diagnostic efficacy of Holter monitoring in the follow-up of pacemaker patients, the recordings of 122 patients were reviewed. Indications for monitoring were: evaluation of pacemaker function in 23.6% of the cases; sporadic appearance of arrhythmias in 26.7%; total or partial unconsciousness in 9.7%; a variety of symptoms such as palpitation (12.7), dizzy-spells (9.7%) and irregular pulse (4.2%). Prolonged monitoring of cardiac activity allowed us to exclude pacemaker malfunction in 87.5% of cases of syncope and 88.6% of cases of palpitation, dizzy-spells and irregular pulse; while it disclosed defects of electrostimulation in 11.4% of cases in loss of consciousness in 12.5% of patients with various symptoms and none in cases of arrhythmias. It allowed us to evaluate the therapeutic efficacy of used drugs in 18.2% of cases. Given the variety of clinical and instrumental problems of pacemaker patients, Holter monitoring proved to be a very essential diagnostic means in the follow-up of such patients.

According to a recent national survey, 387 patients were treated by permanent pacing in 10 Italian centers, between 1961 and 1966. Of these patients 205 have died; 131 (77 males and 54 females) are still alive and no informations could be obtained for the remaining 51 (13%). The overall survival of patients treated during this period of time is therefore not less than 34% which is comparable to that of general population of the same age group. The 131 patients still alive have totaled 1,486 years of pacing and have used up to 784 pacers. Comparing the incidence of the most common causes for replacement during the periods 1961-66 and 1973-77, electrode failures dropped from 21 to 0.9%; circuitry malfunctions occurred in 10.5 and 7.8%; battery depletion rose from 36.8 to 69% of the cases. According to their clinical conditions, the 131 patients on long-term follow-up can be grouped as follows: 62% are in class 1 or 2 of NYHA; 26.7% are in class 3, and 3.8% in class 4. Moreover, 53.4% of patients are living an active life, having some sort of occupation and 29% are holding a driving license.

The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and computerized. The HP-5 program has shown a very high specificity for tracings classified as normal (0.7% of false negatives) and for those classified abnormal (no false positive), while the level of agreement between manual and computer readings of the tracings classified atypical or borderline, was fair (75%). It is concluded that the new program represents a significant step forward in the practical use of computerized ECG.

The HP-5 program for computer analysis of the ECG has been evaluated as far as sensibility and specificity in a multicenter study. A consistent number of tracings (850) were sampled according to a statistical formula and all measurements and statements given by the computer were checked in a standardized manner. The collected data were classified and computerized. The HP-5 program has shown a very high specificity for tracings classified as normal (0.7% of false negatives) and for those classified abnormal (no false positive), while the level of agreement between manual and computer readings of the tracings classified atypical or borderline, was practical of computerized ECG.