👤 Fiorenzo Gaita

Cardiovascular diseases (CVDs) remain a leading global cause of mortality and disability, with significant disparities observed across countries. This is particularly true in Central and Eastern Europe (CEE), where populations are primarily at high and very high CVD risk. Highlighting modifiable risk factors underscores the urgent need for effective prevention programs. This paper introduces the European Program for Prevention (EPP), an initiative by the International Lipid Expert Panel (ILEP), designed to address these challenges. The EPP aims to enhance awareness and knowledge of validated preventive healthcare solutions implemented in CEE countries, showcase the region's potential for innovative strategies, and evaluate the adaptability of successful programs for broader implementation. The EPP strongly supports the EU Cardiovascular Health Plan, as well as initiatives by the World Heart Federation (WHF) and World Health Organization (WHO), by promoting best practices, early detection, integrated prevention frameworks, training, cross-border cooperation, and policy development. It advocates shifting healthcare priorities towards pre-disease prevention, thus reducing reliance on resource-intensive treatments. The program proposes an optimal CVD prevention system that includes mandatory health education, screening programs for familial hypercholesterolemia and universal Lp(a) screening, and comprehensive check-ups, notably integrated, comprehensive care programs. By leveraging existing validated programs and fostering collaboration, the EPP seeks to reduce the burden of CVD, improve outcomes, and promote cardiovascular health across Europe and beyond. Show less

In patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF), radiofrequency catheter ablation (RFCA) represents a promising option. However, the predictors of RFCA efficacy remain largely unknown. We assessed the outcome of a multicentre HCM cohort following RFCA for symptomatic AF refractory to medical therapy. Sixty-one patients (age 54 +/- 13 years; time from AF onset 5.7 +/- 5.5 years) with paroxysmal (n = 35; 57%), recent persistent (n = 15; 25%), or long-standing persistent AF (n = 11; 18%) were enrolled. A scheme with pulmonary vein isolation plus linear lesions was employed. Of the 61 patients, 32 (52%) required redo procedures. Antiarrhythmic therapy was maintained in 22 (54%). At the end of a 29 +/- 16 months follow-up, 41 patients (67%) were in sinus rhythm, including 17 of the 19 patients aged < or = 50 years, with marked improvement in New York Heart Association (NYHA) functional class (1.2 +/- 0.5 vs. 1.9 +/- 0.7 at baseline; P < 0.001). In the remaining 20 patients (33%), with AF recurrence, there was less marked, but still significant, improvement following RFCA (NYHA class 1.8 +/- 0.7 vs. 2.3 +/- 0.7 at baseline; P = 0.002). Independent predictors of AF recurrence were increased left atrium volume [hazard ratio (HR) per unit increase 1.009, 95% confidence interval (CI) 1.001-1.018; P = 0.037] and NYHA functional class (HR 2.24, 95% CI 1.16-4.35; P = 0.016). Among 11 genotyped HCM patients (6 with MYBPC3, 2 with MYH7, 1 with MYL2 and 2 with multiple mutations), RFCA success rate was comparable with that of the overall cohort (n = 8; 73%). RFCA was successful in restoring long-term sinus rhythm and improving symptomatic status in most HCM patients with refractory AF, including the subset with proven sarcomere gene mutations, although redo procedures were often necessary. Younger HCM patients with small atrial size and mild symptoms proved to be the best RFCA candidates, likely due to lesser degrees of atrial remodelling. Show less