Original article Risk factors for cardiovascular disease in Sardinia from 1978 to 2001: A comparative study with Italian mainland Sandro Muntoni a,b, ⁎, Luigi Atzori a , Roberto Mereu a , Antonio Manca c , Graziella Satta d , Alessandro Gentilini c , Paolo Bianco c , Antonio Baule c , Giovanni Maria Baule c , Sergio Muntoni b a Department of Toxicology, Unit of Oncology and Molecular Pathology, University School of Cagliari, Cagliari, Italy b Centre for Metabolic Diseases and Atherosclerosis, The ME.DI.CO. Association, Cagliari, Italy c Third Medical Division, Unit of Diabetes and Metabolic Diseases, SS. Annunziata Hospital, Sassari, Italy d Department of Medical, Internistic and Anestesiological Sciences, Chemical–Clinical Laboratories Unit, University School of Cagliari, Italy abstract article info Article history: Received 17 March 2008 Received in revised form 8 October 2008 Accepted 24 October 2008 Available online 21 December 2008 Keywords: Cardiovascular risk factors Epidemiology Italy Sardinia Survey Background: This study is a survey of cardiovascular risk factors in Sardinia in the years 1999–2001 and allows us to update previously observed trends of such factors and to compare them with those in the Italian mainland. Methods: Random samples of free living population of the Mediterranean island of Sardinia, Italy, were collected. Overall, 6818 subjects, 50% of each sex, and aged 20–80+ years constituted the sample. Personal and family data were collected using a semiquantitative questionnaire of frequencies. Blood biochemical variables related to risk for atherosclerosis were measured. In particular, serum total cholesterol, HDL- cholesterol, triglycerides, Apo A-1, Apo B, Lp(a), uric acid, blood glucose and plasma homocysteine were analyzed in each subject enrolled. Results: In the age classes 20–59 years, during a 30 year period, prevalence of smoking among males continued to decrease from 58 to 24% (p for trend b 0.001), and, for the first time, prevalence of smoking among females decreased as well: from 31% in 1995 to 20% in 2001 (p for trend b 0.001). In contrast, a steady increase inTC (mg/dl) (189, 206, 215, 216, p for trend b 0.05 in males and 184 197, 212, 217, p for trend b 0.05 in females), and LDL-C (136, 143, 138, 144, p for tend b 0.05 in males and 127, 139, 136, 135, p for trend b 0.05 in females) was observed. HDL-C showed a steady increase (p for trend b 0.01 in males and females). Lp(a) values were high in both sexes, a finding linked to the ethnic influence on them. Systolic and diastolic blood pressure values (mm Hg) increased with age. In the present survey (population aged 20–80+ years, current smokers were 17.5% among males and 13.8% among females. Total and HDL-cholesterol were higher than in other parts of Italy (209 vs 205 in males, and 211 vs 204 in females), while systolic and diastolic blood pressure were lower. Conclusion: Overall, total- and LDL-cholesterol showed an increasing trend, while blood pressure and smoking habits had a decreasing tendency. The increase in blood cholesterol follows the trend in other areas of the world, mainly due to changing dietary habits. Therefore, a campaign of eating information and education (population strategy) could favourably modify cardiovascular risk, as occurred in Sardinia during the past decade with the Regional ATS-Sardegna Campaign. © 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction Cardiovascular disease (CVD), i.e. coronary heart disease (CHD), stroke, and peripheral vascular disease, are potentially preventable diseases. Thanks to epidemiological, experimental and clinical studies, the primary determinants of CVD have been identified, as well as the efficacy of specific interventions. The prevalence of cardiovascular disease is increasing in less urbanized, developed populations across the world, as their lifestyles change to a so called “western style”, with increasing consumption of dietary saturated fat, cholesterol and salt, cigarette smoking, decreased physical activity and the rise in CVD risk factors including obesity and diabetes [1]. Other known factors that European Journal of Internal Medicine 20 (2009) 373–377 Abbreviations: Apo A-1, Apolipoprotein A-1; Apo B, Apolipoprotein B; BMI, Body mass index; CVD, Cardiovascular disease; Diast, Diastolic blood pressure; G, Blood glucose; H, Hip circumference; HCY, Homocysteine; HDL-C, High-density lipoprotein cholesterol; LDL-C, Low-density lipoprotein cholesterol; Lp(a), Lipoprotein(a); Syst, Systolic blood pressure; TC, Total cholesterol; TG, Triglycerides; WC, Waist circumfer- ence; W/H, Waist/Hip ratio; 80+, 80 years of age and over. ⁎ Corresponding author. Department of Toxicology, Unit of Oncology and Molecular Pathology, University School of Cagliari, Via Porcell 4 09124 Cagliari, Italy. Tel.: + 39 070 6758634; fax: + 39 070 666062. E-mail address: smuntoni@unica.it (S. Muntoni). 0953-6205/$ – see front matter © 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2008.10.007 Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim