The risk of cardiovascular events in the Italian adult population without prior history of CVD: a systematic review of follow-up studies

Background Cardiovascular diseases (CVDs) remain the leading cause of mortality and morbidity in Europe. Understanding their burden is essential to planning effective public health responses. However, in Italy, comprehensive data on the incidence and lethality of major cardiovascular events, including myocardial infarction and stroke, are fragmented and heterogeneous. This review aims to assess the incidence of fatal and non-fatal major cardiovascular events in Italian adults without prior CVD. Methods A systematic review was conducted according to the PRISMA 2020 guidelines and registered on PROSPERO (CRD42025624126). We searched PubMed and Web of Science to identify longitudinal studies involving Italian adults aged 18–65 years without baseline CVD. Data extracted from the selected studies included study design, population characteristics, follow-up, and results. Quality was assessed using the Newcastle-Ottawa Scale. The results were synthesised narratively and stratified by cardiovascular event and study design. Results Nineteen studies were included, with a follow-up of 1–50 years. The incidence of coronary heart disease ranged from 10‰ per year to cumulative values as high as 46.5‰ over 40 years. The incidence of stroke ranged from 1.6‰ to 2.75‰ per year, with early lethality (28–30 days after the event) between 18.1% and 33%. Variability in estimates was associated with differences in study design, baseline population characteristics, endpoints definition, calendar period and geographical context. Conclusions This systematic review highlights the enduring burden of CVD in Italy in the short- and long-term horizon. Although incidence and lethality have declined in recent decades, the findings underscore the importance of ongoing surveillance and tailored prevention strategies to control CVD in Italy. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42025624126 , PROSPERO CRD42025624126.