What is the clinical evidence from this study?

Study design: Review. Population: Cardiovascular Disease.

What does this research mean for the field?

Cardiovascular disease remains the leading cause of mortality in Europe, with a substantial and enduring burden of incident coronary heart disease and stroke among Italian adults without prior CVD despite recent declines. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This review aims to evaluate the incidence and lethality of fatal and non-fatal major cardiovascular events in Italian adults without a history of CVD.

May 3, 2026Open Access

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

Key Result

Cardiovascular disease remains the leading cause of mortality in Europe, causing 3.9 million deaths annually and accounting for 45% of all deaths.

Key Points

This review aims to evaluate the incidence and lethality of fatal and non-fatal major cardiovascular events in Italian adults without a history of CVD.
Systematic review following PRISMA 2020 guidelines registered on PROSPERO (CRD42025624126).
Search conducted in PubMed and Web of Science for longitudinal studies involving Italian adults aged 18–65 years without baseline CVD.
Quality assessed using the Newcastle-Ottawa Scale; results synthesized narratively and stratified by event type and study design.
Nineteen studies included, with follow-up ranging from 1 to 50 years.
Coronary heart disease incidence ranged from 10‰ per year to cumulative values as high as 46.5‰ over 40 years.
Stroke incidence ranged from 1.6‰ to 2.75‰ per year, with lethality between 18.1% and 33% within 28–30 days post-event.

Structured PICO

Population

Italian adults aged 18–65 years without baseline cardiovascular disease (19 studies included)

Outcome

Incidence of fatal and non-fatal major cardiovascular events (including myocardial infarction and stroke)hard clinical

This systematic review highlights the enduring burden of CVD in Italy, with coronary heart disease incidence up to 10‰ per year and stroke incidence up to 2.75‰ per year in adults without prior CVD.

Limitations

Data presented are variable in quality and are only a selection of those available.
Reliance on individual countries to provide data means statistics might not always be the most up-to-date.

Abstract

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.

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