Check your heart when it’s healthy

Risposta: Cardiovascular prevention should be viewed as an ongoing process that spans the entire lifespan, as vascular damage accumulates silently over time. The diagnostic and preventive approach must, however, be tailored to the individual’s age, family history and overall risk profile.

• Up to the age of 30: In the absence of symptoms or a family history of early-onset heart disease or sudden death, prevention involves having at least one resting electrocardiogram (ECG) — which is essential for ruling out congenital channel disorders or silent structural abnormalities — and occasional monitoring of blood pressure. It is advisable to carry out an initial screening of lipid profile (total cholesterol, HDL, LDL and triglycerides) and blood glucose levels to enable the early identification of hereditary forms of familial hypercholesterolaemia or type 1 diabetes.

• Aged 30 to 40: Blood tests (lipid profile, blood glucose, kidney function) should be repeated every 2–3 years. Blood pressure should be measured annually. In women, it is important to monitor trends in blood pressure and lipid levels, particularly in relation to pregnancy or the use of oral contraceptives, which increase the risk of thrombosis.

• Aged 40 to 60: This is the age group in which absolute cardiovascular risk begins to rise significantly. It is essential that the GP or specialist calculates the risk score using the official ‘cardiovascular risk charts’ (such as SCORE 2 from the European Society of Cardiology). These tables estimate the probability of developing a major cardiovascular event (death, heart attack, stroke) over the next 10 years, taking into account factors such as age, gender, smoking status, systolic blood pressure and non-HDL cholesterol levels. Based on the identified risk category (low, moderate, high, very high), treatment targets are set, with particular emphasis on reducing LDL cholesterol. If comorbidities such as high blood pressure, diabetes or dyslipidaemia are present, the cardiologist may prescribe secondary-level investigations to detect asymptomatic organ damage (e.g. an echocardiogram to assess ventricular hypertrophy, or colour Doppler ultrasound of the supra-aortic trunks, a stress ECG, or a coronary CT scan in selected cases).

• Over 60 years of age: In addition to strict monitoring of metabolic factors, the focus shifts to screening for structural conditions, such as degenerative valvular defects (aortic stenosis) or arrhythmias that are common in older people, foremost among which is atrial fibrillation. An electrocardiogram, laboratory tests such as NT-proBNP, and regular cardiological check-ups are invaluable tools for the early detection of signs of heart failure with preserved ejection fraction.