Chronic diseases, management to be reviewed starting with obesity-related risks

Chronic diseases in Italy affect 24 million people and are responsible for 85% of all deaths, with healthcare expenditure associated with their management exceeding EUR 65 billion per year (and in 2028 we will spend almost EUR 80 billion). More than half of these costs relate to cardio-renal-metabolic syndrome, which afflicts nearly 11.6 million people, 4.7 million of whom simultaneously have at least 2.5 risk factors for this condition. For the public health service, the direct cost amounts to almost 37.1 billion euros: 19.5 of which for the 4.7 most complex, to which must be added out-of-pocket health expenditure of at least another 1.1 billion euros due to 31% of specialist and diagnostic visits made privately.

This is recalled in a document entitled 'Journey into chronic illnesses' produced with the unconditional contribution of Boehringer Ingelheim and created with the aim of shining a spotlight on these 'dangerous relationships'. The interactive document contains for each section a QRcode that refers to the talks held between the political institutions and the various interlocutors.

But what is meant by cardio-renal-metabolic syndrome (Crm)? According to the American Heart Association's definition, it is a systemic disorder characterised by pathophysiological interconnections between metabolic risk factors, chronic kidney disease and the cardiovascular system. The problem is that, in practice, these chronicities result in an increased risk of multi-organ dysfunction and a higher incidence of disease and higher cardiovascular mortality.

The progression of the picture often starts with the accumulation of excess adipose tissue, especially in the abdominal area. Adipose dysfunction is reflected in arterial, cardiac and renal tissues, leading to insulin resistance and hepatic steatosis associated with metabolic dysfunction. Over time, these pathophysiological conditions facilitate the development of subclinical coronary atherosclerosis, myocardial organ damage and progressive decline in renal function, predisposing to an elevated risk of cardiovascular disease, renal failure, and disability.

This is why the approval, a few days ago, of the amendment establishing a fund dedicated to the prevention and treatment of obesity was described as 'a decisive step towards improving public health' by scientific societies. The fund will provide support of EUR 1 million for each of the years 2025, 2026 and 2027, to which additional funding of EUR 200,000 in 2025, EUR 300,000 in 2026 and EUR 700,000 in 2027 will be added.