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Cardiovascular diseases are still the most important cause of mortality, morbidity and disability in Italy, although they are the best understood of the non-communicable diseases in terms of risk factors and preventive interventions based on lifestyle, medication and surgical treatments. Moreover, survivors of an acute form become chronic patients, with significant impacts on quality of life and on the economic and social costs to society. Cardiovascular risk factors are among the major determinants of age-related diseases which produce physical disabilities and cognitive disorders. It is not easy to obtain reliable estimates of cardiovascular risk factors and high-risk conditions or the prevalence and incidence of cardiovascular diseases. For a complete evaluation of their impact, it is necessary to estimate not only the proportion of patients with an acute event (acute coronary syndrome and stroke) admitted to hospital or those who died before admission, but also the portion composed of those with a risk condition or a chronic form not necessarily hospitalized, but equally important in terms of public health. The latter can only be identified by specific health examination surveys. To assess the health of a community, and implement effective preventive actions, the average values of lifestyles and related risk factors (nutrition, alcohol consumption, physical inactivity, smoking habits) need to be estimated through ad hoc surveys in which they are measured and selfreported. All these data, integrated with those routinely collected and validated by standardized diagnostic criteria, provide a complete picture of cardiovascular health. The Istituto Superiore di Sanità (National Health Institute – ISS) has a long tradition of aetiological research and surveillance concerning cardiovascular diseases. In 2003, ISS signed a collaboration agreement with the Associazione Nazionale Medici Cardiologi Ospedalieri (National Association of Hospital Cardiologists-ANMCO) and the Fondazione per il Tuo Cuore (Heart Care Foundation-HCF) to establish an important observatory of cardiovascular risk factors and diseases for the whole country, the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey (OEC/HES). This agreement was renewed in 2013. In two four-year periods, 1998–2002 and 2008– 2012, two large surveys to assess the cardiovascular health of the general adult population were carried out. All regions were represented. Data were collected through the examination of population samples and time trends of lifestyles, risk factors, high-risk conditions and diseases according to educational level were compared in order to reveal potentially reducible disparities. For the first time, estimates of eating behaviours, collected with a validated method (EPIC) are presented providing an overall picture of Italy that is useful for researchers, clinicians and policy-makers. This joint effort was possible thanks to funds received over the years by the projects of the Centre for Disease Control of the Ministry of Health, the ANMCO-HCF, the Joint Action of the European Health Examination Survey of the European Commission, to the cooperation of municipalities, local health districts, cardiology departments, prevention departments, to the availability of staff and facilities at the local level, and to the enthusiasm of many researchers and health care professionals who worked in various capacities. Last but not least we would like to aknowledge the precious role of the participants, who understood that the investigation was not only an opportunity to assess their health but also an important contribution to improving the health of the Italian population overall.

Foreword of the Commissioner and General Director of the Istituto Superiore di Sanità, Rome