Table 1

Clinical definition of diseases and levels of severity

Clinical definitionLevels of severity
Type 2 diabetes mellitus
Syndrome diagnosed on the basis of the following criteria outlined in a first test and confirmed with a second test in an adult, non-pregnant patient, without typical symptoms of the disease: Fasting plasma glucose ≥126 mg/dL (no caloric intake for at least 8 hours), or 2-hour plasma glucose ≥200 mg/dL during an oral glucose tolerance test (OGTT) after a load of 75 g glucose, or glycated haemoglobin ≥6.5%.

Or, in a patient with classic symptoms of hyperglycaemia or hyperglycaemic crisis, a random plasma glucose of plasma glucose ≥200 mg/dL (regardless of food intake).
Level 1: Clinical definition of the disease, no indication for insulin therapy and no complications listed in level 3
Level 2: Clinical definition of the disease, indication for insulin therapy and absence of complications listed in level 3.
Level 3: Clinical definition of the disease, no indication for insulin therapy and one of the following: (1) arterial stenosis (coronary, carotid, peripheral arteries of lower extremities), angina pectoris, MI, TIA, ischaemic stroke of atherosclerotic origin, intermittent claudication, diabetic foot ulcer, lower limb amputation, (2) retinopathy, (3) incipient diabetic nephropathy (microalbuminuria) or overt (albuminuria or GFR abnormal)/dialysis
Level 4: As in level 3, except that insulin is indicated
Hypertension
Syndrome characterised by arterial systolic blood pressure above 140 mm Hg and/or diastolic blood pressure above 90 mm Hg in at least two measurements (patient at rest) confirmed by Holter blood pressure measurements or by home blood pressure monitoring (two measurements in the morning and two in the evening for 7 days) and then calculating the average of all measurements after discarding those of the first day (as recommended by the ESH guidelines)Level 1: Clinical definition of the disease, absence of organ damage and of diabetes
Level 2: Clinical definition of the disease, no HF in level at least C of the ACC/AHA classification and at least one of the following conditions: type 2 diabetes; hypertrophy (ECG or Echo), dilation or left ventricular asynergy (Echo); hypertensive retinopathy; GFR abnormal; microalbuminuria or proteinuria; atherosclerotic plaques in carotid arteries; atherosclerotic peripheral arterial occlusive disease; angina pectoris; coronary revascularisation; AMI; TIA or ischaemic stroke due to atherosclerosis; hypertensive encephalopathy; abdominal aortic aneurysm; aortic dissection; cerebral haemorrhage
Level 3: Clinical definition of the disease and HF in stage C or D of the ACC/AHA classification.
Ischaemic heart disease
Clinical syndrome characterised by typical angina chest pain, and/or transient myocardial ischaemia verified by stress ECG or imaging, and/or significant coronary arteries occlusion verified with angiography, or history of previous AMI.Level 1: Clinical definition of the disease, no evidence of previous AMI nor PTCA, no evidence of HF in stage C or D of the ACC/AHA classification.
Level 2: Evidence of previous PTCA, no evidence of previous AMI, no evidence of HF in stage C or D of the ACC/AHA classification.
Level 3: Evidence of previous AMI, no evidence of previous PTCA, no evidence of HF in stage C or D of the ACC/AHA classification.
Level 4: Evidence of previous PTCA and AMI, no evidence of HF in stage C or D of the ACC/AHA classification.
Level 5: Clinical definition of the disease and evidence of HF in stage C or D of the ACC/AHA classification.
Heart failure
Stage C or D of the ACC/AHA classification: syndrome characterised by the presence of symptoms and signs, current or prior dyspnoea and/or fatigue and/or fluid retention (peripheral oedema and/or pulmonary stasis), and the presence of structural heart disease (left ventricular systolic dysfunction with EF <50% and/or left ventricular diastolic dysfunction and/or right ventricular dysfunction) detected by echocardiographyNone
  • ACC/AHA: American Cardiology Association and American Heart Association; AMI, acute myocardial infarction; EF, ejection fraction; HF, heart failure; GFR, glomerular filtration rate; PTCA, percutaneous transluminal coronary angioplasty.