It is obvious that all of this is too much and too important to be left in the hands of the cardiologists or of the general practitioner alone. First, because they simply do not have the time, and, second, because they do not have the know-how to deal with such a complex issue on their own.

It is all very well and easy to tell patients that they have to ‘change their lifestyle’ and draw up a list of dos and don’ts, of pleasures forbidden and burdens imposed. Taken to the extreme, the issue becomes a philosophical one, in the sense that if we are really in earnest about preventing CVDs, the majority (if not all) aspects of western civilisation will have to be altered dramatically.

Changing the lifestyle of a population for the better is no easy task—ironically, getting it to deteriorate is easily done: the negative influence of subliminal messages from consumer society (TV, movies, internet) is pervasive to the extent that even in Italy, children now prefer burgers and chips to the traditional plate of spaghetti with tomato and basil, which, of course, is the healthier option! Changing the lifestyle of a population means challenging important vested economic interests—such as the tobacco industry, to name but one. The introduction of legislation banning smoking in public places in Italy has been effective in reducing tobacco consumption,and good results in terms of reduction of CVD mortality are already noticeable at a national level [4].

Addressing CVDs requires concrete and substation action in three areas: (1) surveillance and monitoring; (2) prevention and reduction of risk factors; (3) improved management and healthcare through early detection and timely treatment. Not only, but the goal of halting premature death from CVDs will also require global solidarity and broad alliances beyond national, cultural and ethnic boundaries. Heads of State and Governments will have to come together to address prevention and cultural campaigns worldwide. The 2011 high-level meeting of the United Nations General Assembly on the prevention and control of NCDs held in September 2011 [5] is just the beginning of communal concrete action.

In the meantime, however, much lower scale projects should be encouraged and we are pleased to report here an initiative undertaken by the Chair of Cardiology of the University of Ferrara, named “Ferrara, the City of Prevention” [6, 7].

There were several reasons for making Ferrara (a small town of approximately 134,000 inhabitants, located in the county of Emilia Romagna in Italy) the city of prevention. First, Ferrara is known as the city of bicycles. Being situated on a plain, the citizens of Ferrara traditionally use their bicycles to move around town. Second, Ferrara is surrounded by a medieval wall, approximately 9 km in circumference. On top of the wall there is an alley that makes it the ideal place to go for a walk, a run, to go by bike, or to exercise any other type of recreational activity. The city wall, or the so-called ‘mura’, has become a sort of meeting place for the citizens of Ferrara, where they go not only to exercise but also to meet their friends. Therefore, in Ferrara, at least, a small degree of exercise is a must!

Furthermore, from an economic point of view, Ferrara is completely dominated by the agriculture industry and Ferrara is famous all over Italy for its vegetable (mainly asparagus) and fruit production (pears in particular). Therefore, it is not difficult to obtain the recommended five portions of fruits and vegetables a day in Ferrara. Being situated close to the flood plain of the river Po, the biggest river in Italy, Ferrara is also famous for its fish industry and particularly for the so-called ‘bluefish’ which is very tasty, inexpensive and extremely rich in omega 3 which has been proven, once again by two Italian studies—the GISSI trials—to be effective in preventing myocardial infarction and also in reducing the progression of heart failure [8, 9]. Thanks to all of these characteristics Ferrara has the basis for being a city of prevention.

Several initiatives have been put into action to this end, some are still ongoing, and others are in the pipeline. This is indeed a joint effort of the entire city, of its municipality, university, Mayor, hospital local province, supermarkets, banks and private industries, etc.

What have we achieved so far?