Prevention of heart disease

One of the most urgent problems of scientific medicine and practical health care of the early XXI century are diseases of the circulatory system (BSK). These diseases occupy a leading place among all causes of death in most economically developed countries of the world. In our country, blood circulation systems occupy the first place among the causes of disability.

As established by numerous epidemiological studies, cardiovascular diseases appear as a result of various risk factors, although some of the main risk factors (heredity, age) cannot be changed, other factors can be avoided by changing habits and lifestyle.

According to specialists1/3a decrease in mortality from cardiovascular diseases can be ensured by the development of drug therapy and clinical interventions, while2/3A decrease in mortality will ensure a change in habits in lifestyle, among which we can name proper nutrition, control over the course of hypertension, physical exercises and cessation of smoking. WHO experts emphasize that for both economically developed and developing countries, the most practical and least expensive path of prevention is a healthy lifestyle.

The increase in the incidence and mortality from the BSC in the republic is due to objective and subjective factors: the old population, the financial and economic situation, which negatively affects all aspects of the life of the population, the growth of psycho-emotional stress, urbanization of the population, a change in the nature of nutrition, living conditions, labor, and the presence of many residents of the risk of BSC development, primarily the widespread prevalence of smoking, consumption alcoholic beverages, a sedentary lifestyle, an excess body weight, the lack of residents of the republic of motivation for caring for their own health, observing a healthy lifestyle.

In order to effective prevention, reduction of leftist, mortality, and disability from blood circulation diseases, improving the quality and accessibility of medical care to patients with BSK in the republic, the state program “Health of the people and demographic safety for 2016-2020” is being performed. The program provides for a complex of preventive, organizational, educational, scientific, medical and diagnostic measures aimed at preventing BSC, the formation of a healthy lifestyle in the population, care for their own health, improving the quality and accessibility of cardiological assistance to the population, the introduction of the most promising treatment of patients with rhythm disturbances, acute coronary syndrome, acute coronary synthus acute cerebrovascular disorders.

Of particular note is the absence of responsibility for their own health, motivation for observing a healthy lifestyle, the treatment of arterial hypertension (hypertension) and coronary heart disease (coronary heart disease).

The health of the population is influenced by various factors, both personal and acting at the level of each family and the entire population as a whole. Examples of such factors are the level of awareness, the nature of the nutrition, the lifestyle, the observance of sanitary norms and the availability of medical services. In this case, the socio -economic conditions that affect the degree of vulnerability to the influence of risk factors play an important role in this case. Such parameters as the amount of income, the educational level and working conditions are also important. Although all these factors are in a certain dependence on each other, they are not interchangeable: each of them reflects independent aspects of the socio -economic status of the population.

According to WHO experts, a positive dynamics in the level of incidence and mortality due to BSC can only be achieved if the factors affecting the state of health of the population, increasing people's motivation to observe a healthy lifestyle and treating arterial hypertension, which gives such formidable complications as heart attacks, strokes.

A decrease in the incidence and mortality from the BSC among the entire population can be achieved thanks to the population (mass) and individual prevention strategy, which consists in changing the lifestyle and environmental factors associated with diseases, as well as their social and economic consequences.

BSK prevention is a real way to improve the demographic situation in the country.

Classification of risk factors for cardiovascular diseases:

Biological (non -modeled) factors:

• Elderly age, male sex, genetic factors contributing to the occurrence of dyslipidemia, hypertension, glucose tolerance, diabetes and obesity

Anatomical, physiological and metabolic (biochemical) features (modified):

• Arterial hypertension, dyslipidemia, obesity and nature of the distribution of fat in the body, diabetes mellitus

Behavioral factors:

• Food habits, smoking, motor activity, alcohol use, exposure to stress.

The presence of even one of the risk factors increases the mortality of men aged 50-69 years by 3.5 times, and the combined action of several factors is 5-7 times.

Currently distinguish between primary, secondary and tertiary prevention of BSC. The first two types of prevention are consistent with previously advanced provisions, namely: the primary paragraph of coronary heart disease is a prevention of the development of the disease in healthy individuals and persons buried by various risk factors, an authorized one is a prevention of the progression of the disease and the development of complications of BSK in people who already have this disease. Cracked prevention understands the implementation of actions aimed at delaying the progression of heart failure (CH). With SN, the connection between traditional FR and the outcome of the disease breaks. The decisive role is played by the functional condition of the left ventricle. The beginning of remodeling of the left ventricle is the initial moment for tertiary prevention.

The main components of primary prevention are a population strategy and individual prevention (high risk strategy).

Population strategy, or austrategy of mass prevention, consists in a healthy lifestyle, which primarily provides for a decrease in smoking, establishing rational nutrition, increasing physical activity for the entire population and healing of the environment. These are, as a rule, state events involving the involvement of not only and not so much the Ministry of Health as other ministries and departments (Ministry of Education, the Ministry of Trade, the Ministry of Sports and Tourism, the Ministry of Agriculture, the Television and Radio Broadcasting Committee, etc.).

Individual prevention (high risk strategy) is the identification of persons with a high level of FR (smoking, arterial hypertension, hypercholesterolemia, overweight, low physical activity, etc.) and their adjustment.

The priority for primary prevention, according to European recommendations, is healthy persons who have a high risk of developing coronary heart disease or other atherosclerotic diseases due to a combination of FR, including smoking, increased blood pressure and lipid level (increased content of total cholesterol and low-density lipoproteins), low high-density lipoproteins and high density lipoproteins and high density lipoproteins and high density increased - triglycerides, an increased level of blood glucose, burdened family history for premature coronary disease was high in hypercholesterolemia and other forms of dyslipidemia, hypertension or diabetes.

Secondary prevention should also include changes in lifestyle (stop smoking, avoid passive smoking, rationally eat to reduce weight, reduce blood pressure and cholesterol; control of blood glucose, increase physical activity). If, with an active change in lifestyle, it is not possible to achieve targeted levels of the Federal -Ter way station, drug therapy should be added. Sick-packed and myocardial infarction must prefer beta-blockers, and if they are not tolerated-long-acting calcium blocks. ACE inhibitors should be prescribed to patients with reliable systolic dysfunction of the left ventricle. Almost all patients showed the prescription of anti -aggregate drugs such as aspirin at 75 mg per day, etc. The simultaneous prescription of aspirin and ACE inhibitors is undesirable.

If, when lifestyle changes, the target levels of cholesterol and LDL cholesterol are not achieved, lipidormalizing drugs, primarily statins must be prescribed. Also, increased blood pressure and glucose level should be corrected.

The most unfavorable combination of the FR is the so -called metabolic syndrome (MS), which is a complex of interconnected disorders of carbohydrate and fat metabolism, as well as mechanisms for regulating blood pressure and endothelial function. The named disorders are based on a decrease in tissue sensitivity to insulin - insulin resistance. The main components of the MS are abdominal-visceral obesity, hyperthyglyceridemia, hyperinsulinemia and arterial hypertension. With a combination of these factors, the accelerated development of atherosclerosis is underway.

Due to the special aggressiveness of the MS, it is called a “deadly quartet”, “deadly sextot”, “syndrome x”, “insulin resistance syndrome”.

For the diagnosis of MS, they most often resort to measuring the waist circumference, determining the level of triglycerides in blood serum and insulin on an empty stomach, and control of blood pressure.

If MS is detected, preventive and medical measures should be directed to the entire aggregate of the FR and provide for a decrease in body weight, adequate control of glycemia and dyslipidemia, and normalization of blood pressure. The tactics of patients with AG and MS have a number of features:

• The immediate treatment of antihypertensive drugs in combination with non -drug measures (diet, physical activity);
• orientation to achieve optimal or normal blood pressure (below 130/85 mm Hg), since it is proved that the stabilization of blood pressure at this level and below gives a real organoprothetic effect;
• The more frequent use of combinations of antihypertensive drugs, which is due to greater resistance to reducing increased blood pressure in such patients.

Tertiary prevention should purposefully be carried out from the beginning of remodeling of the left ventricle. This is the most important part of all preventive measures at the BSC, since almost half of the hospitalization of patients with cardiovascular pathology falls on heart failure. The frequency of repeated hospitalizations among patients with heart failure within 3 months after discharge reaches 47%, within 6 months - 54%. The costs of treating patients with heart failure exceed the costs of treating patients with the most common forms of cancer and myocardial infarction. The function of the left ventricle in such patients has a paramount effect on the outcome of the disease. Low or normal blood pressure, increased level of cholesterol and cerebral sodium-uoretic peptide increase the risk for SN and are associated with an increase in mortality. C-reactive protein also determines the unfavorable outcome of SN, but protein suppression can also be associated with adverse outcome.

What goals should be achieved in the fight against risk factors?

According to WHO, the greatest contribution to the risk of sudden death is made by three main risk factors: arterial hypertension, hypercholesterolemia (dyslipidemia) and smoking.

Arterial hypertension (AG)Often they are called "a mysterious and silent killer." Mysterious-because in most cases the causes of the development of the disease remain unknown, silent-because in many patients the disease proceeds asymptomatic and they do not know about the presence of increased blood pressure (blood pressure) until any complication develops. In order to correctly determine the risk of developing arterial hypertension and, as a consequence of coronary heart disease, you need to know and control the level of your blood pressure, and if necessary, undergo an examination that will help to clarify the violations of carbohydrate and fat metabolism and the degree of damage to the target organs (blood vessels, heart, kidneys, brain).

In the republic, shares are continuing to identify risk factors in the population and measure blood pressure. The high prevalence of cases of increased blood pressure is due to numerous factors that can be changed. These include the use of products containing too much salt and fat, a lack of fruits and vegetables, overweight and obesity, harmful use of alcohol, insufficient physical activity, psychological problem, social and economic determinants.

Under the leadership of the European League for AH, an international study was conducted by BP-Care (control of blood pressure), the purpose of which was to analyze the quality of examination and treatment, patients with AG in 9 European countries. In the Republic of Belarus, this study included 3219 patients with AG from AG from Minsk and regional cities. Analysis of the results of the study showed that for the diagnosis of target lesions in our country, such examination methods as ultrasound of brachiocephalic arteries are rarely used (in 9% of patients, versus 24.1% in other countries), the determination of microalbuminuria (in 0.7% of patients against 10% in other countries), and less often daily monitoring of blood pressure (in 8.9% of patients, against 24.5% in European countries). An analysis of the prescribed antihypertensive therapy showed that the treatment of patients with hypertension in the Republic of Belarus is carried out by modern drugs, combined therapy is prescribed in 80.4%, which is comparable to the results of treatment in other European countries. In our country, as well as in the countries of comparison, there is a low efficiency of treatment of AH patients with concomitant diabetes (the target level is achieved only in 10% of patients).

Atherosclerosis

Atherosclerosis- This is a process flowing in the walls of large and medium arteries, in the veins it does not develop. In this process, excessive deposition of lipids (fats) in the thickness of the walls of the arteries occurs.

At the first stage, spots are formed, then elevations, and the final result of atherosclerosis is the formationatherosclerotic plaques, which leads to a narrowing of the lumen of the artery and, as a result, the organs do not receive oxygen. The first to react to such oxygen starvation for which the absence of oxygen, even within a few seconds, leads to a violation of their work: heart, brain.AtherosclerosisIt begins to develop from young age, and each of us with nature is destined for its own speed of development of this process.

However, there are risk factors that contribute to the progression of atherosclerosis - these are smoking, an increase in blood cholesterol, arterial hypertension, diabetes mellitus, and age: for men 55 years for women 60.

An interesting fact is that a woman at a young age is much better protected from atherosclerosis than men. As long as a woman is capable of childbearing and she does not have a gynecological pathology, she is protected from him by almost one hundred percent. But if a woman smokes or enters the menopause, then this natural immunity disappears and in terms of incidence of the cardiovascular system, they immediately catch up with men, and sometimes distillation.

Dyslipidemia-This is an endowment or acquired state, characterized by a violation of education, exchange and excretion from the circulation of lipoproteins and fats, which leads to an increase or decrease in their blood content.

Respectively identifyDyslipidemiaIt is possible only after a biochemical blood test - a lipid spectrum or lipidogram.

CholesterolIt is a special fat -like substance. It enters all the organs of ites. The extension, the compound contains gluttonous membranes, the outlet produced by many hormones, for example, sexual ones. In addition, cholesterol is necessary to maintain the correct operation of the central nervous system, regulation of the process of digesting food.

Thus, cholesterol is vital for a person. Most of the cholesterol is produced. In addition, cholesterol comes into the waxing of the sleeping. Cholesterol's scenes are associated with single particles (cholesterol + protein), which are called lipoproteins. Particles have a different density of Irability.

Lipoproteins of low density (LDL) orpoproteins are distinguished very low density (LOPP). The latter are called the “bad” due to the fact that they deliver cholesterol to the vessel, which subsequently gives a clearance of the lumen, that is, the cobbing of an atherosclerotic plaque. They are called upon to derive cholesterol in the vessels of the “good” high density lipoproteins (HDLs). That is, dyslipidemia causes difficult to increase the indicators of the content of cholesterol of the ramps, the akathetic ratio of lipoproteins.

The ratio of components of general cholesterol (OKS) and HDL (high density lipoproteins) plays a not small role in the development of the atherosclerotic process. In order for this ratio to be more clearly, useAtherogenicity index (IA),It is also calledatherogenicity coefficient (ka).NormallyAtherogenicity indexIt should be no more than 3.0. If it is higher than the norm, then this suggests that the rate of development of atherosclerosis is increased, as well as the risk of complications.

It must also be said that HDLs are “useful” and slow down the progression of atherosclerosis, the more there are, the better. A decrease in HDL, even with a normal level of total cholesterol and its fractions, leads to the progression of atherosclerosis. As for LDL (low density lipoproteins) and LOPP (very low density lipoproteins), they are considered extremely atherogenic and their content must be reduced as low as possible, and it is difficult to overdo it here.

Triglycerides- These are neutral fats entering the human body with food. They are absorbed in the intestines and, ultimately, after a series of transformations, become a source of energy for skeletal muscles and myocardium.TriglyceridesThey almost do not register in the development of atherosclerosis, but their high level is considered not very favorable. By the level of triglycerides, the doctor can judge how carefully the patient observes the diet.

Lipoproteins(Lipoproteins) - these are water -soluble particles, which are a complex of fats and proteins. They provide lipid transport in the bloodstream and their delivery to various organs and tissues, since in their free form fats cannot be absorbed from the intestines and move in the bloodstream.

There are several varietiesLipoproteinsthat divide by density. LOPP - very low density lipoproteins, LDL - low density lipoproteins and HDL - high density lipoproteins. The first two varieties are extremely atherogenic, that is, those that are actively involved in the development of atherosclerosis, HDLs are their complete opposite.

According to the European Society of Cardiologists, the following norms are established regarding the content of cholesterol and its constituent in the blood:

• Total cholesterol <5.0 mmol/l
• LDL <3.0 mmol/l
• HDL> 1.0 mmol/l (men)> 1.2 mmol/l (women)
• Triglycerides <1.7 mmol/l

If the indicators go beyond these boundaries, then the risk of progression of atherosclerosis increases. The fact of the presence of dyslipidemia is established by a doctor based on the results of biochemical analysis of venous blood. In the presence of dyslipidemia, its correction begins with a diet. If you faced the fact that against the backdrop of a hard diet, the cholesterol level remains high, then you probably wondered “why?”, “Where does it come from?”. The fact is that half of cholesterol synthesizes the liver, processing blood fats and fatty tissue, this is something no current production and even with large “reserves of raw materials”. Therefore, even if it is completely excluded from outside cholesterol, its stocks will be enough for a long time, and if 3-6 months of drug treatment did not give results, then all these events, pay attention to: instead of (!), They prescribe the drug from the group of statins, it just depresses the synthesis of cholesterol with liver.

In some cases, drug treatment begins immediately (without waiting for 3-6 months), if the patient was originally at a high risk group, namely he has one or more of the states below:

• Coronary heart disease (statins are required for life!);
• Hypertension (in some cases);
• Heredity;
• Smoking;
• Diabetes mellitus;
• Age for more than 75 years;
• Obesity.

If high cholesterol demanded taking medication, then before the start of treatment, it is necessary to do a blood test for the so -called liver tests - ALT, KFK. This is necessary to ensure the safety of the patient.

If cholesterol against the background of treatment remains high, then an increase in the dose of the drug is required or the addition of another group of drugs. Which path will be elected depends on many points, so the decision is made individually.

If, in spite of all the measures taken (not medication, an increase in the dose and a combination of medicines) the target level is not reached, this sometimes happens, then there is nothing to be done. In this case, treatment is considered “successful” if the LDL level decreased by at least 50% of the original.

Pay attentionthat if necessary, taking drugs reducing cholesterol, can be carried outFor life and without any "breaks"!

Self-medication, as well as delay, can harm your health and significantly complicate the doctor’s work, so it is better to spend an hour or two time for a consultation than later-weeks to eliminate the consequences of unsuccessful self-medication.

With the exception of a small number of people with hereditary hypercholesterolemia, the level of cholesterol is usually associated with malnutrition.

Rational nutrition- This is a balanced, regular (at least 4 times a day) food with restriction of salt consumption. Scientists' studies have shown that if you limit the use of salt, the risk of myocardial infarction and other cardiac disasters may decrease by 25 %. It is very useful to increase the use of products containing potassium and magnesium (sea cabbage, raisins, beets, apricots, zucchini, pumpkin, buckwheat).

The choice of healthy food

All persons should receive a professional consultation on the choice of food and observe a diet that is associated with a minimum risk of CVD development.

General recommendations (determined in accordance with cultural traditions):

• Food should be diverse, energy consumption should be optimal for maintaining perfect weight;
• The consumption of the following products should be encouraged: fruits and vegetables, whole grains of cereals and bread, low -fat dairy products, low -fat meat, fish;
• consume products containing fish oil and W-omega, having special protective properties;
• The total content of fats should be no more than 30% of the total energy composition, and the content of saturated fats should not exceed a third of all fat used; The amount of cholesterol consumed should be less than 300 mg/day;
• With an isulloloric diet, saturated fats should be replaced by partially carbohydrates, partially with monoen -saturated and polyunsaturated fats of vegetables and marine animals.

The table below has a detailed list of products for use for atherosclerosis. Approximate nutrition recommendations.

The basic principles of a diet recommended for the prevention of atherosclerosis:

1. regular consumption of various vegetables, fruits (fresh vegetables for dessert);
2. The ratio between saturated, mono- and polyunsaturated fats should be 1: 1: 1;
3. moderate consumption of dairy products (removed milk, low fat cheese and low -fat yogurt);
4. fish and poultry (without skin) give preference to meat products;
5. From meat products, choose skinny meat, without fat layers;
6. consume no more than 2-3 eggs per week (the use of yolks is limited, but not a protein that can not be limited);

Excess body weightIncreases the risk of IBS and other diseases associated with atherosclerosis. To evaluate your weight, use a simple formula for determining the body weight index (weight (kg) /height (m²) = body mass index).

If the body mass index is less than 25 - this is the desired body weight; If more than 28 in women and 30 in men we can talk about obesity.

Moreover, the so -called central obesity (male type) is more dangerous when fat is deposited on the stomach. The presence of central obesity can be judged by the circumference of the waist and the ratio of the waist circle to the circumference of the hips.

The risk of SVD rises in men with a waist circumference of more than 94 cm and, especially with a circle of more than 102 cm, in women - more than 80 cm and 88 cm, respectively. The ratio of the waist circumference to the circumference of the hips in men is more than 1.0 and in women more than 0.85 is a more accurate indicator of the central type of obesity.

The most common causes of overweight are family factors (they, partly, can be genetically determined, but more often reflect common food habits), overeating, a high content of fats and carbohydrates, as well as insufficient physical activity. Excessive weight is most often found among layers of society with a lower cultural and educational level, especially among women due to the lack of a balanced diet.

Smoking- One of the main risk factors. Why is smoking dangerous? Because even one cigarette increases the pressure by 15 mm Hg, and with constant smoking, the tone of blood vessels increases, the effectiveness of drugs decreases. If a person smokes 5 cigarettes per day - this is an increase in the risk of death by 40%, if one pack per day is 400%, that is, there are 10 times more chances!

According to WHO, 23% of IBS deaths are due to smoking, reducing the life expectancy of smokers aged 35-69 by an average of 20 years. A sudden death among people who smoke a pack of cigarettes and more during the day is observed 5 times more often than among non -smokers. Smokers not only risk their lives, but also the life of others (passive smoking increases the risk of coronary heart disease by 25-30%). After 6 weeks of observing a healthy lifestyle, striking changes in health come, and among those who quit smoking the risk of coronary heart disease, it is significantly reduced and after 5 years it becomes the same as those who have never smoked.

Physical activity.Low physical activity contributes to the development of the SVD 1.5-2 times more often than in people leading a physically active lifestyle. Walking at a fast pace for half an hour per day can reduce the risk of cardiovascular diseases by about 18% and a stroke by 11%. For the prevention of SSZ and health promotion, physical exercises that include regular rhythmic contractions of large muscle groups are most suitable: fast walking, running a cowardly, cycling, swimming, skiing, etc. The frequency of physical exercises should be at least 2-3 times a week, the duration of classes 30-40 minutes, including the period of heating and cooing. When determining the intensity of physical exercises permissible for a particular patient, they proceed from the maximum heart rate (heart rate) after physical activity - it should be equal to the difference in the number of 220 and the age of the patient in years. For persons with a sedentary lifestyle without symptoms of coronary heart disease, it is recommended to choose such an intensity of physical exercises, in which the heart rate is 60-75% of the maximum. Recommendations for persons suffering from coronary heart disease should be based on clinical examination data and test results with physical exertion.

Achieving goals on physical activity requires multi -sectional interaction between the bodies responsible for transport, urban planning, rest, sports and education, which will allow you to form a safe environment that stimulates physical activity of a variety of age groups.

In accordance with the recommendations of the European Society of Cardiologists (ESC), the main tasks of the prevention of CVD in a healthy person are:

• Sistolic blood pressure below 140 mm Hg.
• Lack of tobacco use
• The level of total cholesterol is below 5 mmol/l
• low -density lipoproteins cholesterol below 3 mmol/l
• Walking 3 km per day or 30 minutes of any other moderate physical activity
• food consumption with a reduced sodium content,
• daily use of at least 5 pieces of fruits and vegetables
• Prevention of obesity and diabetes.

Thus, for the effective prevention of most cardiovascular diseases and their complications, several rules must be complied with:

• Control your blood pressure.
• Control the level of cholesterol and lipid spectrum.
• Eat correctly.
• Do physical exercises: even a little better than nothing.
• Do not start smoking, and if you smoke, try to quit, no matter how difficult it seemed to be.
• Do not abuse alcoholic beverages.
• Try to avoid long stress.

In conclusion, it should be noted that even small changes made in a lifestyle can slow down the aging of the heart. It's never too late to start a healthy lifestyle. After the person’s emergence of IBS, risk factors continue to act, contributing to the progression of the disease and a worsening prognosis, therefore their correction should be an integral part of the treatment tactics.

The main freelance cardiologist

Ministry of Health of the Republic of Belarus,

Director of the RSPC "Cardiology",

MD, professor, academician of the NAS of Belarus A.G. Mroke