Heart Disease Prevention Day

April 18th

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One of the most pressing problems of scientific medicine and practical healthcare at the beginning of the 21st century is diseases of the circulatory system (CVD). These diseases occupy a leading place among all causes of death in most economically developed countries of the world. In our country, diseases of the circulatory system occupy first place among the causes of disability.

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

According to WHO experts, 1/3 of the reduction in mortality from cardiovascular diseases can be achieved through the development of drug therapies and clinical interventions, while 2/3 of the reduction in mortality will be achieved by changing lifestyle habits, including proper nutrition, control for the course of hypertension, physical exercise and smoking cessation. WHO experts emphasize that for both economically developed and developing countries, the most practical and least expensive way of prevention is not medicine, but a healthy lifestyle.

The increase in morbidity and mortality from CVD in the republic is due to objective and subjective factors: the aging of the population, the financial and economic situation, which negatively affects all aspects of the population’s life, the growth of psycho-emotional stress, the urbanization of the population, changes in the nature of nutrition, living conditions, work, the presence of For a significant part of the population, there are many risk factors for the development of CSD, primarily the widespread prevalence of smoking, drinking alcoholic beverages, a sedentary lifestyle, excess body weight, and the lack of motivation among residents of the republic to take care of their own health and maintain a healthy lifestyle.

In order to effectively prevent, reduce morbidity, mortality, disability of the population from diseases of the circulatory system, improve the quality and accessibility of medical care for patients with CVD in the republic, the State Program “People's Health and Demographic Security for 2016-2020” has been developed.

The state program provides for a set of preventive, organizational and methodological, educational, scientific, therapeutic and diagnostic measures aimed at preventing CVD, creating among the population the need to maintain a healthy lifestyle, taking care of their own health, improving the quality and availability of cardiac care to the population, introducing the most promising technologies for treating patients with rhythm disturbances, acute coronary syndrome, acute cerebrovascular accident.

Among the main reasons for the increase in mortality in working age are: patients’ inadequate attitude towards their health, lack of motivation for treatment (58.0% of cases); social disadvantage, in particular alcohol abuse (up to 50.0%); failure to seek medical help in a timely manner (about 14%); the presence of concomitant pathology that aggravates the prognosis (10%), most often type II diabetes mellitus and liver cirrhosis of alimentary-toxic origin.

Particularly noteworthy is the lack of responsibility among the population for their own health, motivation to maintain a healthy lifestyle, treatment of arterial hypertension (AH) and coronary heart disease (CHD).

The health of the population is influenced by various factors, both personal and operating at the level of each family and the entire population as a whole. Examples of such factors include awareness, diet, lifestyle, sanitation and access to health services. An important role is played by socio-economic conditions that influence the degree of vulnerability to the effects of risk factors. Parameters such as income, educational level and working conditions also matter. Although all these factors are somewhat dependent 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, positive dynamics in the level of morbidity and mortality due to CSD can only be achieved under the condition of a comprehensive impact on the factors influencing the health status of the population, increasing the motivation of people to maintain a healthy lifestyle and treat arterial hypertension, which gives such serious complications as heart attacks, strokes.

Reducing morbidity and mortality from CSD among the entire population can be achieved through population-based (mass) and individual prevention strategies, which consist of changing lifestyle and environmental factors associated with diseases, as well as their social and economic consequences.

Prevention of CVD is a real way to improve the demographic situation in the country.

Classification of risk factors for cardiovascular diseases :

Biological (non-modifiable) factors:

  • Old age, male gender, genetic factors contributing to dyslipidemia, hypertension, glucose tolerance, diabetes and obesity

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

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

Behavioral factors :

  • Eating habits, smoking, physical activity, alcohol consumption, exposure to stress.

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

Currently, primary, secondary and tertiary prevention of CSD are distinguished. The first two types of prevention are consistent with previously put forward provisions, namely: primary prevention of IHD is the prevention of the development of the disease in healthy individuals and persons burdened with various risk factors, authoritative prevention is the prevention of the progression of the disease and the development of complications of the course of CHD in individuals who already have this disease. Tertiary prevention refers to the implementation of actions aimed at delaying the progression of heart failure (HF). In HF, the relationship between traditional risk factors and disease outcome breaks down. The functional state of the left ventricle plays a decisive role. The onset of left ventricular remodeling is the starting point for tertiary prevention.

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

The population strategy, or mass prevention strategy, is to create a healthy lifestyle, which primarily involves reducing smoking, establishing a balanced diet, increasing physical activity for the entire population and improving the environment. These are, as a rule, government events that involve the involvement of not only and not so much the Ministry of Health, but other ministries and departments (Ministry of Education, Ministry of Trade, Ministry of Sports and Tourism, Ministry of Agriculture, Committee on Television and Radio Broadcasting, etc.).

Individual prevention (high-risk strategy) is the identification of individuals with high levels of risk factors (smoking, arterial hypertension, hypercholesterolemia, excess weight, low physical activity, etc.) and their correction.

The priority for primary prevention, according to European recommendations, are healthy individuals who have a high risk of developing coronary artery disease or other atherosclerotic diseases due to a combination of risk factors, including smoking, high blood pressure and lipid levels (increased total cholesterol and low-density lipoprotein (LDL), low high-density lipoprotein and high triglycerides, elevated blood glucose, family history of premature coronary disease or high hypercholesterolemia and other forms of dyslipidemia, hypertension or diabetes.

Secondary prevention should also include lifestyle changes (stop smoking, avoid second-hand smoke, eat rationally to lose weight, reduce blood pressure and cholesterol levels, control blood glucose, increase physical activity). If active lifestyle changes fail to achieve target levels of risk factors, drug therapy should be added. Patients with angina pectoris and those who have had a myocardial infarction should give preference to beta-blockers, and if they are not tolerated, long-acting calcium channel blockers. ACE inhibitors should be prescribed to patients with significant left ventricular systolic dysfunction. Almost all patients are prescribed antiplatelet drugs such as aspirin 75 mg per day, etc. Simultaneous administration of aspirin and ACE inhibitors is undesirable.

If, with lifestyle changes, target cholesterol and LDL cholesterol levels are not achieved, lipid-normalizing drugs, primarily statins, should be prescribed. It is also necessary to correct high blood pressure and glucose levels.

The most unfavorable combination of risk factors is the so-called metabolic syndrome (MS), which is a complex of interrelated disorders of carbohydrate and fat metabolism, as well as the mechanisms of regulation of blood pressure and endothelial function. The basis of these disorders is a decrease in tissue sensitivity to insulin - insulin resistance. The main components of MS are abdominal-visceral obesity, hypertriglyceridemia, hyperinsulinemia and arterial hypertension. When these factors are combined, atherosclerosis develops at an accelerated rate.

Due to the particular aggressiveness of MS, it is called “deadly quartet”, “deadly sextet”, “syndrome X”, “insulin resistance syndrome”.

To diagnose MS, they most often resort to measuring waist circumference, determining the level of triglycerides in the blood serum and fasting insulin, and monitoring blood pressure.

When MS is detected, preventive and therapeutic measures should be aimed at the entire set of risk factors and include weight loss, adequate control of glycemia and dyslipidemia, and normalization of blood pressure. The management tactics for patients with hypertension and MS have a number of features:

  • immediate initiation of treatment with antihypertensive drugs in combination with non-pharmacological measures (diet, physical activity);
  • focus on achieving optimal or normal blood pressure (below 130/85 mm Hg), since it has been proven that stabilizing blood pressure at this level and below gives a real organ-protective effect;
  • more frequent use of combinations of antihypertensive drugs, which is due to greater resistance to reducing high blood pressure in such patients.

Tertiary prevention should be targeted specifically from the onset of left ventricular remodeling. This is the most important part of all preventive measures for CSD, since almost half of the hospitalizations of patients with cardiovascular pathology are for heart failure. The rate of re-hospitalization among patients with CHF within 3 months after discharge reaches 47%, within 6 months - 54%. The costs of treating patients with CHF exceed the costs of treating patients with the most common forms of cancer and myocardial infarction. Left ventricular function in such patients has a primary influence on the outcome of the disease. Low or normal blood pressure, elevated cholesterol and brain natriuretic peptide levels increase the risk of heart failure and are associated with increased mortality. C-reactive protein also predicts poor outcome in heart failure, but protein suppression may also be associated with poor outcome.

What goals need to be achieved in the fight against risk factors?

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

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

The republic continues to carry out campaigns to identify risk factors among the population and measure blood pressure. The high prevalence of high blood pressure is due to numerous modifiable factors. These include eating foods containing too much salt and fat, not eating enough fruits and vegetables, overweight and obesity, harmful use of alcohol, lack of physical activity, psychological stress and socio-economic determinants.

Under the leadership of the European League on Hypertension, an international study BP-CaRE (BP control) was conducted, the purpose of which was to analyze the quality of examination and treatment of patients with hypertension in 9 European countries. In the Republic of Belarus, this study included 3219 patients with hypertension from Minsk and regional cities. Analysis of the study results showed that to diagnose target organ damage in our country, such examination methods as ultrasound of the brachiocephalic arteries (in 9% of patients, versus 24.1% in other countries), determination of microalbuminuria (in 0.7% of patients versus 10% in other countries), and 24-hour blood pressure monitoring is performed less frequently (in 8.9% of patients, versus 24.5% in European countries). An analysis of prescribed antihypertensive therapy showed that treatment of patients with hypertension in the Republic of Belarus is carried out with modern drugs, in 80.4% combination therapy is prescribed, which is comparable to the results of treatment in other European countries. In our country, as well as in comparison countries, there is a low effectiveness of treatment of patients with hypertension with concomitant diabetes mellitus (the target level is achieved in only 10% of patients).

Atherosclerosis

Atherosclerosis is a process that occurs in the walls of large and medium-sized arteries; it does not develop in veins. During this process, excessive deposition of lipids (fats) occurs in the thickness of the artery walls.

At the first stage, spots are formed, then elevations, and the final result of atherosclerosis is the formation of atherosclerotic plaque , which leads to a narrowing of the lumen of the artery and, as a result, the organs do not receive enough oxygen. The first to react to such oxygen starvation are those organs for which the absence of oxygen, even for a few seconds, leads to disruption of their functioning: the heart, the brain. Atherosclerosis begins to develop from a young age, and each of us is destined by nature to have our own rate of development of this process.

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

An interesting fact is that women at a young age are much better protected from atherosclerosis than men. As long as a woman is capable of childbearing and has no gynecological pathology, she is almost one hundred percent protected from it. But if a woman smokes or enters menopause, then this natural immunity disappears and in terms of cardiovascular disease, they immediately catch up with men, and sometimes even surpass them.

Dyslipidemia is a hereditary or acquired condition characterized by impaired formation, metabolism and removal from circulation of lipoproteins and fats, which leads to an increase or decrease in their content in the blood.

Accordingly, dyslipidemia can be detected only after a biochemical blood test - lipid spectrum or lipid profile.

Cholesterol is a special fat-like substance. It is included in all organs and tissues. In particular, the compound is contained in cell membranes, from which many hormones are produced, for example, sex hormones. In addition, cholesterol is necessary to maintain the correct functioning of the central nervous system and regulate the process of food digestion.

Thus, cholesterol is vital for humans. Most cholesterol is produced in the liver. In addition, cholesterol enters the body through food. In the blood, cholesterol is bound to certain particles (cholesterol + protein) called lipoproteins. Particles have different densities and different properties.

Low density lipoproteins (LDL) or very low density lipoproteins (VLDL) are isolated. The latter are called “bad” due to the fact that they deliver cholesterol to the vessel wall, which subsequently leads to blockage of the lumen, that is, the formation of an atherosclerotic plaque. “Good” high-density lipoproteins (HDL) are also called upon to remove cholesterol from the walls of blood vessels. That is, dyslipidemia is caused by elevated levels of cholesterol in the blood and the quality ratio of lipoproteins.

The ratio of total cholesterol (TC) and HDL (high-density lipoprotein) components plays an important role in the development of the atherosclerotic process. To make this ratio more clear, the atherogenic index (AI) is used, also called the atherogenic coefficient (AC). Normally, the atherogenic index should be no more than 3.0. If it is higher than normal, then this indicates that the rate of development of atherosclerosis is increased, as is the risk of complications.

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

Triglycerides are neutral fats that enter the human body with food. They are absorbed in the intestine and, ultimately, after a series of transformations, become a source of energy for skeletal muscles and myocardium. Triglycerides are almost not involved in the development of atherosclerosis, but their high level is considered not very favorable. Based on triglyceride levels, the doctor can judge how carefully the patient is following the diet.

Lipoproteins ( lipoproteins ) are water-soluble particles that are a complex of fats and proteins. They ensure the transport of lipids 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 types of lipoproteins , which are divided by density. VLDL – 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; HDL is their complete opposite.

According to the European Society of Cardiology, the following standards have been established regarding the content of cholesterol and its components 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 limits, then the risk of progression of atherosclerosis increases. The presence of dyslipidemia is determined by a doctor based on the results of a biochemical analysis of venous blood. If dyslipidemia is present, its correction begins with diet. If you have encountered the fact that cholesterol levels remain high despite a strict diet, then you probably asked the question “why?”, “where does it come from?” The fact is that half of the cholesterol is synthesized by the liver, processing blood fats and fatty tissue; this is something that is produced without waste, and even with large “reserves of raw materials.” Therefore, even if you completely exclude the intake of cholesterol from the outside, its reserves will last for a long time. Therefore, if 3-6 months of non-drug treatment did not produce results, then pay attention to all these measures: a drug from the statin group is prescribed to THEM, and not – INSTEAD (!), which is what inhibits the synthesis of cholesterol by the liver.

In some cases, drug treatment begins immediately (without waiting 3-6 months) if the patient was initially considered to be at high risk, namely, he has one or more of the following conditions:

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

If high cholesterol requires taking medications , then before starting treatment it is necessary to do a blood test for the so-called liver tests - ALT, AST and bilirubin. It is known that statins can slightly accelerate the death of liver cells. To a certain extent, such a sacrifice is justified, because the liver has very powerful regenerative abilities, and there is a considerable amount of truth in the “legend of Prometheus,” whose liver was pecked out by a raven, and the next day it was restored again. But the heart, unfortunately, is not at all capable of restoring dead cells (cardiomyocytes), so the lesser of two evils is chosen. So, based on the level of ALT and AST, they judge which “evil” is the least.

Repeat the analysis again after 6 months

If cholesterol is no longer high and has returned to normal, then in some cases a break in treatment can be taken for 3-6 months, after which a control analysis can be carried out. If everything returns to normal, treatment is resumed and carried out for life; if not, then you can cope with diet and monitor the situation.

If cholesterol remains high during treatment, then an increase in the dose of the drug or the addition of another group of medications – fibrates – is required. Which path will be chosen depends on many factors, so the decision is made individually.

If, despite all the measures taken (non-medicinal, increasing the dose and a combination of medications), the target level is not achieved, this sometimes happens, then nothing can be done. In this case, treatment is considered “successful” if the level of total cholesterol and LDL cholesterol has decreased by at least 50% from the original level.

Please note that, if necessary, cholesterol-lowering medications can be taken for life and without any “breaks”!

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

With the exception of a small number of people with hereditary hypercholesterolemia, cholesterol levels are generally associated with poor diet.

A balanced diet is a balanced, regular (at least 4 times a day) diet with limited salt intake. Research by scientists has shown that if you limit your salt intake, the risk of myocardial infarction and other cardiac events can be reduced by 25%. It is very useful to increase the consumption of foods containing potassium and magnesium (seaweed, raisins, beets, apricots, zucchini, pumpkin, buckwheat).

Healthy food choices

All individuals should receive professional advice on food choices and follow a diet that is associated with minimal risk of developing CVD.

General recommendations (determined according to cultural traditions):

  • food should be varied, energy consumption should be optimal to maintain ideal weight;
  • The consumption of the following foods should be encouraged: fruits and vegetables, whole grains and breads, low-fat dairy products, lean meats, fish;
  • consume products containing fish oil and w-omega, which have special protective properties;
  • the total fat content should not exceed 30% of the total energy composition, and the saturated fat content should not exceed a third of all fat consumed; the amount of cholesterol consumed should be less than 300 mg/day;
  • with an isocaloric diet, saturated fats should be replaced partly with carbohydrates, partly with monounsaturated and polyunsaturated fats from vegetables and marine animals.

The table below provides a detailed list of products for use in atherosclerosis. Approximate nutritional recommendations.

PRODUCT GROUPRECOMMENDED FOR USE TO BE CONSUMED IN MODERATION PERMITTED FOR USE IN EXCEPTIONAL CASES
Cereals and bakery productsWhole grain bread, whole grain breakfast cereals, oatmeal, cereals, whole grain pasta, crispbread, matzoWhite pasta, riceCroissants, buns
DairySkim milk, low-fat cheeses, freshly prepared skim or quark cheese, low-fat yogurt, egg whites, egg substitutesSemi-skimmed milk, reduced and low fat cheeses (Camembert, Eddam, Feta, Ricotta) and low fat yoghurts. Two whole eggs per weekWhole milk, condensed milk, cream, artificial milk, full-fat cheeses (Brie, Gouda), full-fat yoghurts
SoupsCanned, vegetable soupsChicken soups, creamy soups
SeafoodOysters, escalopesMussels, lobster, scampi, shrimp, squid
FishAny white and fatty fish (baked, boiled, smoked) Avoid eating skin (sardine, anchovy, etc.)Fish fried in vegetable oilCaviar, fish fried not in vegetable oil
MeatTurkey, veal, chicken, game, rabbit, lamb, extra lean beef, ham, bacon, veal or chicken sausageDuck, goose, all fatty-looking meats, regular sausage, salami, meat pies, pate, chicken skinLamb, liver
FatsAll vegetable oils except palm oil, non-hydrogenated margarines, low-fat patesButter, lard, lard, fat from meat during frying, palm oil, heavy margarine
Fruits and vegetablesAny fresh or frozen vegetables, boiled potatoes, fresh or dried fruitsFried potatoes cooked in vegetable oilFried potatoes or french fries, vegetables or rice fried in other oil or fat, crisps, chips, salted and canned vegetables
SweetsSherbet, jelly, skim milk puddings, fruit salads, meringuesIce cream, puddings, dumplings, cream or butter based sauces
BakeryBaked goods, cookies made with unsaturated margarine or butterStore-bought baked goods, cookies, store-bought pies, snacks
ConfectioneryTurkish delight, nougat, caramelMarzipan, halvaChocolate, toffee, fudge, coconut bars
NutsWalnuts, almondsCashews, peanuts, pistachiosCoconut, salted nuts
BeveragesTea, coffee, water, non-caloric soft drinksAlcohol, low fat chocolate drinksChocolate drinks, boiled coffee, regular soft drinks
SeasoningsPepper, mustard, herbs, spicesLow Fat Salad DressingsИзлишняя соль, салатные заправки, салатные сливки, майонез

Basic principles of the diet recommended for the prevention of atherosclerosis:

  1. regular consumption of a variety of vegetables and 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 (skim milk, low-fat cheese and low-fat yogurt);
  4. fish and poultry (without skin) should be given preference over meat products;
  5. from meat products, choose lean meat, without layers of fat;
  6. consume no more than 2-3 eggs per week (limit the consumption of yolks, but not the white, which can be unlimited);

Excess body weight increases the risk of developing coronary artery disease and other diseases associated with atherosclerosis. To estimate your weight, use a simple formula for determining your body mass index (weight (kg) / height (m 2 ) = 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), when fat is deposited on the abdomen, is more dangerous. The presence of central obesity can be judged by waist circumference and the ratio of waist circumference to hip circumference.

The risk of CVD increases in men with a waist circumference greater than 94 cm and, especially, with a circumference greater than 102 cm; in women, greater than 80 cm and 88 cm, respectively. The ratio of waist circumference to hip circumference in men is greater than 1.0 and in women greater than 0. 85 is a more accurate indicator of the central type of obesity.

The most common causes of excess weight are family factors (some of which may be genetic, but more often reflect general eating habits), overeating, a diet high in fat and carbohydrates, and lack of physical activity. Overweight is most common among sections of society with lower cultural and educational levels, especially among women due to lack of a balanced diet.

Smoking is one of the main risk factors. Why is smoking dangerous? Because even one cigarette increases blood pressure by 15 mmHg, and with constant smoking, vascular tone increases and the effectiveness of medications decreases. If a person smokes 5 cigarettes a day, this increases the risk of death by 40%, if one pack a day - by 400%, that is, the chances of dying are 10 times greater!

According to WHO, 23% of deaths from coronary heart disease are caused by smoking, reducing the life expectancy of smokers aged 35-69 years by an average of 20 years. Sudden death among people who smoke a pack of cigarettes or more per day is 5 times more common than among non-smokers. Smokers not only put their lives at risk, but also the lives of others (passive smoking increases the risk of coronary artery disease by 25-30%). After just 6 weeks of following a healthy lifestyle, dramatic changes in health occur, and among those who quit smoking, the risk of coronary heart disease is significantly reduced and after 5 years it becomes the same as for those who have never smoked.

Physical activity. Low physical activity contributes to the development of CVD 1.5-2 times more often than in people leading a physically active lifestyle. Walking at a brisk pace for half an hour a day can reduce the risk of heart disease by approximately 18% and stroke by 11%. For the prevention of CVD and health promotion, the most suitable physical exercises are those that involve regular rhythmic contractions of large muscle groups: brisk walking, jogging, cycling, swimming, skiing, etc. The frequency of physical exercise should be at least 2-3 times a day. week, duration of classes is 30-40 minutes, including a warm-up and cool-down period. When determining the intensity of physical exercise acceptable for a particular patient, they proceed from the maximum heart rate (HR) after physical activity - it should be equal to the difference between the number 220 and the patient’s age in years. For people with a sedentary lifestyle without symptoms of coronary artery disease, it is recommended to choose an intensity of exercise at which the heart rate is 60-75% of the maximum. Recommendations for individuals with CAD should be based on clinical examination and exercise test results.

Achieving physical activity goals requires multi-sectoral collaboration between transport, urban planning, recreation, sport and education to create a safe environment that encourages a wide range of age groups to be physically active.

The Committee of the European Society of Cardiology has developed the main tasks for the prevention of CVD in a healthy person:

  • systolic blood pressure below 140 mm Hg.
  • no tobacco use
  • total cholesterol level below 5 mmol/l
  • low-density lipoprotein cholesterol below 3 mmol/l
  • consumption of foods low in sodium,
  • daily use of at least 5 pieces of fruits and vegetables
  • prevention of obesity and diabetes.

Experience of measures for multifactorial prevention of coronary artery disease, carried out by the Republican Scientific and Practical Center "Cardiology" since 2000. at the population level in Minsk showed that a decrease in the levels of risk factors in combination with active measures for secondary prevention is accompanied by a decrease in the incidence of myocardial infarction by 21%, and cerebral stroke by 24%. At the same time, the practical implementation of preventive programs, which involves a set of measures to increase the population’s literacy in matters of a healthy lifestyle and resolve a number of social issues relating to a balanced diet, the organization of physical culture and health activities for the population, etc., requires the widespread involvement of Republican and local government bodies.

Thus, to effectively prevent most cardiovascular diseases and their complications, several rules must be followed:

  • Monitor your blood pressure.
  • Control your cholesterol levels.
  • Eat right.
  • Get some exercise: a little is better than nothing.
  • Don't start smoking, and if you smoke, try to quit, no matter how difficult it may seem.
  • Avoid excessive consumption of alcoholic beverages
  • Try to avoid prolonged stress.

In conclusion, even small lifestyle changes can slow down the aging of the heart. It's never too late to start leading a healthy lifestyle. After a person develops signs of coronary artery disease, risk factors continue to act, contributing to the progression of the disease and worsening the prognosis, so their correction should be an integral part of treatment tactics.

Chief freelance cardiologist

Ministry of Health of the Republic of Belarus,

Director of the Republican Scientific and Practical Center "Cardiology",

Doctor of Medical Sciences, Professor, Academician of the National Academy of Sciences of Belarus A.G. Mrochek