1ST CITY CLINICAL HOSPITAL

Cardiovascular pathology is the leading cause of death and disability in all industrialized countries. The widespread introduction of expensive diagnostic and treatment methods does not allow us to radically solve this problem. Throughout the world, prevention is considered the most effective strategy to combat it.

Atherosclerosis , leading to the development of angina pectoris, myocardial infarction, heart rhythm disturbances, heart failure, and sudden cardiac death is an insidious disease. His character is secretive: for many years the person feels well, has no complaints, does not go to the doctor, and thinks ironically about a healthy lifestyle. Atherosclerosis can debut immediately with a heart attack, stroke or amputation of limbs. Increasingly, doctors are dealing with an atypical clinical picture: myocardial infarction begins without characteristic pain in the heart: it can be mistaken for a cold, sore throat, intestinal infection, ulcer or appendicitis. The patient turns to a specialist when time has already been lost and all that remains is to deal with complications, and it is not always possible to return a person to a full life.

Management of risks

In 2003, “Recommendations for the prevention of cardiovascular diseases in clinical practice” were published in the European Heart Journal. In order to begin preventive measures in a timely manner, it is recommended to identify categories of patients with a high risk of developing cardiovascular disasters - myocardial infarction, stroke, cardiac death using the SCORE and SCORECARD scales, taking into account correctable and non-correctable factors.

Prevention gives the most visible positive result in the so-called. the highest risk group - in persons who have been diagnosed with coronary artery disease, atherosclerosis of the vessels of the lower extremities or cerebral arteries at least once in their lives. However, it is also effective in the so-called. asymptomatic patients - without cardiac complaints, but with at least one of the following conditions:

• total cholesterol 8 mmol/L and/or low-density lipoprotein (LDL) level 6 mmol/L;
• blood pressure 180/110 mm Hg. st;
• diabetes mellitus type II or diabetes mellitus type I with microalbuminuria.

The high-risk group also includes close relatives of patients who developed atherosclerosis of any localization at a young age.

In the United States, general preventive measures over a 20-year period reduced the incidence of strokes by more than 50% and coronary pathology by 30%. Research by the All-Union Cardiology Center in the 80s of the last century showed that the multifactorial prevention system can reduce overall mortality by 22%, and from cardiovascular diseases by 41%, including from myocardial infarction by 42%.

For patients with atherosclerosis of any location, the specialist should recommend active lifestyle changes and constant use of prescribed medications.

For asymptomatic high-risk patients, individually, using the SCORE scale, calculate the probability of complications in the next 10 years, determine measures for lifestyle changes, and, if necessary, prescribe medications.

If the risk of cardiovascular complications is less than 5%, it is advised to adhere to a healthy lifestyle in order to maintain this condition for as long as possible without taking medications.

According to European experts in prevention and rehabilitation, the components of risky behavior are unhealthy diet, smoking, and physical inactivity. The way of life is formed over the years. For many people, it is difficult to change their life after a one-time conversation with a doctor who will report a high risk of developing atherosclerosis or the initial signs of the disease. Often, patients prefer an “ostrich” policy, because it is easier to hide from problems than to start solving them. This is especially difficult for people who are socially and economically vulnerable, in low-paid or monotonous work; those who have a chronic stressful situation in the family, as well as those who are lonely and deprived of the support of family, friends and relatives. Negative emotions - depression, irritability, anger and hostility - can become an insurmountable barrier and negate all preventive measures. The attending physician is able to find out this point with the help of leading questions and decide whether in this case the situation can be resolved without the help of a specialist psychologist or psychotherapist, or whether special pharmacological agents are needed to treat depression. The European recommendations especially emphasize that every possible effort must be made, first of all, to eliminate the unfavorable psychological situation where possible.

Steps to health

To prevent atherosclerosis and its complications you need:

• create an alliance between doctor and patient;
• ensure that the patient understands the relationship between behavior, health and illness;
• obtain patient consent to change behavior and habits;
• involve the patient in choosing those factors that he can really change;
• combine medicinal and non-medicinal, social and psychological methods of eliminating risk factors, including the patient’s own efforts;
• jointly develop a new life plan;
• monitor the patient's progress;
• if possible, involve doctors from other specialties.

To give up smoking. The “5 A” rules will help:

1 A - ask: talk about the dangers of smoking with all smokers whenever possible;

2 A - assess: assess the degree of dependence of the smoker and his/her readiness to quit smoking;

3 A - advise (advice): in a strict form, order to quit smoking;

4 A - assist (help): when obtaining the smoker’s consent to quit smoking, develop a strategy that includes behavior change, replacement therapy and other pharmacological agents;

5 A - arrange (systematize): schedule the next visit to evaluate what has been done.

Diet.

Provide each patient with a professional explanation of what a healthy diet is and dietary recommendations that reduce the risk of developing CSD. Proper nutrition contributes not only to weight loss, but also to the normalization of blood pressure and blood lipid levels. Blood glucose levels and the tendency to form blood clots depend on it.

General recommendations of the European Society for Prevention:

• food should be varied, the amount of energy consumed with food should help maintain the “ideal” body weight;
• The consumption of fruits and vegetables, cereals and cereals, low-fat foods, fish and lean meats should be encouraged;
• Oily fish and omega-3 polyunsaturated fatty acids have a protective effect;
• the total amount of fat in the diet should not exceed 30% of the total daily caloric intake, and saturated fat - 1/3 of the total fat consumed; cholesterol intake from food - 300 mg per day;
• when compiling a daily diet, it is better to partially replace saturated fats with carbohydrates; mono- and polyunsaturated fats found in vegetables and seafood.

Patients with hypertension, diabetes, hypercholesterolemia or any other dyslipidemia should be consulted by a nutritionist.

Physical activity. Individually select exactly the level of load that will help reduce risk. Although half an hour of physical activity most days of the week is preferred for the prevention of CHD, more moderate exercise is also beneficial.

Healthy people can exercise for 30–45 minutes. a day 4–5 times a week. The training effect occurs when a heart rate reaches 60–75% of the maximum for a given age.

For patients with an established diagnosis of CVD, the load should be selected taking into account the results of a stress test (bicycle ergometer test or treadmill test), and a physical rehabilitation program should be drawn up by a rehabilitation specialist.

Risk factors for the development of coronary artery disease and atherosclerosis

Non-correctable:

• age over 60 years;
• male gender;
• development of IHD at a young age in close relatives.

But their presence does not mean that nothing can be corrected.

Adjustable:

• smoking;
• poor nutrition;
• high blood cholesterol levels;
• obesity;
• high blood pressure;
• sedentary lifestyle;
• chronic (especially professional) stress;
• social isolation;
• aggressive behavior and willingness to argue;
• depression, fear;
• unfavorable socio-economic conditions.

The most manageable are smoking, nutrition, physical inactivity and chronic stress.

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