How can cardiovascular disease be prevented?
Despite significant reductions in mortality, cardiovascular disease remains the leading cause of death worldwide.
Primary prevention is measures to prevent or increase resistance to a disease that a person does not have. Examples of this are vaccines used in medicine and routine checkups.
Since the end of the last century, the number of deaths from cardiovascular disease in the United States has decreased by 28%. This decrease has been seen in both women and men. The analysis showed that half of the decrease was due to early diagnosis and intensive treatment. The other half of the reduction was associated with lifestyle measures, particularly smoking cessation.
However, cardiovascular disease (CVD) is still the leading cause of death in the United States, as well as in most of the world. There is no denying the importance of better diagnosis, but there is a great need to identify, address, and modify risk factors. Studies in many countries have identified five modifiable risk factors that contribute to CVDs. These risk factors are: high cholesterol, diabetes mellitus, hypertension, obesity and smoking. These risk factors account for half of all CVD deaths in people aged 45-79. Most of the risk factors for cardiovascular disease can be eliminated or changed through preventive measures. These preventive measures include lifestyle changes as well as pharmacotherapy.
The INTERHEART study, conducted with patients from 52 countries, identified 9 risk factors for myocardial infarction. These risk factors include smoking, dyslipidemia (lipid metabolism disorder), hypertension (high blood pressure), diabetes mellitus, overweight and obesity, including abdominal obesity, low physical activity, and psychosocial factors. It should be noted that patients with more than one risk factor are at high risk.
THE MAIN COMPONENTS OF PREVENTION
A healthy diet should include the following components:
Foods rich in plant fiber
Foods with a low glycemic index
Foods low in saturated and trans fats, but high in monounsaturated fats
Foods rich in omega-3 fatty acids (fish and seafood).
Studies have shown that a diet rich in fruits and vegetables (such as the Mediterranean diet) reduces the risk of CVDs. It is believed that people who eat a lot of fruits and vegetables tend to consume less meat and saturated fats.
Smoking remains a preventable and harmful habit that leads to premature death and disability. Numerous studies have shown that the number of cigarettes smoked has a direct impact on mortality and the incidence of cardiovascular disease. The health benefits of quitting smoking become apparent in just a few months. Therefore, it is never too late to quit smoking in terms of preventing CVDs. In order to prevent the development of cancer, smoking should be quit as early as possible.
Doctors can also use nicotine replacement therapy and medication to speed up quitting smoking.
Controlling high blood pressure
High blood pressure is a risk factor associated with the development of CVDs. Hypertension increases the risk of death from stroke, coronary heart disease, heart failure, and the risk of sudden death.
The classification below was later adopted by the American and International Hypertension Societies:
Normal blood pressure: systolic BP<120 mmHg and diastolic BP <80 mmHg.
Prehypertension and high normal blood pressure: systolic BP 120-139 mmHg and diastolic BP 80-89 mmHg.
The exact prevalence of prehypertension and high normal blood pressure in Azerbaijan is unknown. According to a U.S. study, 37% of older adults in the United States have prehypertension.
Examination of patients with prehypertension condition for signs of target organ damage and regular monitoring for the development of arterial hypertension should be part of the follow-up of such patients.
According to the recommendations of the American and International Hypertension Societies, the treatment of diabetes mellitus, chronic kidney disease, target organ damage and cardiovascular disease without clinical manifestations, should be carried out by non-medicinal methods, such as: weight reduction, salt restriction, increased physical activity and cessation of alcohol consumption).
Treatment of patients with antihypertensive drugs is prescribed when arterial hypertension develops (BP>140/90 mm Hg). However, antihypertensive therapy may be used earlier in patients with comorbidities.
Choice of antihypertensive medication
The use of antihypertensive pharmacologic agents is necessary to treat patients with persistent arterial hypertension despite non pharmacologic therapy. Some patients may require treatment with more than one medication to achieve target blood pressure levels. Three types of drugs are used for primary monotherapy: thiazide diuretics, angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers, and dihydropyridine calcium channel blockers.
Attention to dyslipidemia
Clinical studies have shown that statins reduce CVD mortality in high-, intermediate-, and low-risk patients without clinical signs of coronary heart disease. Screening for dyslipidemia, as well as pharmacotherapy, is determined individually for each patient.
Control of body weight
Increased body weight is an important risk factor for metabolic syndrome. Studies in the United States have shown that only 5% of people of normal weight are diagnosed with metabolic syndrome, with 22% being overweight and 60% being obese. Thus, overweight and obesity are key factors in the development of CVD. Lifestyle modification measures aimed at reducing body weight and increasing physical activity form the basis of metabolic syndrome treatment.
In addition to its effect on body weight, several studies have shown that physical activity or exercise prevents the risk of CVDs. Current physical activity guidelines recommend that adults maintain a moderate level of moderate-intensity physical activity. It is recommended that each person engage in moderate-intensity physical activity (for example, frequent or brisk walking) for 30 minutes a day. A number of studies have shown that 150 minutes of weightlifting or aerobic physical activity per week reduces the risk of developing CVDs.
Treatment of type II diabetes mellitus
There is currently a pandemic of type II diabetes mellitus in the world. Overweight and obesity are some of the main causes of the growing incidence of diabetes mellitus. Diabetes mellitus morbidity and mortality are associated with macrovascular (coronary heart disease, stroke and peripheral artery disease) and microvascular (retinopathy, nephropathy and neuropathy) complications.
Maintaining control of body weight, blood pressure, lipids, and blood glucose levels is especially important to prevent and reduce the risk of macrovascular complications. Better control of blood glucose levels is necessary to reduce the risk of microvascular complications associated with diabetes mellitus. Better control of blood glucose levels also reduces the risk of macrovascular complications. The American Diabetes Association recommends checking fasting blood glucose levels in all patients at risk of developing diabetes and in all people over 45 years of age.
Fasting blood triglyceride levels help predict the risk of developing type II diabetes in the future.
Clinical studies have shown that aspirin significantly reduces the risk of myocardial infarction. However, the extent to which aspirin affects cardiovascular mortality has not been established. For primary prevention of CVDs, aspirin is prescribed by the doctor individually, taking into account the risk of CVD in the patient, his comorbidities and the risk of bleeding.