Helps reduce mortality from cardiovascular diseases. Prevention of cardiovascular diseases

Among premature deaths in our country, cardiovascular diseases have long and firmly held first place. And in terms of mortality from acute myocardial infarction, Russia occupies one of the leading places in the world. Why?

We turned to leading cardiologists for an answer.

Bitter realities

Until the thunder strikes, the man will not cross himself - the overwhelming majority of our fellow citizens profess such an attitude towards their own health. Experts have been sounding the alarm for a long time: despite the efforts being made in our country to prevent and treat cardiovascular diseases, a significant reduction has not been observed. According to data presented by the Russian Society of Cardiology and the Arterial Hypertension Society, 40-42% of the adult population has high blood pressure.

The situation is no better with the control of other risk factors that lead to coronary heart disease, and ultimately to acute myocardial infarction. We are talking about disorders of lipid and carbohydrate metabolism. The recent NATION All-Russian epidemiological study to assess the prevalence of type 2 diabetes mellitus, which involved more than 26 thousand people aged 20 to 79 years from 63 regions of Russia, leads to sad thoughts: 54% of people with diabetes identified during the study do not knew about their illness.

For doctors, this state of affairs causes nothing but grief.

Maria Glezer, chief freelance cardiologist of the Ministry of Health of the Moscow Region, professor of the Department of Preventive and Emergency Cardiology of the First Moscow State Medical University named after I.M. Sechenov, Doctor of Medical Sciences:

In the Moscow region today we have 26 health centers for adults and 8 for children, 8 prevention centers (including at the regional level). There are prevention rooms in every clinic.

Specially trained doctors work there, and if desired, every resident of the Moscow region who has a compulsory medical insurance policy has the opportunity to quickly, within one day, undergo basic screening examinations, and if necessary, receive a referral for a more in-depth examination and consultation with medical specialists. But, unfortunately, not everyone takes advantage of this opportunity.

Dangerous scenario

Our fellow citizens also underestimate the risk that arises as a result of acute coronary circulatory disorders. Having analyzed the data on how long it takes from the onset of an attack to calling an ambulance for squeezing, pressing or burning pain in the chest, which is not relieved by taking nitroglycerin, experts were puzzled: this period sometimes reaches ... 5-6 hours, or even 2-3 days! And this despite the fact that recently in our country the situation with the provision of emergency medical care to patients with myocardial infarction has improved.

Dmitry Napalkov, Professor of the Department of Faculty Therapy No. 1 of the First Moscow State Medical University named after I. M. Sechenov, Doctor of Medical Sciences:

The introduction of an algorithm for helping patients with acute myocardial infarction and coronary syndrome, the re-equipment of vascular departments of hospitals and the emergence of new vascular centers have led to the fact that mortality from heart attack in our country has decreased significantly.

It could have decreased even more if not for the arrogance of our citizens. People often endure until the last minute, not suspecting that from the moment heart pain occurs, only 90 minutes are allotted to save heart cells, and sometimes their lives. These are the canons of emergency medical care for myocardial infarction, one of the cornerstone principles of which is the maximum possible reduction in the time of delivery of the patient to the hospital. This period is called the “therapeutic window”, during which it is necessary to restore the patency of the vessels supplying the heart: either by introducing special drugs, or by using stenting, in which a thin metal spacer is inserted into the damaged vessel under the control of special equipment.

Area of responsibility

Doctors also have many questions about how patients, even those who have already suffered a heart attack, follow medical recommendations.

Maria Glezer:

Today in our country we use absolutely the entire arsenal of medicines that are available in the world for the treatment and prevention of cardiovascular diseases. The problem is that people do not always use even well-chosen medications correctly: they skip doses, change doses themselves, do not take some of the prescribed medications, which leads to a decrease in the effectiveness of treatment.

However, there is another problem that doctors talk about with alarm and pain: interruptions in holding auctions for the purchase of preferential medicines, the list of which, according to experts, contains a lot of unnecessary things, and of those that exist, not all of them are the most effective. But a way out of this situation could also be found.

Dmitry Napalkov:

I have long been talking about the need to monetize benefits, providing some kind of social and financial support to our citizens, who, having paid a little extra, could go to the pharmacy for more expensive, but, most importantly, better quality drugs. Taking into account the crisis situation, not a single state, even the most advanced one, can afford to provide them to everyone in full. But are our citizens, many of whom are accustomed to receiving treatment for free, ready for such a step?

Experts agree on the following conclusions: in order to reverse the situation, the efforts of the medical community alone are not enough. It is necessary to change the attitude of citizens themselves towards their own health, for whom it is time to understand: first of all, this is an area of our personal responsibility. And already in the second - a doctor.

How to recognize a heart attack:

You urgently need to dial “103” if there is pain in the heart area:

is not similar to the previous ones and is not controlled by a standard dose of nitro drugs;
lasts more than 15 minutes;
radiates to the shoulder, epigastric region, jaw, neck;
first occurred in a man over 30-35 years of age or in a woman over 40-45 years of age;
accompanied by cold sweat, shortness of breath, general weakness, and increased blood pressure.

Before the ambulance arrives, it is not prohibited to take nitrospray once or twice (preferably in a sitting or lying position, this prevents a sharp decrease in blood pressure and the appearance of fainting).

What leads to disaster:

High blood pressure

The risk of dying from a heart attack is much higher if high blood pressure is added to the increase in cholesterol levels.

What to strive for: Normally, blood pressure should not be higher than 140/90 mm Hg.

Lipid metabolism disorder

An increase in blood cholesterol levels of just 10% increases the death rate from heart attack by 15%.

What to strive for: Optimally, the level of low-density lipoprotein (LDL) “bad” cholesterol is less than 3.0 mmol/L, and total cholesterol is less than 5.0 mmol/L.

Smoking

People who smoke have an 8-10 times higher risk of developing cardiovascular diseases. Smoking is especially dangerous for women. For them, even one cigarette a day becomes a risk factor for the heart.

What to strive for: to a gradual reduction in the number of cigarettes smoked and to a complete cessation of tobacco.

Obesity

In people with excess body weight, the risk of developing a heart attack is 3-4 times higher (especially if obesity is combined with high blood pressure, high cholesterol and blood glucose).

What to strive for: to the normal waist size, which for women should be less than 80 cm, for men - less than 94 cm.

High blood glucose levels

A round of elevated blood glucose brings with it a whole trail of hormonal and metabolic disorders, which primarily lead to damage to the cardiovascular system. In 80% of cases, patients with diabetes die from heart attacks and strokes.

What to strive for: According to the recommendations of the World Health Organization, the normal level of plasma glucose (blood from a vein) on an empty stomach is less than 6.1 mmol/l, and 2 hours after the stress test - less than 7.8 mmol/l.

When to get examined

Starting from 40 years of age (for men) and 45 years of age (for women), it is necessary to undergo an annual cardiac examination, which includes:

blood test for cholesterol levels and various
its fractions (lipid profile)
blood test for blood glucose levels
uric acid level test
ECG, echocardiogram (if indicated)
Ultrasound of the carotid arteries (if there are risk factors)

Memo for patients after a heart attack

Is it possible to live a full life after a heart attack and avoid its recurrence?

Doctors say: it’s possible. The main thing is to follow a number of important rules.

Take necessary medications.

Namely: ACE inhibitors, beta blockers, antiplatelet agents and statins. Patients who have had a heart attack must take these medications for the rest of their lives.

Visit a cardiologist regularly.

Preferably the same person who knows your medical history well and can adjust the dose of medications.

Maintain optimal levels of blood pressure and pulse.

In a person who has had a heart attack, target blood pressure values should be higher than is customary for hypertension: systolic (upper) - no lower than 120 and no higher than 150, and diastolic (lower) - no higher than 90. In this case, the recommended pulse rate should be 56-60 beats per minute.

Don't lie down!

The sooner a patient begins physical rehabilitation after an uncomplicated heart attack, the better. First, with the help of massage, walking on a cardio machine. The part of the heart muscle that remains healthy after a heart attack needs training.

Five steps to a healthy heart

Monitor blood pressure levels

World experience of recent decades shows that thanks to control of blood pressure, which must be measured regularly starting from the age of 40, it was possible to reduce the incidence of myocardial infarction by 30%, and stroke by 50%.

Stop smoking and do not abuse alcohol

According to the Ministry of Health of the Russian Federation, in just the first year from the start of the anti-tobacco campaign in our country, as a result of quitting smoking, mortality from cardiovascular diseases decreased by 15.7%.

Establish nutrition

Reduce salt intake to 5 g per day.

Limit your consumption of sweets (sugar, honey, baked goods).

Limit consumption of animal products rich in cholesterol (fatty meat, sausages, fatty cheeses and dairy products, canned food).

Eat more plant-based foods (raw vegetables and fruits). The average norm is 600 g per day.

Move more

The best option is walking at a brisk pace (preferably in the fresh air), the average norm is 10 thousand steps per day (3-5 km). Swimming and cycling are also beneficial for vascular health.

Develop resistance to stress

First, improve your sleep, which should average at least 8 hours a day. Maintain alternating work and rest schedules.

Cardiovascular disease (CVD) is a group of diseases of the heart and blood vessels. All these diseases are treated by cardiologists.

This group of diseases includes:

Arterial hypertension (high blood pressure).
Coronary heart disease (IHD) – angina pectoris, silent myocardial ischemia and myocardial infarction, as the most severe manifestation of IHD, there may be other manifestations of IHD, which we will talk about later.
Cerebrovascular accidents (treatment in conjunction with neurologists).
Diseases of peripheral vessels (atherosclerosis of peripheral vessels, the most severe manifestation is intermittent claudication and gangrene), treatment together with vascular surgeons.
Rhythm disorders (joint treatment with arrhythmologists).
Cardiomyopathy of various origins.
Heart failure, which develops as a result of various diseases and lesions of the heart.
Congenital and acquired heart defects (joint treatment with rheumatologists and cardiac surgeons).

As part of our project, we will primarily talk about disease prevention, which are based on atherosclerosis, that is, damage to blood vessels by stenosing (closing the lumen) atherosclerotic plaques. The process of development of atherosclerosis in blood vessels occurs unnoticed and painlessly, since there are no pain receptors inside the vessels. Early detection of this disease requires a doctor's examination and additional research methods.

The resulting disruption of the blood supply to any organ leads to disruption of its function or even death. This is especially important nowadays, since there are many ways to prevent these processes.

Relevance of the problem

According to statistics, diseases of the cardiovascular system are one of the leading causes of death and disability throughout the world. In recent years, thanks to preventive measures and treatment of CVD, oncological diseases have come to the fore. In our country, more than 1.2 million people die from CVDs per year, while in Europe there are just over 300 thousand people. The leading role in the structure of mortality belongs to coronary heart disease (CHD). Every year, 450 thousand people suffer a stroke, which is 4 times higher than in the USA and Canada.

We are starting an educational project that will introduce anyone who is interested in ways to prevent cardiovascular diseases and their complications.

Risk factors for cardiovascular disease

Experience from the United States and Europe shows that preventive measures aimed at reducing CVD risks can be very effective. Since 1980, the incidence and mortality from coronary heart disease, especially in high-income countries, has decreased significantly, which is associated primarily with preventive measures carried out both at the state level (smoking ban laws) and at the individual level, each specific humans (including limiting cholesterol and salt in foods).

With age, atherosclerosis develops to one degree or another in all people, but the rate of its development varies. In some cases, already at a young age, plaques close the vessels so that the blood supply to the organs is disrupted, in other cases, even at 90 years of age, the vessels can fully cope with their function.

What determines the degree and rate of development of atherosclerosis? This is exactly the question that was posed in 1948 in the USA. In search of answers, the famous Framingham Study was launched, which continues to this day. All residents of the small town of Framingham, which is located 30 km from Boston, were included in lifelong observation. They were interviewed and examined by doctors. During the observation process, about 30 different parameters were taken into account. This research is currently ongoing, evaluating approximately 1,500 parameters simultaneously, including a complete genome analysis.

Already in 1957, it became clear that the presence of arterial hypertension and increased cholesterol are associated with the risk of developing coronary heart disease (CHD), that is, with the development of atherosclerosis of the heart vessels. In 1961, the term risk factor (RF) was first introduced. Risk factors are conditions and diseases that contribute to the development of atherosclerosis and related diseases, which can lead to premature death.

The list of risk factors was expanded in subsequent years: the role of smoking, diabetes mellitus, obesity, sedentary lifestyle, stress (psychosocial factor), as well as age, gender, and family history became clear. Currently, there is an intensive search for genetic markers associated with the main risk factors for the development of coronary artery disease and atherosclerosis in general.

The Framingham Study data have been confirmed in numerous epidemiological studies involving thousands of people and in clinical work on risk factor interventions.

Risk of death from CVD (SCORE scale)

Currently, tables have been developed that allow, taking into account age, gender, smoking habits, blood pressure levels and total cholesterol levels, to calculate the risk of death for each individual person over the next 10 years and, most importantly, to significantly reduce this risk by controlling these factors.

Let's look at two examples of calculating the risk of death from CVD in the next 10 years using the SCORE scale (highlighted in green and blue in Figure 1).

Case 1. A 60-year-old man, blood pressure 160 mm Hg. Art., smoker, cholesterol level - 8 mmol/l. The SCORE risk of death is 24%.

Case 2. After carrying out preventive measures aimed at reducing negative factors, we get: a 60-year-old man, blood pressure 120 mmHg, non-smoker, cholesterol level - 4 mmol/l. The SCORE risk of death is 3%.

As you can see, there was an 8-fold reduction in the risk of death!

We will try in subsequent chapters of our project to learn how to minimize the risks associated with the above factors.

In 2017, cardiovascular diseases claimed the lives of 858 thousand people, which is 5% less than the year before. The death rate has reached its lowest level since the beginning of the decade. The Ministry of Health believes that mass clinical examination and the creation of vascular centers throughout the country played a role in this. According to experts, increased attention is now being paid to reducing mortality from circulatory disorders, as it leads to an increase in life expectancy and a strengthening of the economy.

In 2017, the mortality rate from cardiovascular diseases fell below 600 per 100 thousand population for the first time since the beginning of the decade. This is evidenced by Rosstat data, which Izvestia reviewed. Last year, 858 thousand people died from diseases of the circulatory system - 5% less than in 2016. This is 584.7 cases per 100 thousand population.

A systematic decline has been observed since 2010. But cardiovascular diseases still remain the main cause of death for Russians - almost half (47%) of deaths.

Who is at risk of dying from noncommunicable diseases?

Thanks to medical examinations, which more and more residents of the Leningrad region undergo every year, doctors are able to identify not only the chronic non-infectious diseases they have, but also the risk factors that lead to their development, Alexey Valdenberg told Public Control.

The risk of death fell more sharply for heart disease than for cancer, offset the increase in mortality from heart disease, and partially offset the increase in cancer mortality caused by demographic changes over the past 4 decades. If current trends continue, cancer will become the leading cause of death.

For most of the last century, the leading cause of death in the United States, measured by actual deaths, was heart disease, followed by cancer. Age-standardized mortality approximates the risk of death from a given cause and is used to compare the risk of death between populations or a population over time. Falling death rates indicate that the overall risk to the population of dying from heart disease or cancer has decreased. However, age-standardized mortality rates do not fully reflect the burden of these diseases because they effectively remove the impact of demographic changes associated with population growth and changing age structures.

According to him, there are several hundred such risk factors, but the main ones are diabetes, arterial hypertension, smoking and high cholesterol.

In order for mortality from non-communicable diseases in the country to decrease, it is necessary that the population lead a healthy lifestyle, so that the system of early detection of diseases and risk factors works

Mortality from cardiovascular diseases in the world

The number of deaths is a function of the population's risk of being diagnosed and dying from that cause, as well as the size and age structure of the population. For these analyses, we defined heart disease as rheumatic heart disease, hypertensive heart disease, hypertensive heart and kidney disease, acute myocardial infarction, ischemic or ischemic heart disease, atrial fibrillation, other arrhythmias, heart failure, and other heart disease; we defined cancer as malignant neoplasms.

Type 2 diabetes mellitus often causes heart attacks and strokes, but, as a rule, it is asymptomatic, and people find out that they have it very late. Ideally, after 40 years, all people should check their blood sugar levels twice a year, and those who are overweight even more often, explained Alexey Waldenbarg.

Population estimates and projections were used as denominators in rate calculations. We used the terms “increase or decrease” to describe significant trends and persistence to describe minor trends. Methods for predicting mortality and number of cancer deaths are described in detail elsewhere. Separate models were constructed for deaths from cardiovascular disease and for causes of death from cancer, by sex, for all races combined. We based projections for all cardiovascular disease deaths and all cancer deaths on aggregate estimates among individual disease categories.

Vasily Ivanov, head of the Leningrad Regional Center for Medical Prevention of Non-Infectious Diseases, noted that the risk of dying from cardiovascular diseases, respiratory and gastrointestinal diseases, neoplasms and others can only be reduced by the person himself.

A doctor cannot force a patient to give up smoking, alcohol, or unhealthy eating. He can explain what the consequences of these bad habits are, but the choice always remains with the person, said Vasily Ivanov, emphasizing that, according to WHO, quitting smoking and alcohol, switching to proper nutrition and increasing physical activity can prevent 60% of cases of coronary heart disease. heart disease, strokes, diabetes and 40% of cancer cases.

Causes of heart disease

Methods for apportioning the relative contributions to changes in the total number of new heart diseases or cancer deaths each year that may be attributable to changes in demographic risk and demographic changes associated with population size and age structure are described elsewhere. The third data set was created for the observed number of deaths that actually occurred and thus reflects the combined effects of changes in demographic risk, height, and aging.

The percentage change in mortality from cardiovascular disease decreased among men and women. By race and gender, the percentage declines were 8% among white men, 6% among white women, 4% among black men, and 8% among black women. By race and gender, the percentage change decreased by 9% among white men, 5% among white women, 3% among black men, and 0% among black women.

In order for mortality from non-communicable diseases in the country to decrease, it is necessary that the population lead a healthy lifestyle, that the system of early detection of diseases and risk factors works, and that the treatment of these diseases is timely and effective, the specialist noted.

Symptoms of heart attack and stroke, first aid

Our health and well-being largely depend on ourselves, but Russian people are distinguished by their patience, which sometimes leads to irreversible consequences, says Tatyana Tyurina, chief physician of the Regional Clinical Hospital.

Our projections indicate that cancer will soon become the leading cause of death in the United States if trends in the risk of death from cancer and heart disease and population growth and aging continue. The decline in heart disease began earlier and was steeper than the decline in risk of death from cancer, which occurred after about 20 years. The magnitude of the reduction in heart disease risk offset the increase in heart disease mortality caused by population growth and aging, while the reduction in the risk of cancer deaths only partially offset the increase in cancer mortality caused by demographic changes associated with population growth and aging.

During myocardial infarction, a person experiences a sudden attack of pain behind the sternum. This pain is pressing, squeezing. Sometimes this pain is localized in the abdomen. It becomes difficult for a person to breathe, perspiration appears

According to her, many, feeling unwell, put off visiting a doctor or calling an ambulance. But if we are talking about heart attacks and strokes, then a person’s life hangs by a thread.

These results are similar for black Americans. Several factors have contributed to the reduced risk of heart disease. Among smokers, the reduction in excess risk of death from heart disease occurs soon after cessation and is reduced by about half after one year of smoking. After 15 years of cessation, the risk of death is slightly increased but similar to those who have never smoked, supporting the hypothesis that the inflammatory component of cardiovascular disease is reversible. Although the reduction in the risk of death from cardiovascular disease has been accompanied by a decrease in smoking prevalence, the treatment of cardiovascular risk factors has also improved.

If a person has a heart attack, their chances of survival decrease sharply after six hours. In cases of stroke - after 2-4 hours. That is why it is necessary to know what the symptoms of these acute diseases are and what actions should be taken by people who find themselves close to a person who has a heart attack or stroke, says Tatyana Tyurina.

The remaining reduction was due to further reductions in key risk factors - total cholesterol, high blood pressure and smoking - as well as increased physical activity. Further reductions in the risk of death from heart disease may have been mitigated by increases in body mass index and diabetes prevalence.

Timing and stages of the Program implementation

The overall risk of death from cardiovascular disease has decreased among both black Americans and is expected to continue to decline based on our model. This reduction in risk led to an overall decrease in the observed number of deaths from heart disease. The decline in deaths from cardiovascular disease among women has only recently begun and is expected to continue.

You need to immediately call an ambulance and lie down and chew an aspirin tablet until the doctors arrive. If the pressure is not low, then take a nitroglycerin tablet, the doctor advises.

During a stroke, a person may feel a sharp headache, weakness in the face, arm, or leg. His speech is impaired and he begins to choke.

If a person is asked to raise and lower his arms, then one of them will act asymmetrically. Asymmetry on one side of the face will be observed when smiling. It is urgent to call an ambulance, because the faster qualified assistance for a stroke is provided, the greater the chance of reducing the likelihood of complications, explains Tatyana Tyurina.

During a stroke, a person may feel a sharp headache, weakness in the face, arm, or leg. His speech is impaired and he begins to choke

What to do if you see a person fallen and showing no signs of life? The head physician of the Leningrad Regional Clinical Hospital advises to approach him, if there is no danger to yourself, that is, there are no exposed electrical wires nearby, for example, ask: “What happened?”, Listen to breathing and heartbeat. If a person does not react to anything, is not breathing, and his heart has stopped, you need to urgently call an ambulance, and while the doctors are traveling, you must try to bring the person back from the state of clinical death by performing cardiopulmonary resuscitation. But you need to act quickly and confidently, since the time interval between the onset of clinical death and the occurrence of irreversible changes in the cerebral cortex is extremely short.

The person needs to be placed on his back, his head thrown back, his mouth open and his lower jaw pushed forward. The resuscitator clasps his hands and vigorously presses on the middle of the patient's chest with straight hands with an amplitude of 5-6 centimeters. The frequency of pressure should be 80-100 per minute. In this case, every 30 pressures it is necessary to make two deep exhalations into the victim’s mouth with an interval of a couple of seconds. The patient's chest should rise at this moment. In this way, we will restore minimal blood flow in the body,” explains Tatyana Tyurina.

According to the expert, 99% of people saved from clinical death outside the walls of medical institutions were rescued from this state not by doctors, but by those who were nearby and performed cardiopulmonary resuscitation.

In the five minutes after which brain death begins, not a single ambulance will arrive. Therefore, knowledge of how to provide first aid to a person who has lost consciousness and shows no signs of life is extremely important for each of us. Nobody knows what will happen to us and our loved ones today, says Tatyana Tyurina.

Three complementary strategies can reduce morbidity and mortality from cardiovascular diseases. The first (population) strategy is population-wide interventions that can reduce risk factors and the burden of CVD among the entire population. This strategy includes monitoring of risk factors and CVD, educational campaigns and low-cost preventive measures among the entire population.

Examples of these actions include national campaigns aimed at banning smoking. The second strategy (high-risk strategy) is to form groups at high risk of CVD to carry out certain effective, inexpensive preventive measures (screening and treatment of hypertension or hypercholesterolemia).

Third strategy(secondary prevention strategy) involves the allocation of resources to expensive treatments for acute or chronic conditions, as well as to the implementation of secondary prevention activities. Typically, allocated resources are used to execute all 3 strategies simultaneously; however, all of these time-consuming strategies are being implemented simultaneously mainly in high-income countries where significant financial resources are spent on health care.

One way or another, implementation strategies in each country depends on its resources, social conditions and determination of priorities. The following sections will identify the main problems facing each region and possible solutions to them.

In many countries with high level income, mortality from cardiovascular diseases is decreasing, but some important problems remain unresolved. First, socioeconomic and racial disparities in CVD mortality persist. For example, in the United States there are large disparities between individual racial and ethnic groups. Thus, a major goal should be to accelerate the widespread adoption of preventive and treatment technologies across racial, ethnic, and socioeconomic groups.

Secondly, the rate of decline mortality from cardiovascular diseases seems to have slowed down. Countries are entering a period of NFA and obesity. This may be caused by negative changes in the prevalence of certain CVD risk factors: although many older men and women quit smoking, young people and adolescents are still taking up smoking; in the last decade, the number of patients with hypertension who are treated effectively has decreased slightly; The increasing prevalence of obesity and diabetes is of great concern. The biggest concern is the rise in obesity and NFA among children.
These changes in risk factor levels can be explained by the flattening of the mortality curve, as well as the faster decline in mortality rates than the emergence of new cases of cardiovascular disease.

If they don't taken measures to change existing trends regarding risk factors, an increase in mortality from . In healthcare, more funds need to be allocated to activities for high-risk groups, such as adolescents, as well as against smoking and the widespread implementation of guidelines for the diagnosis and treatment of patients with hypertension and DLP. There is a need to develop and use effective strategies to increase PA and reduce the prevalence of obesity and diabetes.

Thirdly, due to the aging population prevalence of cardiovascular diseases will rise in parallel with the increase in the average age of the population, even if the age-standardized mortality rate among this population continues to decline. New advances in treatment and secondary prevention technologies will promote survival and increase the number of patients with CVD, which will further require increased resources.

With the development of a large number strategies, saving the lives of patients with acute complications of atherosclerotic diseases, an increasing number of such patients survive such severe complications as myocardial infarction (MI). For example, in the 1950s. 30% of patients admitted to the hospital for AMI died. Nowadays, intrahospital mortality has decreased by more than 2 times, despite the fact that such patients continue to be admitted to hospitals. The number of people diagnosed with CAD before clinical symptoms appear is increasing. Thousands of pacemakers and defibrillators are implanted every year.

As more and more patients cardiovascular diseases are living longer, the number of patients with heart failure is increasing even as mortality from it decreases. As a result, more and more resources are required to treat patients with HF. The main problem for most countries with developed market economies will be the increase in financial costs for the treatment of CVD, so more effective and inexpensive technologies will need to be developed to treat such patients.