Atherosclerosis - causes and risk factors. Methods for diagnosing vascular atherosclerosis. Menopause and other hormonal changes

The desire for a beautiful and slim body is commendable, but we should not forget that health is a fundamental factor. A person’s full existence is based on both physical and psychological well-being. Based on this, it is worth paying attention to fitness, since this type of technique affects the body at all levels. At the same time you acquire beautiful body and reduce the risk of disease.

Factors contributing to the development of atherosclerosis include hyperlipoproteinemia, increased platelet aggregation, decreased vascular endothelial cells, and increased smooth cell proliferation. Leukocytes, monocytes and macrophages are present in atherosclerotic lesions, indicating inflammatory response in its development 34.

Once activated, they initiate the production of various cytokines, interleukins, tumor necrosis factor alpha, interferon-gamma. It has been demonstrated that atherosclerosis is not simply a disease of lipid deposition and that inflammation plays a key role in the initiation, progression and destabilization of atheroma 36 .

What is atherosclerosis

Pathology that affects blood vessels. The essence of the problem is that plaques form inside the arteries, or more precisely, on their walls. Oval-shaped connections with an uneven surface significantly narrow the lumen of blood vessels. In this case, they can grow and form sclerosis, that is, connective tissue, which is capable of completely blocking the vessel. In turn, the main sources of atherosclerosis include: chemical compound, like cholesterol.

Acute phase reaction of inflammation. Living things survive by maintaining a dynamic and complex balance that is often threatened by internal and external forces. Maintaining this balance is ensured by some physiological mechanisms, so that any factor that disrupts the integrity of the body causes a series of metabolic and systemic changes that are aimed at restoring homeostasis. These changes represent the process of inflammation and a group of humoral and cellular responses that begin soon after injury and are collectively called the reaction acute phase 39.

Cholesterol is a fat that is produced both in the human body itself and comes from food. WITH medical point In terms of perspective, fats are called lipids, and proteins. At the same time, protein-fat compounds are formed in the blood, which are called lipoproteins. In our case, only three of their classes are of interest, which have high, low and extreme reduced density. If the first two types only contribute to the development of the disease, then the latter can slow down the process.

Acute phase reaction allows you to survive for postoperative period tissue damage, causing the synthesis and secretion of several cellular mediators at the site of injury, which mobilizes the metabolic response of the entire body. Thus, the acute phase response is a homeostatic, dynamic and defensive response that the host mounts against the various aggressions to which it is exposed.

Most of the time, inflammatory mediators act locally to limit the effects and extent of tissue damage. Under conditions where this local homeostatic capacity is overcome either by the magnitude of the aggressor stimulus or by the failure of regulatory mechanisms, the inflammatory response exceeds the limits of its microenvironment and can manifest itself systemically41.

Reasons for the risk of atherosclerosis

It can be conditionally divided into three categories.

Initial Factors

If you have relatives who have coronary heart disease or suffer from hypertension, then your risk of atherosclerosis increases significantly. In this case, we can say that everything is determined at the genetic level.
Gender also influences the development of the disease. This is due to the fact that women, until menopause has occurred, have some protection, since their body produces hormones such as estrogens. Based on this, the disease is more often manifested in men. Although it should be noted that in some cases the disease progresses in young women. But this fact is more associated with the use of hormonal contraception, smoking.
Age characteristics are also important. Greatest risk onset of the disease in men aged 35 to 50 years.
Psychological aspects of personality have a significant impact on the risk of atherosclerosis. People who have a high sense of purpose stand out with the greatest predisposition. This category of individuals copes with stress quite poorly, which is why they fall into the risk zone.

Accelerating factors

Elevated cholesterol leads to destabilization of the lipid metabolism process. Cholesterol begins to settle on the walls of blood vessels, which leads to the creation of plaques. Over time, these formations harden as calcium accumulates in them. In this case, plaques protrude into the lumen of the vessel, which leads to the formation of so-called vortices. In turn, this process causes the collision of blood cells, which die and settle on the plaque. As a result, a blood clot forms that blocks the vessel, which can result in a heart attack.
High arterial pressure– this is one of the most significant factors.
If you smoke, you should know that nicotine can raise cholesterol levels in the blood and cause vasospasm.
Obesity is also one of the most important factors, which lead to pathology. Man suffering from overweight, increases the load on your heart. In addition, fat metabolism is disrupted, and the body has a hard time coping with physical activity.
Diabetes mellitus disrupts carbohydrate metabolism, which, in turn, harms both small and large vessels. Therefore, it is worth checking your blood sugar levels regularly.
The harm of physical inactivity is well known, and if it is supported by smoking and excess weight, then the occurrence of atherosclerosis is guaranteed.

Provoking factors

Tobacco smoking and stress lead to the fact that the walls of blood vessels are damaged, and cholesterol begins to accumulate in this place, which is then reorganized into dense formations. What contributes to the occurrence of pathology.

Molecular mechanisms of the acute phase reaction. Regardless of the nature of the triggering stimulus, the activated cells of the system mononuclear phagocytes initiate a cascade of acute events in the response phase, secreting, on early stage, cytokines of the interleukin-1 family and tumor necrosis factor. These molecules act both locally and systemically 42.

At the systemic level, the liver is a major target for inflammatory mediators, providing metabolites necessary for the stress response and components necessary for first-line defense at the site of inflammation 47. Through its specific receptors, the hepatocyte responds to four types of mediators of the inflammatory response.

Development of the disease

Includes three stages: ischemic, thromonecrotic and sclerotic. At the first stage, there is a decrease in blood flow to organs and tissues, and a number of other functional changes. The second stage is a pronounced circulatory disorder, which is accompanied by the formation of blood clots, and necrosis is also possible in areas of degeneration. Finally, the third stage is characterized by the appearance of so-called scar tissue.

These acute phase proteins play important role in host defense, such as direct neutralization of inflammatory agents, reduction local damage tissues, participation in tissue repair and regeneration. This is likely due to the amount of protein required to effectively participate in the acute phase response.

Although the acute phase response is not specific, it can be used in clinical practice as part of the diagnosis, both in assessing the intensity of inflammatory activity and in recognizing inflammatory diseases. It is obvious that healthy people with more high level, even at high normal levels, are exposed to more high risk development of peripheral arterial disease 4.

Symptoms of atherosclerosis

Often the disease affects the aorta and the large trunks that arise from it. If the left and innominate arteries are affected, the blood supply to the brain is disrupted. At the same time it appears headache and tinnitus. And also noted general weakness and aches in upper limbs. When the plaques disintegrate, the lumen of the branches that extend from the aorta may be blocked. If formations are localized in iliac arteries, then lameness may be noted. When the mesenteric vessels are susceptible to atherosclerosis, pain begins in the upper abdomen. They differ from the cuts that occur when peptic ulcer, since they have a shorter time period.

In studies conducted with children and adolescents, fat accumulation has been observed in the area abdominal cavity and hyperinsulinemia associated with a thrombogenic and inflammatory profile. Elevated concentrations of fibrinogen and plasminogen activator inhibitor 1 have been reported in individuals with visceral obesity, which increases the risk of thrombosis in these patients.

The authors concluded that overweight, body fat And abdominal obesity are predictors of changes in the fibrinolytic system in young people. From the point of view of preventing atherosclerotic disease, work on physical activity in youth, examined their level of physical activity, the effects of school and community health education interventions, strategies to increase physical activity levels, and the effect of physical activity in preventing or managing cardiovascular risk factors57.

When damage occurs renal arteries, then this is caused by pain in the lower back and abdomen. This continues for several days. In turn, atherosclerosis of the vessels of the legs manifests itself in pain that occurs when walking. They often hurt calf muscles and feet. In addition, you may feel chilly, and late stages Ulcers may appear in the heels, toes and shins.

Although some studies have shown that adolescents who engage in more physical activity tend to remain more active as young adults, other authors have demonstrated that physical activity is more childhood does not provide cardiovascular protection unless associated with continued active lifestyle during adulthood 58.

The American Heart Association states that, beginning at age 2, encouragement to adopt an active lifestyle should begin and be maintained. adolescence in adult life. Beneficial effects have also been demonstrated aerobic training on lipoprotein lipase activity, which would explain the better release of triglyceride-rich lipoproteins.

Treatment of atherosclerosis

The process includes diet, certain physical exercise and medicines. If cholesterol is high, then special nutrition is almost always provided. At the same time, you need to use multivitamins with antioxidants, and if you are overweight, you should use drugs that normalize fat metabolism.

Isolated physical training, without food control, causes moderate weight loss. However, when combined with diets, it promotes food control and guarantees greater success in maintaining lean mass and reducing fat mass. The same authors also noted that regular aerobic training enhances fat loss but does not prevent lean mass loss, while resistance training appears to minimize this loss. A combination of aerobic training and strength training appears to provide concomitant fat loss and lean mass maintenance.

If the diet fails to reduce cholesterol, then you should start taking medications. When there are no contraindications, the first stage is to take statins. In case of high triglyceride levels, it is better to start therapy with fibrates. The duration of treatment with medications depends on lipid metabolism. When the goal is to achieve stabilization of atherosclerosis, drug treatment is carried out for about two months, and then a return to diet occurs. It is also worth noting that blood purification methods have proven themselves well.

They found in the same group that promoting exercise increased arterial blood flow, supporting the importance of an exercise program as a form of treatment for obese children as primary prevention of atherosclerosis. The effects of exercise on systemic hypertension occur due to the cardiovascular and respiratory adaptations that the human body undergoes during a period of exercise to meet the increased demands of active muscles and as these adaptations are repeated, changes occur in these muscles allowing the body to improve its performance.

Drugs

Treatment involves a long process of using medications. Therefore, we must be extremely careful about medications that are anti-atherosclerotic. There is quite a large number of classes of drugs related to the treatment of atherosclerosis.

The most active group includes statins, which are essentially antibiotics. Since cholesterol not only comes from food, but is also produced directly in the human body, in the liver, these medications block the formation of cholesterol.

Physiological and metabolic processes that optimize the distribution of oxygen to active tissues come into play. Postoperative physical pressure drop is associated with hemodynamic, humoral and neural factors 64. However, it is still impossible to clarify the dose-response effect of exercise for its treatment or prevention 65.

However, it is worth emphasizing that a good part or almost all of these positive effects will return if the person stops engaging in physical activity 67. Potential conflict of interest. There were no sources of external funding for this study.

Fluvastatin

Refers to synthetic drugs groups. Has less side effects compared to other statins. The result of its use is noticeable after seven days of taking it. On this moment is the best in the group.

Fenofibrate

Refers to the most effective drugs groups. Effective in reducing uric acid.

This article is part of Marina Pegoraro's Master's thesis by the Federal University of Parana. Coronary heart disease: admission, length of stay and costs. Mechanisms of acute ischemic syndrome and progression of coronary atherosclerosis.

Association of C-reactive protein with markers of common atherosclerotic disease. Behavioral Methods treatment of chronic systemic inflammation: Effects of dietary weight loss and exercise. Highly sensitive C-reactive protein: a potential addition for global risk assessment in primary prevention cardiovascular diseases.

Clofibrate

Affects the synthesis of triglycerides, which form extremely low density lipoproteins. negative quality is a large number of side effects.

Bezafibrate

Relatively poorly reduces total cholesterol, but at the same time quite well increases the number of lipoproteins with a significant density.

Hypercholesterolemia in schoolchildren and risk factors. Intra-individual variability in the concentration of children's blood, lipids and lipoptotins: a review. Risk factors for the development of atherosclerotic disease in adolescence. Risk factors for atherosclerosis in children and adolescents with a family history premature illness coronary artery.

High blood pressure in childhood. Summary third report of the National Expert Group on Cholesterol Education Program on the detection, evaluation and treatment of high blood cholesterol in adults. Trends in diabetes mellitus in Brazil: the role of nutritional transition.

Gemfibrozil

This drug is effective for high triglyceride levels. Maximum effect achieved if this drug is taken long enough.

Ciprofibrate

Side effects are minimal, but otherwise similar to other drugs in the group.

In addition, for the treatment a nicotinic acid, as well as its derivatives. The action is determined by the fact that the process of transformation of fats in the body is accelerated. This condition leads to a decrease in their concentration in the blood. Bile acid sequesters are also used, for example, colestipol and cholestyramine. These drugs slow down the absorption of bile acids, which leads to a decrease in cholesterol.

The effects of exercise training on vascular function in obese children. Pathological determinants of atherosclerosis in a youth research group: determinants in young people. Effects of cigarette smoking on lung function in adolescent boys and girls.

Guiding exercises for the prevention of cardiovascular diseases. Importance of physical activity in prevention overweight and obesity in childhood: a review and opinion. Leptin and total cholesterol are predictors of weight gain in prepubescent children.

Establishing the prevalence of hypertension: the impact of sampling criteria. Vasomotor function testing: nitric oxide, multipotent molecule. Endothelial function and disease coronary arteries. Pediatric precursors of adult atherosclerosis.

Pravastin

Slightly worse effect on cholesterol increased density compared to lovastine. Although the mechanism of action is almost identical.

Simvastin

Is different quick effect. So, after two weeks you can get a reduction total cholesterol by ten percent. Simvastin is quite well tolerated by patients.

Is obesity inflammatory disease? Inflammation in atherosclerosis and implications for therapy. Looking to the future and monitoring actions. Endothelium and lipid metabolism: real understanding. C-reactive protein, inflammation and innate immunity.

Atherosclerosis and inflammation: patterns of cytokine regulation in patients with peripheral arterial disease. Immune mechanisms with atherosclerosis. Inflammation and atherosclerosis. Low co-inflammation and coronary artery disease: a prospective study and updated meta-analyses. Interleukin-6 and acute coronary syndrome.

Lovastatin

Reduces and increases total cholesterol, which has high density. Long-term use The drug effectively reduces the number of plaques in the blood vessels of the heart.

Treatment with folk remedies

We must always use non-standard healing approaches with caution and attentiveness. Therefore, the tips below are for informational purposes only.

Predisposition to atherosclerosis during infections: the role of endothelial dysfunction. C-reactive protein: to screen or not to screen? Individual relationship between progression of radiation damage and acute phase response with early rheumatoid arthritis. Towards the development of a decision support system.

Clinical use of C-reactive protein for the detection and prevention of cardiovascular diseases. Aortic stiffness as a risk factor for recurrent acute coronary events in patients with coronary disease hearts. Association between plasminogen activator inhibitor antigen-1, leptin, and fat mass in obese children and adolescents.

Hypertension often causes the occurrence of atherosclerosis. In this case, you can use a remedy such as garlic. It should be ground and placed in a jar. Then vegetable oil is added and the resulting mixture is infused for 24 hours. Then you need to add the juice of one lemon and continue to steep for another week. Take one tablespoon at least three times a day.

Rosehip helps with many diseases. And such a disease as atherosclerosis is no exception. The preparation of rosehip infusion is carried out using glass containers. The nuts are placed in a bottle or jar and filled with water, and then the container must be placed in a dark place for two weeks. The only thing that should not be forgotten during the entire period is to shake the composition daily. You need to take twenty drops. To do this, use a piece of sugar.

For headaches and tinnitus, use herbal treatment, in particular, lemon balm is ideal. To do this, pour boiling water over one tablespoon of this plant and drink. About four times a day will be enough.

Prevention of atherosclerosis

Much attention is paid proper nutrition, physical exercise and the ability to avoid stressful situations.

Obesity is your enemy, so stick to a low-calorie diet to avoid problems in the future. In turn, stress leads to vasospasm, which also has a bad effect on the system. Try to maintain a fair amount of optimism in yourself, and you can protect yourself from atherosclerosis. Normal pressure should be around 140/90. At the same time, its control is a fundamental factor in the prevention of this disease. To prevent plaques from appearing on the walls of your blood vessels, keep active image life and don't neglect physical exercise. If you smoke, then get rid of this habit, as it acts as the main culprit in the occurrence of atherosclerosis.

Nutrition

The principle of the diet is low calorie content. Based on this, you should significantly reduce your consumption of animal fats and, in particular, fatty meats. If you eat chicken, you should first remove the skin. It is also forbidden to use the internal organs of animals for food. In addition, you should exclude dairy products, which are high in fat, from your diet. Concerning vegetable oils, then they can be used, but in reasonable quantities. Flour coarse is an excellent product for this type of diet, since the fiber found in the grain has the quality of binding cholesterol and removing it from the body. A good option the use of products of marine origin, for example, squid, mussels, etc., is considered.

If the diet is aimed at cardiac patients, then it is necessary to reduce the amount of salt consumed and add foods that have high content potassium (dill, green onions, black currant, bananas). It is also important to reduce your sugar intake, flour products and egg yolks. It is advisable to include corn and oat-based cereals in your diet. Vegetables and soy products are completely acceptable. Almost all fruits can be consumed with the exception of grapes. In this case, food should be taken five or six times a day. Apples should be present in your daily diet.

Sad statistics show: the main risk factors for atherosclerosis are not quality medical care population, and wrong image life. Of course, this disease can be caused by genetics. However, as medical practice shows, those who smoke, eat unhealthy foods and have excessive body weight are mainly at risk for atherosclerosis.

What are the unmodifiable risk factors for the development of atherosclerosis?

All risk factors for atherosclerosis are divided into two main groups - immutable and modifiable.

What are the immutable risk factors for the development of atherosclerosis that cannot be influenced medically?

These include:

age;
heredity.

Age. The older a person is, the higher the risk factor for developing atherosclerosis. Quite often, this disease is considered as one of the manifestations of the aging process of the body, since atherosclerotic plaques appear in all elderly people. The risk of developing atherosclerosis increases after 50 years.

Floor. As already noted, the risk factor for atherosclerosis is increased in men compared to women. In addition, the disease begins to develop in representatives of the stronger half of humanity 10 years earlier than in women.

Heredity is the most common cause of early (before the age of 45 years) onset of atherosclerosis. However, in people over 50 years of age, genetic predisposition does not play a special role in the occurrence of the disease.

Modifiable risk factors for atherosclerosis: smoking, diabetes and others

Modifiable causes are those that can be eliminated by changing a person’s lifestyle or during treatment.

These include:

arterial hypertension;
smoking;
violation of fat metabolism;
poor nutrition;
sedentary lifestyle life;
infectious diseases.

Arterial hypertension- this is the so-called independent factor in the development of atherosclerosis. Against the background of increased pressure, the walls of the arteries become saturated with fats, and this, as already noted, is initial stage emergence atherosclerotic plaques.

Smoking is a risk factor for atherosclerosis, which doctors call one of the most insidious. Firstly, it increases the risk of many cardiovascular diseases. Secondly, at people who smoke the disease develops much faster than in non-smokers.

Smoking people are 3 times more likely than non-smokers to suffer from atherosclerosis, arterial hypertension, coronary heart disease and hyperlipidemia.

Obesity- one of the most common factors in the development of atherosclerosis. Typically, people with overweight The first symptoms of the disease appear before the age of 45.

Diabetes increases the risk of atherosclerosis by 4-7 times. With this disease, fat metabolism is disrupted, which causes the appearance of atherosclerotic plaques.

Fat metabolism disorder, or dyslipidemia, is the main factor in the development of atherosclerosis. It is worth noting that most of the reasons arise precisely because of dyslipidemia, that is, as a result of a disorder in fat metabolism. The development of the disease is affected increased content in the blood of cholesterol, as well as atherogenic lipoproteins and triglycerides. And one of the main causes of dyslipidemia, and therefore atherosclerosis, is an increase in the amount of cholesterol in the blood. plays significant role in the human body.

It's complicated organic compound, a representative of the fat class, performs a number of important functions:

structural- is one of the main components included in the structure cell membranes. Due to cholesterol, cell membranes gain elasticity and stability;
digestive- synthesis occurs due to cholesterol in the liver bile acids;
hormonal- on the basis of cholesterol, the synthesis of hormones of the adrenal cortex and sex hormones is carried out.

It is important that the amount of cholesterol in a person’s blood is always at an optimal level. An increase in the content of this compound is fraught with the development of a number of diseases, including atherosclerosis.

Cholesterol enters the human body in two ways: through products of animal origin and as a result of internal synthesis. In the first case, the compound enters the intestines, where the process of its absorption occurs, after which, together with chylomicrons, it is carried to those organs that need cholesterol for normal height and synthesis of various chemical elements.

The largest amount of cholesterol is absorbed by the liver, which requires the compound for the synthesis of bile acids. Internal cholesterol synthesis occurs when the body is deficient in cholesterol and cannot obtain it from food. Then the substance is formed from the breakdown products of fats. By the way, the use fatty foods enhances its production. U completely healthy person the processes of accumulation and elimination of cholesterol are normal. As already noted, people with high levels of this compound often develop dyslipidemia, and therefore atherosclerosis.

Poor nutrition. This factor leads to increased cholesterol levels, impaired fat metabolism, resulting in the development of atherosclerosis.

Sedentary lifestyle, or physical inactivity, leads to obesity, arterial hypertension, diabetes mellitus, and therefore to atherosclerosis. In general, a decrease in physical activity is one of the main factors affecting the metabolism of fats and carbohydrates.

Infections. Relatively recently, a theory appeared in medical circles about infectious nature atherosclerosis. According to research, the factors of occurrence and rapid development This disease can be chlamydial and cytomegalovirus infections.

Test for those at risk for atherosclerosis development factors

To assess the risk of developing atherosclerosis, it is recommended to undergo a simple test. Each “yes” answer counts as one point.

Test.

1. You are a man over 45 years old.

2. You are a woman over 50 years old.

3. One of your close relatives (father, mother, grandmother, grandfather) suffers (suffered) from atherosclerosis.

4. You are overweight.

5. You lead a sedentary lifestyle.

6. You have been stressed for several months or longer.

7. You drink alcohol twice a week or more often.

8. You smoke.

9. Every day you eat food containing a lot of cholesterol.

10. You eat fatty foods several times a week.

11. Your blood pressure periodically rises.

12. You suffer from hypertension.

13. You suffer from insomnia.

14. You often suffer from infectious diseases.

15. You have diabetes.

16. When walking or running short distances, your legs get tired.

17. You suffer from pain in your legs, especially after physical activity.

18. Some weather conditions cause your blood pressure to increase.

19. You eat at catering establishments more often than at home. It happens that you snack on the go.

20. Your work and rest schedule is far from perfect (you often work without days off or vacation, sleep little, think about work all the time, etc.).

Grade.

To evaluate the results of the test to identify risk factors for the development of atherosclerosis, add up all “yes” answers.

0 points- there is no risk of developing atherosclerosis in the next few years.

1-2 points- average risk of developing atherosclerosis. In the next 10 years it will be 10-15%.

3-5 points- high risk of developing atherosclerosis, as well as heart disease (in the next 10 years it is 15-30%).

More than 5 points- the risk of developing atherosclerosis is extremely high.

The disease may already be progressing. It is necessary to urgently consult a doctor and undergo a medical examination.

Methods for diagnosing vascular atherosclerosis

Diagnosis of vascular atherosclerosis is always difficult, since the symptoms of this disease are similar to those of a number of other diseases, as well as manifestations of aging of the body. In addition, atherosclerosis in most cases develops against the background various ailments, accompanies them or is the result of their course.

It is not difficult to make a diagnosis old age, because this pathology observed in almost all older people. However, it is necessary to establish the exact characteristics of the disease of a particular patient: determine the complexity of the pathology, the exact location of atherosclerotic plaques, possible complications, presence of other diseases.

To diagnose atherosclerosis, the patient will need to undergo a full medical examination.

In each specific case, the attending physician independently decides what kind of examination the patient should undergo to clarify the diagnosis.

General diagnostics:

general examination of the patient;
identification of risk factors and ways to eliminate them;
instrumental and laboratory research, allowing to diagnose the disease, determine the location of atherosclerotic plaques, and assess the condition internal organs. Additional diagnostics:
determination of lipid metabolism disorders, including establishing the exact level of cholesterol in the blood;
X-ray examination for suspected atherosclerosis of the aorta;
Ultrasound of vessels to identify the location of atherosclerotic plaques, as well as the presence (absence) of blood clots.

One of the methods for diagnosing atherosclerosis is biochemical analysis blood. Indicators indicating atherosclerosis are elevated cholinesterase (ChE), triglycerides (TG) and cholesterol. Normal indicator ChE - 5300-12900 units/l, total cholesterol - 3-6 mmol/l.

Normal indicators LDL cholesterol and HDL and TG are indicated in the tables.

Normal levels of LDL and HDL cholesterol (mmol/l):

Normal TG values (mmol/l) depending on age:

Age (years)	Men	Women








60-65 65 and older	0,65-3,29; 0,62-2,94	0,63-2,7; 0,68-2,71

Another method for diagnosing atherosclerosis is vascular ultrasound, or Dopplerography, which is prescribed to determine the state of blood flow in the veins and arteries.

Prevention of atherosclerosis is aimed, first of all, at eliminating modifiable factors, if any. It is necessary to refuse bad habits and eating fatty foods. In addition, it should be increased motor activity and avoid stressful situations whenever possible.

It is advisable to undergo periodic examinations to monitor the levels of lipids and cholesterol in the blood.

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