Prevention of cardiovascular diseases. Is it possible to reduce the risk of CVD and death from them? Diseases of the cardiovascular system statistics

Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?

Weir, Ph.D., did not disclose any relevant financial relationships. Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland. Anderson, Ph.D., did not disclose any relevant financial relationships.

According to Alexei Valdenberg, head of the department for organizing medical and drug assistance to the population of the Leningrad Region Health Committee, the action plan to reduce the mortality of the region's population consists of five areas: informing citizens about risk factors and motivating them to a healthy lifestyle, providing conditions for a healthy lifestyle, medical examination of the population, dispensary observation and preventive work in hospitals and sanatoriums.

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Registration Department, Norway Cancer Registry, Oslo, Norway. Disclosure: Bjorn Moller, PhD, has not disclosed any relevant financial relationships. Heart disease and cancer are the first and second causes of death in the United States. We analyzed mortality data to estimate and predict the impact of risk reduction, population growth, and aging on the number of heart disease and cancer deaths per year.

Who is at risk of dying from noncommunicable diseases?

Thanks to the clinical examination, which more and more residents of the Leningrad Region undergo every year, doctors manage to identify not only their chronic non-communicable diseases, but also the risk factors that lead to their development, - Alexey Valdenberg told Public Control.

The risk of death has declined more sharply in heart disease than cancer, offset the increase in death from heart disease, and partially offset the increase in cancer death 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. Decreasing mortality rates indicate that the overall risk for the population dying from heart disease or cancer has decreased. However, age-standardized mortality rates do not fully reflect the burden of these diseases, as they effectively offset the impact of demographic changes associated with population growth and changing age structure.

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

In order to reduce mortality from non-communicable diseases in the country, it is necessary that the population leads a healthy lifestyle, 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 risk to the population of being diagnosed and dying from that cause, as well as the size and age structure of the population. For these analyzes, we defined heart disease as rheumatic heart disease, hypertensive heart disease, hypertensive heart and kidney disease, acute myocardial infarction, coronary or ischemic heart disease, atrial fibrillation, other arrhythmias, heart failure, and other heart diseases; we defined cancer as malignant neoplasms.

Type 2 diabetes often causes heart attacks and strokes, but it is usually asymptomatic, and people learn that they have it very late. Ideally, after the age of 40, 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 speed calculations. We have used the terms "increase or decrease" to describe significant trends and persistence to describe minor trends. Methods for predicting mortality and the number of cancer deaths are described in detail in other sections. Separate models were constructed for cardiovascular deaths and for the development of causes of cancer deaths, by sex for all races combined. We based projections for all CVD deaths and all cancer deaths on aggregate estimates across selected disease categories.

Vasily Ivanov, head of the Leningrad Regional Center for Medical Prevention of Noncommunicable Diseases, noted that only the person himself can reduce the risk of dying from cardiovascular diseases, respiratory and gastrointestinal diseases, neoplasms and others.

The doctor cannot force the patient to give up smoking, alcohol, unhealthy eating. He can explain what are the consequences of these bad habits, 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 ischemic heart disease, strokes, diabetes and 40% of cancer cases.

Causes of heart disease

Methods for distributing the relative contribution to changes in the total number of new heart diseases or cancer deaths each year, which may be associated with changes in demographic risk and demographic changes associated with population size and age structure, are described elsewhere. A third data set was created for the observed number of deaths that actually occurred and thus reflects the combined impact of changes in demographic risk, growth and aging.

The percentage change in mortality from cardiovascular diseases has decreased among men and women. By race and gender, the percentage decline was 8% for white men, 6% for white women, 4% for black men, and 8% for black women. By race and gender, the percentage change was down by 9% for white men, 5% for white women, 3% for black men, and 0% for black women.

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

Symptoms of heart attack and stroke, first aid

Our health and well-being largely depends on ourselves, but the 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, as well as population growth and aging, continue. The decline in heart disease began earlier and was steeper than the decline in the risk of dying from cancer, which occurred about 20 years later. The magnitude of the decline in heart disease risk offset the increase in heart disease deaths from population growth and aging, while the reduction in cancer death risk only partially offset the increase in cancer deaths brought about by demographic changes associated with population growth and aging.

With a myocardial infarction, a person experiences a sudden onset of chest pain. This pain is pressing, squeezing. Sometimes such pain is localized in the abdomen. It becomes difficult for a person to breathe, perspiration appears

According to her, many, feeling unwell, postpone a visit to the doctor or call an ambulance. But if we are talking about heart attacks and strokes, then a person’s life hangs in the balance.

These results are similar to 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 never smoked, supporting the hypothesis that the inflammatory component of CVD is reversible. Although the reduction in the risk of death from cardiovascular disease was accompanied by a decrease in the prevalence of smoking, treatment of cardiovascular risk factors also improved.

If a person has a heart attack, then his 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 next to a person who has a heart attack or stroke, says Tatyana Tyurina.

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

Terms and stages of the Program implementation

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

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

With a stroke, a person may feel a sharp headache, weakness in the face, arm, leg. His speech is disturbed, choking appears.

If a person is asked to raise and lower his hands, 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 sooner qualified assistance is provided for a stroke, the more likely it is to reduce the likelihood of complications, explains Tatyana Tyurina.

With a stroke, a person may feel a sharp headache, weakness in the face, arm, leg. His speech is disturbed, choking appears

And what to do if you see how a person has fallen and does not show signs of life? The head physician of the Leningrad Regional Clinical Hospital advises you to approach him if there is no danger to yourself, that is, there are no, for example, bare electrical wires nearby, ask: “What happened?”, listen to breathing and heartbeat. If a person does not react to anything, does not breathe, and his heart has stopped, you need to urgently call an ambulance, but while the doctors are on the way, you must try to return the person from a 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 small.

A person needs to be put on his back, his head thrown back, his mouth open and his lower jaw pushed forward. The resuscitator folds his hands into a lock and vigorously presses on the middle of the patient's chest with straight arms 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 mouth of the victim with an interval of a couple of seconds. The patient's chest should rise at this point. Thus, we will restore the minimum blood flow in the body, - Tatyana Tyurina explains.

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

For five minutes, after which the death of the brain begins, not a single ambulance will arrive. Therefore, knowledge of how to provide first aid to a person who has lost consciousness and does not show signs of life is extremely important for each of us. Nobody knows what will happen today to us and our loved ones, - says Tatyana Tyurina.

Mortality from cardiovascular diseases continues to be the leading component in the overall structure of mortality (up to 59%), while up to 91% of mortality is due to coronary heart disease and arterial hypertension and their complications in the form of acute myocardial infarction (AMI), heart failure (HF) . About 17 million people die from CVD every year in the world.

The development of CVD is not only a tragedy for every person, but also leads to huge socio-economic damage due to significant costs for the treatment and rehabilitation of patients.

In the USA, Canada, Germany, Belgium, France, Finland and some other countries, CVD mortality, incl. from IHD, tends to decrease. In the countries of Eastern Europe, Russia and the CIS, the growth of these indicators is determined. According to the State Committee of Russia on Statistics for 1998-2002. mortality from CVD increased by 21.9%, mortality from coronary artery disease - by 23.1%.

In Russia, CVD accounts for 55.4% of the mortality structure. Mortality from CVD is 90% determined by coronary artery disease and myocardial infarction, only 10% - by other types of pathology of the cardiovascular system.

In Uzbekistan, over the past two decades, there has been an increase in morbidity and mortality from cardiovascular pathology, and the structure of mortality does not differ from the world: the most significant cause of death is also diseases of the circulatory system (CVD) (59.3%).

Diseases of the cardiovascular system are one of the most important public health problems of the republic. An analysis of the causes of mortality showed that mortality from cardiovascular diseases remains predominant in the structure of total mortality, amounting to 79,120 people (56%) in 2005, 80,843 (57.9%) in 2006, and 80,843 (57.9%) in 2007. 80320 (58.4%), in 2008 - 82036 (59.1%), in 2009 - 79239 people (59.3%); and the main causes of death from cardiovascular diseases are coronary heart disease (CHD), arterial hypertension (AH) and cerebrovascular disease (CVD), which account for at least 90% of all deaths from CVD. Mortality at working age is much higher among men, and among the elderly and senile it is almost the same, regardless of gender.

In order to raise public awareness of the danger caused by the epidemic of cardiovascular diseases in the world, as well as to initiate comprehensive preventive measures against coronary disease and cerebral stroke in all population groups, a new date has been introduced - World Heart Day, celebrated annually on the last Sunday of September, which was first organized in 1999 at the initiative of the World Heart Federation. This action was supported by the World Health Organization (WHO), UNESCO and other significant organizations.

In partnership with WHO, the World Heart Federation organizes events in more than 100 countries, including health screenings, guided walks, running and fitness classes, public lectures, performances, scientific forums, exhibitions, concerts, festivals and sports competitions.

World Heart Day is held annually with the aim of conveying to the population of the whole world information about:

1. That arterial hypertension, coronary heart disease (including myocardial infarction) and stroke are the leading cause of death in the population worldwide;

2. That at least 80% of premature deaths from these diseases can be avoided if key risk factors such as smoking, poor diet and sedentary lifestyles are controlled.

The mission of the World Heart Federation is to help people around the world prolong and improve their lives by preventing the development of arterial hypertension, coronary heart disease and stroke, or actively control the course of these diseases. It includes members of 195 cardiology associations and foundations from more than 100 countries. In 2011, the motto of World Heart Day is "Heart for Life".

On this day, the Republican Specialized Center for Cardiology (RSCC) annually holds a charity event "Open Doors Day". In 2011, World Heart Day was held on September 30 under the motto: "Combating the main risk factors (RFs) for cardiovascular disease, such as high blood pressure, high blood cholesterol, overweight, smoking, sedentary lifestyle." About 200 patients participated in this action. These risk factors lead to such formidable diseases as coronary heart disease (heart attacks), cerebrovascular disease (stroke), high blood pressure (hypertension), peripheral arterial disease, rheumatic heart disease, and heart failure. The risk factors for coronary artery disease, which cannot be changed, include gender, age and heredity. Of the risk factors that can be changed, the most important are cigarette smoking, hypercholesterolemia and arterial hypertension, etc.

Currently, more than 200 different risk factors are known that affect the development of coronary artery disease. However, only in relation to 50-60 their real connection with the development of pathology has been established. For practice, a significantly smaller number of RFs matters. According to the WHO Expert Committee, the most important of them are:

Dyslipidemia (elevated cholesterol and especially LDL cholesterol, low HDL cholesterol, elevated triglycerides);
- AG;
- smoking;
- hyperglycemia;
- diabetes;
- obesity;
- low physical activity;
- hereditary predisposition;
- pathology of the blood coagulation system;
- psychosocial factors.

It has been proven that the presence of only one RF (hypertension, hypercholesterolemia or smoking) increases the likelihood of death over the next 10 years in men aged 50-59 years by 51%, the combination of hypertension with smoking or hypercholesterolemia increases this risk by 166%. Mortality from coronary artery disease and acute cerebrovascular accident with a combination of all three of these factors increases by more than 5 times. After the appearance of signs of CVD associated with atherosclerosis in a person, RFs continue to act, contributing to the progression of the disease and worsening the prognosis.

Dyslipidemia

Lipid metabolism disorders, the main manifestation of which is an increase in the concentration of cholesterol in the blood (especially LDL cholesterol), is the main factor in the development of atherosclerosis and coronary artery disease. The results of numerous epidemiological studies have clearly shown that there is a direct relationship between the level of cholesterol and the likelihood of developing coronary artery disease, especially myocardial infarction. It has been convincingly proven that lowering the level of cholesterol in the blood significantly reduces the likelihood of developing new cases of the disease. It is estimated that a decrease in the concentration of cholesterol in the blood of just 1% in the population leads to a decrease in the risk of developing coronary artery disease in the population by 2.5%.

Obesity is one of the most common chronic diseases in the world. Obesity is now becoming a pandemic.

The results of epidemiological studies have revealed a clear relationship between the increase in the prevalence of obesity and the increase in the incidence of CVD. The likelihood of developing these severe disabling diseases increases with increasing BMI and fat deposits in the abdominal-visceral region.

The impact of smoking on mortality rates should be noted. More than 5 million people worldwide die each year from smoking-related causes. There is a clear relationship between the number of cigarettes smoked and the incidence of CVD. Smoking has a particularly unfavorable effect on people who have acquired this habit at a young age, at the same time, the prognosis of life due to the fact that the negative effect on the body begins very early, and its duration is the greatest, the least favorable. According to some reports, if a person smokes at the age of 15, then his life expectancy decreases by more than 8 years, for those who started smoking at 25 years and later - by 4 years. Smoking is believed to be responsible for 325,000 premature deaths annually in the US alone.

The risk of developing coronary artery disease in smokers is 3.3 times, and the risk of death from CVD is 2-2.5 times higher than in non-smokers. There is a strong relationship between the risk of developing coronary artery disease and the number of cigarettes smoked per day. For people who smoke half a pack of cigarettes a day, the risk value is 1.6; more than one pack - 2.40. Smoking affects the onset and development of atherosclerosis and coronary artery disease in different ways: by lowering the level of HDL cholesterol, by modifying LDL, which become more atherogenic.

According to some reports, the complete cessation of smoking reduces the incidence of coronary artery disease in the population by 30%.

Alcohol consumption is one of the most important risk factors for various diseases. At present, both general estimates of the impact of alcohol abuse on people's health and estimates for certain types of diseases and causes of death have been obtained. According to the WHO, mortality rates among alcoholics are 2-4 times higher than among the general population. If men die from cardiovascular diseases most often (in 75% of cases) over the age of 60, then men who abuse alcohol die from this cause mainly before the age of 60. There is no doubt that abuse dramatically increases mortality in general and from coronary artery disease in particular. Alcohol can contribute to the development of coronary artery disease through other risk factors: increased blood pressure, body weight, triglyceride levels in the blood. It was shown that hyperlipidemia and myocardial infarction were more common among those who drank alcohol regularly than among those who did not drink or drink alcohol irregularly.

According to the US National Heart, Lung and Blood Institute, insulin-dependent diabetes mellitus in the elderly increases the risk of coronary artery disease by 3 times in men, and even higher in women. The frequency of carbohydrate intolerance disorders among IHD patients, according to the results of studies by different authors, varies widely - from 29 to 76%, and hyperglycemia is considered as an unconditional risk factor.

The World Heart Federation has listed the factors that provoke the development and worsening of the course of cardiovascular diseases:

The main risk factor for the normal functioning of the heart is malnutrition. For many years, a person violates the correct regimen, qualitative and quantitative characteristics of nutrition, as a result, he has overweight and a high risk of developing heart attacks and strokes. Malnutrition in most cases is characterized by the abuse of excessively high-calorie foods, animal fats and simple carbohydrates; deficiency in the diet of vegetable oils, increased consumption of table salt; power failure.

In addition to malnutrition, often people suffer from physical inactivity, which, aggravating obesity, increases the risk of cardiovascular disease. In conditions of hypodynamia, when a person does not perform the number of movements necessary for the body, the vessels cannot work correctly. As a result of such violations, cholesterol deposits accumulate on the vessel wall and they become less elastic.

To keep your heart healthy you need:

Tobacco abstinence: Nicotine leads to a sharp decrease in the amount of oxygen in the blood, which forces the heart to compensate for the "oxygen hunger" with increased work. Vessels also suffer, in which the tone and throughput are sharply reduced. Passive smoking is also dangerous. The risk of heart attack or stroke begins to decrease immediately after quitting tobacco use, and after a year it can be reduced by 50%. Do not allow smoking in the house. By quitting smoking, you will improve your health and the health of your loved ones. Set a rule: for every cigarette smoked, the smoker does additional housework.

Proper Diet: To maintain a healthy cardiovascular system, a balanced diet that includes plenty of fruits and vegetables, whole grains, lean meats, fish, and legumes with limited intake of salt, sugar, and fat is essential. It has been proven that the abundance of fatty and salty foods in our diet not only causes obesity, but also has a bad effect on the elasticity of blood vessels, and this disrupts blood flow. In addition, there are products that, having a tonic effect on the body, can directly affect the cardiovascular system. These include strong tea, coffee, alcoholic beverages. All this, especially alcohol, should not be abused. Stick to the principles of a healthy diet. Avoid fatty, fried and high-calorie foods.

Regular physical activity and maintenance of optimal body weight: To maintain a healthy state of the cardiovascular system, regular physical activity is necessary, at least for half an hour daily. These are sports, long walks in the fresh air, swimming, hiking, that is, any physical activity that gives a person pleasure. Hardening procedures will also be useful: it can be a contrast shower, dousing with cold water or long walks in the fresh air, and everyone can find what he likes. Such activities strengthen the walls of blood vessels and thereby prevent many serious diseases. Rest should also be complete. The normal duration of sleep should be 8-10 hours a day, and it is better when there is an opportunity to rest during the day. Encourage physical activity. Limit the amount of time you and your family members spend in front of the TV and computer. Organize family walks, hikes and outdoor games.

Knowing your numbers - indicators of health, such as: high blood pressure in some cases is not accompanied by any symptoms, but can lead to a sudden stroke or heart attack. Check your blood pressure yourself, or ask relatives to help you, or visit a health facility such as a Health Center where you will have your blood pressure checked, your blood glucose and cholesterol levels checked, and your body mass index calculated. Knowing your risk of developing cardiovascular disease, you can develop a specific action plan to improve heart health.

R. Kurbanov, director of the RSCC, professor. O. Urinov, researcher of the RSCC.

Three Complementary Strategies Can Reduce Morbidity and Mortality from cardiovascular disease. The first (population) strategy is population-wide interventions that are able to reduce RF levels and the burden of CVD in the entire population. This strategy includes RF and CVD monitoring, educational campaigns, and low-cost preventive interventions in the entire population.

These actions are exemplified by national campaigns to ban smoking. The second strategy (high-risk strategy) consists in the formation of high-risk CVD groups for the implementation of certain effective low-cost preventive measures (screening and treatment of hypertension or HCH).

Third strategy(secondary prevention strategy) involves allocating resources for expensive treatments for acute or chronic conditions, as well as for secondary prevention activities. Usually dedicated resources are used to execute all 3 strategies at the same time; however, all of these long-term strategies are being implemented simultaneously, mainly in high-income countries where significant financial resources are spent on health.

Anyway, implementation strategies in each country depends on its resources, social conditions and prioritization. The following sections will outline the main challenges that each region faces and how they can be addressed.

In many countries with high level income mortality from cardiovascular diseases is declining, but some important problems remain unresolved. First, socioeconomic and racial disparities in CVD mortality rates persist. For example, in the United States there are large differences between individual racial and ethnic groups. Thus, the main goal should be to accelerate the widespread adoption of preventive and curative technologies among racial, ethnic and socio-economic groups of the population.

Second, the rate of decline mortality from cardiovascular disease seems to have slowed down. Countries are entering a period of NFA and obesity. This may be due to negative changes in the prevalence of some CVD risk factors: although many older men and women quit smoking, young people and adolescents still start smoking; in the last decade, the number of patients with hypertension who are treated effectively has slightly decreased; Of great concern is the increase in the prevalence of obesity and diabetes. The biggest concern is the rise in obesity and NFA among children.
These changes in levels of risk factors could explain 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 won't undertaken measures to change existing trends regarding risk factors, an increase in mortality from . In health care, more funds should be allocated to activities for high-risk groups, such as adolescents, as well as anti-smoking and the widespread implementation of guidelines for the diagnosis and treatment of patients with hypertension and DLP. It is necessary to develop and use effective strategies to increase FA and reduce the prevalence of obesity and DM.

Thirdly, due to the aging of the population prevalence of cardiovascular disease 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 require additional resources in the future.

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 after such severe complications as myocardial infarction (MI). For example, in the 1950s 30% of patients admitted to the hospital for AMI died. Now intra-hospital mortality has decreased by more than 2 times, despite the fact that such patients continue to be admitted to hospitals. The number of people who are diagnosed with CAD before the onset of clinical symptoms is increasing. Thousands of pacemakers and defibrillators are implanted every year.

As more and more patients cardiovascular diseases live longer, the number of patients with heart failure is rising even as deaths from heart failure are falling. As a result, more and more resources are needed 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 for the treatment of such patients it will be necessary to develop more effective and inexpensive technologies.

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 (increased blood pressure).
Cardiac ischemia (ischemic heart disease) – angina pectoris, painless myocardial ischemia and myocardial infarction, as the most severe manifestation of IHD, there may be other manifestations of IHD, which we will discuss later.
Cerebral circulation disorders (treatment in conjunction with neurologists).
Diseases of peripheral vessels (atherosclerosis of peripheral vessels, as the most severe manifestation - intermittent claudication and gangrene), treatment in conjunction with vascular surgeons.
Rhythm disturbances (treatment jointly 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 talk primarily 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 the vessels proceeds imperceptibly and painlessly, since there are no pain receptors inside the vessels. For early detection of this disease, a doctor's examination and additional research methods are needed.

The resulting violation of the blood supply to any organ leads to a violation of its function or even death. This is especially important at the present time, 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 main causes of death and disability worldwide. 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 CVD annually, while in Europe just over 300 thousand people die. 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 US 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

The experience of the US and Europe shows that preventive measures aimed at reducing CVD risks can be very effective. Since 1980, morbidity and mortality from coronary artery disease, especially in high-income countries, has decreased significantly, which is primarily due to preventive measures carried out both at the state level (laws to ban smoking) and at the individual level, by each specific a person (including limiting cholesterol and salt in foods).

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

What determines the degree and rate of development of atherosclerosis? This question was raised in 1948 in the USA. In search of answers, the famous Framingham Study was started and 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. About 30 different parameters were taken into account during the observation process. Currently, this study is ongoing, with about 1500 indicators being evaluated simultaneously, including a full genome analysis.

Already in 1957, it became clear that the presence of arterial hypertension and high 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. RFs 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 replenished in subsequent years: the role of smoking, diabetes mellitus, obesity, a 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 data from the Framingham Study have been confirmed in numerous epidemiological studies involving thousands of people and in clinical studies on the impact on risk factors.

Risk of death from CVD (SCORE scale)

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

Consider 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. Man, 60 years old, blood pressure 160 mm Hg. Art., smoking, cholesterol level - 8 mmol / l. The risk of death on the SCORE scale is 24%.

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

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

In the subsequent chapters of our project, we will try to learn how to minimize the risks associated with the above factors.

The death rate is on the rise. This is cold data. Is it our neglect of health or the wrong health care system? Discussing with an expert

Photo: Dmitry POLUKHIN

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According to official data from the Ministry of Health, in the first quarter of 2015, mortality increased by more than 3 percent. It's a lot. Given that new technologies are being actively introduced, a healthy lifestyle is endlessly advertised, these data are slightly discouraging. Yes, we can say that there is no one to work with modern equipment - there are no personnel, there is a reduction in doctors and hospitals in the country, there are constantly not enough nurses ... But at the same time, the pharmaceutical industry, it would seem, is one step ahead of these negative aspects - in pharmacies you the choice will be offered such a mass of drugs that it is simply impossible not to recover. True, for a lot of money, because the price of medicines is growing at some wild pace.

We discussed these and other issues with Doctor of Medical Sciences, Professor, Head of the Laboratory of the State Research Center for Preventive Medicine of the Ministry of Health of Russia Mehman Mammadov.

Is the system to blame?

- Mehman Niyazievich, in your opinion, is the inefficient work of leaders of various ranks in the healthcare structure primarily to blame, or are there some other factors?

Name the various reasons for the increase in mortality. These are the inefficient work of the territorial heads of health authorities, the unoptimized system of social benefits, insufficient drug provision and medical care, etc. In our opinion, if this phenomenon is widespread throughout the country. And it is necessary to analyze the situation more purposefully. It can be assumed that this trend is based on complex causes, including socio-economic factors.

- In Russia, as well as other countries, in the first place among the causes of death - cardiovascular diseases. Why is this happening - are we to blame or is it the lack of organization of the health care system?

Every year, about 17.5 million people die from cardiovascular diseases (CVD) in the world, primarily from complications of coronary heart disease (CHD). In terms of mortality from coronary artery disease, our country occupies one of the leading places. And, indeed, in the overall structure of mortality in Russia, more than 55 percent are just complications of diseases of the cardiovascular system. According to Rosstat, in 2014, 64,548 people died in Russia from CVD complications. This is 2-3 times more compared to traffic accidents and infectious diseases.

Nevertheless, despite these sad data, the diagnosis of cardiovascular diseases has improved in the country over the past 15 years. A system was introduced to provide high-tech medical care to the population: 112 regional vascular centers, 348 primary vascular departments in 80 constituent entities of the Russian Federation were created in Russia. In all 85 subjects, the formation of a three-level system for providing care to vascular patients has been completed, at the rate of one center per 500,000 population. In large cities, including Moscow, Krasnodar, Kemerovo, Perm, Novosibirsk, St. Petersburg, Tyumen, round-the-clock and affordable assistance is organized. This, of course, reduces mortality from myocardial infarction and cerebral strokes. Recently, some restrictions have been experienced in the financing of high-tech medical care, but this is compensated by the growth of its volumes through the system of compulsory medical insurance.

The future of cardiology is prevention

- And yet it is not enough. Problem with underfunding?

In the United States, 18% of GDP is spent on medicine. According to American colleagues, if such rates of development are maintained, in the near future it will be necessary to spend more than 40% of US GDP on cardiac surgery. And this will not withstand the economy of any country. In general, the future of cardiology is the prevention of diseases and their complications. Therefore, the prevention of cardiovascular diseases is one of the most important and cost-effective methods of maintaining the health of the population. I am glad that over the past two years, the system of medical examination of the population has been restored throughout the country. Numerous health centers operate to identify risk factors on an outpatient basis free of charge. This should in many ways help to identify and cure heart disease in the early stages.

Meanwhile, a set of measures for primary prevention provides for active work in the media, campaigns to promote a healthy lifestyle among the population, medical examinations, including the departure of mobile teams to rural areas, achievement of target levels of the main risk factors, in particular blood pressure control, cholesterol and sugar levels. Alas, while in Russia these measures are clearly not enough.

- But we have a lot of rests on the reluctance of people to go to the doctors. Here they are dragging to the last ...

I agree. Our people do not have a commitment to a healthy lifestyle, they devote little time and energy to the prevention of diseases, including cardiovascular diseases. We have a whole network of Health Centers in our country, and a medical examination program has been launched. But do all people know about them, who come voluntarily to learn about their health? Most of them turn to doctors only when the disease has already entered into rights. In my opinion, as well as in the opinion of many regional health officials, this largely depends on the fact that there is no proper advertising for the fight against bad habits and a healthy lifestyle. It is necessary to provide prime time for commercials on TV, radio and newspapers, as well as more street banners about a healthy lifestyle, about disease prevention.

What will calm the heart ...

- The President of Russia declared 2015 the year of the fight against cardiovascular diseases. Is there a national plan to reduce coronary heart disease?

To solve this problem, the President of the country emphasized the need to unite the efforts of medical workers, representatives of culture, education, the media, public and sports organizations. And, by the way, indeed, there is a successful experience of such joint efforts. For example, in Finland, which in the 70s had a high mortality rate from cardiovascular diseases. After the implementation of the North Karelia project, statistics from CVD and other socially significant complications decreased to 60%. If we talk about Russia, then in early 2015, the Ministry of Health, together with a group of scientific experts, developed an action plan to reduce mortality from coronary heart disease (CHD), consisting of 4 blocks: prevention, secondary prevention, improving the efficiency of medical care and continuous monitoring of indicators . Each section contains at least 10 items. They will help improve the delivery of cardiac care.

- But difficulties are clearly inevitable ...

Of course, in the implementation of the comprehensive plan, there are a number of difficulties associated not only with insufficient funding and the level of medical care, but also with unsatisfactory propaganda and motivation of the population for a healthy lifestyle, staffing of individual healthcare units, etc. In our opinion, the comprehensive implementation of these plans, even in conditions of moderate funding, can significantly reduce the incidence and mortality from coronary artery disease. But this requires long-term work and effective control of the health care system.

On the positive side, the Ministry of Health of the Russian Federation does not plan to reduce state guarantees of free medical care until 2030. However, according to the auditors of the Accounts Chamber of the Russian Federation, the volume of paid medical services increased by more than 20% over the past year, which claims to replace free medical care with paid one.

According to Deputy Prime Minister Olga Golodets, there are reserves for reducing mortality in the Russian Federation, in particular, in the area of CVD treatment. According to her, the work of the healthcare system needs to be improved through proper organization, improved interaction with the population, advanced training, and responsibility of doctors, which, apparently, are aimed at the ongoing reforms in the healthcare system.

On my own behalf, I can add that in order to effectively combat cardiovascular diseases, in particular coronary heart disease, an integrated approach is required in optimizing primary and secondary prevention. As well as rehabilitation, a system of control at all levels of the implementation of federal programs and legislation, the interaction of local medical and social services.

ONLY THE FACTS

In October 2014, the head of the Ministry of Health, Veronika Skvortsova, said that this year life expectancy in Russia was 71.6 years, which is 0.8 years more than in 2013.

Over the years, life expectancy in Russia has changed dynamically, it was like waves that are slowly but surely growing. But there were also downturns. For example, in the 70-80s of the XX century, the average life expectancy of the population was 68-69 years, since 1990, there has been a decrease in this indicator to 65 years. And the second peak of its increase was registered in 2011, which amounted to 69.4 years.

According to the World Bank, in developed countries there is a trend towards a rapid increase in life expectancy. For example - the USA - 78.7 years, Japan - 83.1 years. Some developing countries are also rapidly overtaking us. In China, the average life expectancy is 75.2 years.