Contributes to the reduction of mortality from cardiovascular diseases. Prevention of cardiovascular diseases

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

For an answer, we turned to leading cardiologists.

Bitter realities

Until the thunder breaks out, the peasant will not cross himself - such an attitude towards their own health is professed by the vast majority of our fellow citizens. Experts have been sounding the alarm for a long time: despite the efforts that are being made in our country to prevent and treat cardiovascular diseases, there is no significant reduction in them. According to data provided by the Russian Society of Cardiology and the Society for Arterial Hypertension, 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 lipid and carbohydrate metabolism disorders. The recent NATION All-Russian epidemiological study on 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 did not knew about their illness.

For doctors, this state of affairs does not cause anything but chagrin.

Maria Glezer, Chief Freelance Cardiologist of the Ministry of Health of the Moscow Region, Professor of the Department of Preventive and Emergency Cardiology at I.M. Sechenov First Moscow State Medical University, Doctor of Medical Sciences:

We currently have 26 health centers for adults and 8 for children, 8 prevention centers (including those at the regional level) in the Moscow Region. There are prevention rooms in every polyclinic.

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 specialist doctors. But, unfortunately, not everyone takes advantage of this opportunity.

Dangerous Scenario

Our fellow citizens also underestimate the risk that arises as a result of an acute violation of the coronary circulation. After analyzing the data on how much time passes from the moment an attack begins to contacting an ambulance about compressive, pressing or burning pain behind the sternum, which is not stopped by taking nitroglycerin, the experts were puzzled: this period sometimes reaches ... 5-6 hours, and 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 the vascular departments of hospitals and the emergence of new vascular centers have led to a significant decrease in mortality from a heart attack in our country.

It could have decreased even more if it were not for the arrogance of our citizens. People often endure to the last, not suspecting that since the onset of heart pain, only 90 minutes have been allotted to save heart cells, and sometimes even 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 that feed the heart: either by introducing special preparations 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 have many questions and how patients, even those who have already had a heart attack, follow medical recommendations.

Maria Glazer:

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

However, there is another problem that doctors talk about with anxiety and pain: interruptions in auctions for the purchase of subsidized medicines, the list of which, according to experts, is a lot of superfluous, and of those that are, far from being the most effective. But even from this situation it would be possible to find a way out.

Dmitry Napalkov:

I have been talking about the need to monetize benefits for a long time, 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 drugs. Given the crisis situation, no one, even the most advanced state, can afford to provide them all in full. But are our citizens ready for such a step, many of whom are used to being treated “for free”?

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

How to recognize a heart attack:

It is urgent to dial "103" if pain in the heart area:

is not similar to the previous ones and is not stopped by a standard dose of nitropreparations;
lasts more than 15 minutes;
gives to the shoulder, epigastric region, jaw, neck;
first appeared in a man over 30-35 years old or in a woman over 40-45 years old;
accompanied by cold sweat, shortness of breath, general weakness, rise in blood pressure.

Before the ambulance arrives, it is not forbidden 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 aim for: normal blood pressure should not be higher than 140/90 mm Hg.

Lipid metabolism disorder

An increase in the level of cholesterol in the blood by only 10% increases the death rate from a heart attack by 15%.

What to aim for: optimally, the level of low-density lipoprotein (LDL) "bad" cholesterol should be less than 3.0 mmol/l, and total cholesterol - less than 5.0 mmol/l.

Smoking

Smokers have a 8-10 times higher risk of developing cardiovascular diseases. Smoking is especially dangerous for women. They even one cigarette a day becomes a risk factor for the heart.

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

Obesity

In overweight people, 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 levels).

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

High blood glucose

A coil of elevated blood glucose pulls 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 aim 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 exercise test - less than 7.8 mmol / l.

When to be examined

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

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

Reminder 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 should take these drugs for the rest of their lives.

Visit a cardiologist regularly.

Preferably the same one who knows your medical history well and can adjust the dose of medication.

Observe the optimal level of blood pressure and pulse.

In a person who has had a heart attack, blood pressure targets should be higher than is customary for hypertension: systolic (upper) - not lower than 120 and not higher than 150, and diastolic (lower) - not higher than 90. At the same time, the recommended pulse rate should be 56-60 beats per minute.

Don't lie!

The sooner the 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

Control blood pressure levels

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

Quit smoking and do not abuse alcohol

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

Establish nutrition

Reduce salt intake to 5 g per day.

Limit the consumption of sweets (sugar, honey, pastries).

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

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

Move more

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

Build resistance to stress

To get started, adjust your sleep, which should average at least 8 hours a day. Observe the alternation of the regime of work and rest.

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.

In 2017, cardiovascular diseases claimed the lives of 858 thousand people, which is 5% less than a year earlier. The death rate has reached its lowest level since the beginning of the decade. The Ministry of Health believes that mass medical examinations 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 of the population and strengthening the economy.

In 2017, the death rate from cardiovascular disease dropped below 600 per 100,000 for the first time since the beginning of the decade. This is evidenced by the data of Rosstat, which Izvestia got acquainted with. Last year, 858 thousand people died from diseases of the circulatory system - 5% less than in 2016. This is 584.7 cases per 100,000 people.

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

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The main weapon in the fight against circulatory disorders is prevention, the Ministry of Health notes. Mortality continues to decline due to the mass medical examination, which has been carried out in the country since 2013. This made it possible to increase the coverage of the population by 18% - up to almost 59 million people, which makes it possible to more often detect diseases in the early stages.

In addition, there are more than 593 vascular centers operating in the country, where modern technologies for managing patients with complex conditions have been introduced.

As a result, mortality from strokes decreased by 25%, from myocardial infarction - by 14%, the Ministry of Health said.

Cardiovascular diseases are in first place in the overall mortality statistics in many countries of the world, said the deputy director of the Institute of Cardiac Surgery named after V.I. IN AND. Burakovsky Yuri Buziashvili. According to him, in recent years, doctors have begun to actively use invasive examination methods (with penetration into the organ itself, for example, heart sounding or vascular catheterization).

The decrease in mortality from cardiovascular diseases leads to an increase in the average life expectancy of Russians. This is a direct contribution to the Russian economy, which is why diseases of the cardiovascular system are given increased attention, said Yury Krestinsky, director of the Institute for the Development of Public Health.

In recent years, many clinics with high-tech equipment have indeed been opened, and a network of vascular centers has been developed. These measures help to respond quickly and save patients,” he explained.

Earlier, Izvestia announced that it was planned to allow the use of defibrillators for first aid. So far, this is prohibited, because this method of cardiopulmonary resuscitation is not on the list approved by the order of the Ministry of Health. The department plans to correct this situation. After that, defibrillators may appear in crowded places - at train stations, airports, subways, stadiums.

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.

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.