Heart of heart in old age: prevention of cardiovascular diseases

Heart of heart in old age: prevention of cardiovascular diseases

Section 1: age-related changes in the cardiovascular system and risks

Age is one of the most significant risk factors for the development of cardiovascular diseases (SVD). Aging is inextricably linked with a cascade of physiological changes that make the heart and blood vessels more vulnerable to various diseases. Understanding these changes is extremely important for the development of effective preventive strategies.

1.1 changes in the structure and function of the heart:

• Increase in the size of the heart (hypertrophy): With age, a thickening of the walls of the left ventricle occurs – the main chamber of the heart, which is responsible for pumping blood in a large circle of blood circulation. This is due to the increased load on the heart, the need to overcome more resistance in blood vessels, and is often a consequence of arterial hypertension. Hypertrophy of the left ventricle reduces its elasticity and the ability to effectively relax in the diastole phase (blood filling). Diastolic dysfunction, as a result, is often found in older people and can lead to heart failure.
• Reducing the elasticity of myocardium: Connecting tissue (collagen) gradually replaces muscle fibers in the heart. This leads to a decrease in myocardial elasticity and a decrease in its ability to reduce and relax. The contractile ability of the heart (ejection fraction) can slightly decrease with age, especially in the presence of concomitant diseases.
• Lipofuscin accumulation: Lipofuscin is an aging pigment that accumulates in myocardial cells. Its excess accumulation can disrupt the function of the cells and contribute to their degeneration.
• Changes in the conducting system of the heart: The cells of the sinus node, which is a natural driver of the heart rhythm, are gradually replaced by fibrous tissue. This can lead to the development of arrhythmias such as bradycardia (slow -hearted rhythm) and sinus node weakness syndrome. Atrioventricular node (AB-Ozel), which conducts an impulse from atrial to ventricles, can also be subjected to age-related changes, which leads to conductivity violations (for example, AB-block).
• Increase in the size of the atrial: The atrium with age increases in the amount, which is associated with increased pressure in them and the need to compensate for a decrease in ventricular function. Increased atrium increases the risk of atrial fibrillation – common arrhythmia in the elderly.
• Calcification of heart valves: The aortic and mitral heart valves are subject to calcification with age. Calcinosis leads to a narrowing (stenosis) or incomplete closing (insufficiency) of the valves, which disrupts the bloodstream and increases the load on the heart. Aortic stenosis is one of the most common diseases of the heart valves in the elderly.

1.2 changes in blood vessels:

• Atherosclerosis: Atherosclerosis is a progressive arterial disease characterized by the formation of atherosclerotic plaques on the internal walls of the vessels. Plains consist of cholesterol, fats, calcium and other substances. They narrow the lumen of the arteries, limit the blood flow and can lead to ischemia (lack of oxygen) of organs and tissues. Atherosclerosis is the main reason for the development of coronary heart disease (IBS), stroke and diseases of the peripheral arteries.
• Increase in the rigidity of arteries (arterial rigidity): With age, arteries lose their elasticity and become more stringent. This is due to a change in the composition of the walls of the arteries, an increase in the content of collagen and calcium, as well as with damage to elastic fibers. Arterial rigidity leads to an increase in systolic blood pressure, an increase in the load on the heart and a violation of its diastolic function.
• Endothelium dysfunction: Endothelium is the inner layer of cells lining the blood vessels. He plays an important role in the regulation of blood vessels, blood coagulation and inflammation. With age, the function of the endothelium is disturbed, which contributes to the development of atherosclerosis, arterial hypertension and other SVDs.
• Varicose veins: The walls of the veins with age become less elastic and durable, which predisposes to the development of varicose veins. Vienna loses the ability to effectively return blood to the heart, which leads to stagnation of blood in the lower extremities, swelling and other problems.

1.3 Risk factors for cardiovascular diseases in older people:

In addition to age -related changes, there are other risk factors that increase the likelihood of SVD in the elderly. It is important to note that often these risk factors interact with each other, enhancing the negative impact on the cardiovascular system.

• Arterial hypertension: Increased blood pressure is one of the most common and significant risk factors in the elderly. Arterial hypertension increases the load on the heart, damages the walls of arteries and promotes the development of atherosclerosis.
• Dyslipidemia: The increased level of cholesterol and other blood lipids (dyslipidemia) is an important risk factor for atherosclerosis. Especially dangerous is the increased level of “poor” cholesterol (low density lipoproteins – LDL) and the low level of “good” cholesterol (high density lipoproteins – HDLP).
• Diabetes sugar: Diabetes mellitus significantly increases the risk of CVD, especially IBS, stroke and diseases of the peripheral arteries. A high blood sugar damage blood vessels and promotes the development of atherosclerosis.
• Smoking: Smoking is one of the most harmful risk factors for the cardiovascular system. Nicotine and other toxic substances contained in tobacco smoke damage the walls of arteries, increase blood pressure and blood coagulation, and also reduce the level of “good” cholesterol.
• Obesity: Excess weight and obesity increase the risk of arterial hypertension, dyslipidemia, diabetes and other risk factors of the SVD.
• Sedentary lifestyle (hypodynamia): The lack of physical activity contributes to the development of obesity, arterial hypertension, dyslipidemia and other risk factors of the SVD. Regular physical activity, on the contrary, strengthens the cardiovascular system and reduces the risk of SSZ.
• Inal meals: Excessive consumption of saturated fats, trans fats, cholesterol, salt and sugar contributes to the development of atherosclerosis, arterial hypertension and other risk factors of the CVD.
• Chronic stress: Chronic stress can increase blood pressure, blood cholesterol and blood coagulation, which increases the risk of CVD.
• Genetic predisposition: The presence of SVD in close relatives increases the risk of developing these diseases in humans.
• Chronic diseases: Chronic diseases, such as chronic kidney disease (CBP), chronic obstructive lung disease (COPD) and rheumatoid arthritis, increase the risk of SVD.
• Inflammation: Chronic inflammation plays an important role in the development of atherosclerosis and other SSZs. Inflammatory processes damage the walls of arteries and contribute to the formation of atherosclerotic plaques.

Section 2: Preventive measures to maintain heart health in old age

Prevention of the SSZ in old age is an integrated approach that includes a change in lifestyle, control of risk factors and, if necessary, drug therapy. The main goal of prevention is to slow down the progression of age-related changes in the cardiovascular system, to reduce the risk of CVD development and improve the quality of life.

2.1 Change in lifestyle:

A change in lifestyle is the cornerstone of the SSZ prevention at any age, especially in the elderly. Even small changes can have a significant positive effect on the health of the heart.

• Healthy nutrition: Healthy nutrition is the basis of SVD prevention. It is recommended to adhere to the following principles:

  • Reducing the consumption of saturated fats and trans fats: Saturated fats are found in red meat, fatty dairy products and some vegetable oils (for example, coconut and palm). Transfiders are contained in processed products, such as pastries, fast food and fried products. It is recommended to limit the consumption of these fats, as they increase the level of “poor” cholesterol (LDL) and increase the risk of atherosclerosis.
  • Consumer of cholesterol consumption: Cholesterol is found in animal products, such as meat, eggs and dairy products. It is recommended to limit cholesterol consumption up to 300 mg per day.
  • Increased consumption of unsaturated fats: Unsaturated fats are found in vegetable oils (olive, sunflower, corn), nuts, seeds and fatty fish (salmon, tuna, mackerel). Unsaturated fats help reduce the level of “poor” cholesterol and increase the level of “good” cholesterol.
  • Increase in fiber consumption: Fiber is found in vegetables, fruits, whole grain products and legumes. Fiber helps to reduce blood cholesterol, control blood sugar and maintain healthy weight.
  • Decrease in salt consumption (sodium): Excessive salt consumption increases blood pressure and increases the risk of CVD. It is recommended to limit salt consumption up to 2.3 grams per day (about 1 teaspoon). The use of processed products that often contain a large amount of salt should be avoided.
  • Sugar consumption restriction: Excessive consumption of sugar contributes to the development of obesity, diabetes and other risk factors of the SVD. It is recommended to limit the consumption of sugar, especially added sugar, which is contained in sweets, carbonated drinks and processed products.
  • Increase in fruits and vegetable consumptions: Fruits and vegetables are rich in vitamins, minerals, antioxidants and fiber. It is recommended to use at least 5 portions of fruits and vegetables per day.
  • Moderate alcohol consumption: Moderate drinking of alcohol (no more than 1 serving per day for women and no more than 2 servings per day for men) can have a certain protective effect on the cardiovascular system. However, excessive alcohol consumption increases the risk of SVD, so it is important to observe the measure.
  • Compliance with the diet: Regular nutrition and the avoidance of long breaks between meals help maintain a stable blood sugar and control weight. It is recommended to eat in small portions several times a day.

• Regular physical activity: Regular physical activity is one of the most effective ways to prevent the CVD. Physical activity strengthens the cardiovascular system, reduces blood pressure, improves blood cholesterol, helps to control weight and reduces the risk of diabetes.

  • Physical activity recommendations: It is recommended to devote at least 150 minutes a week of moderate intensity of aerobic activity (for example, fast walking, swimming, cycling) or 75 minutes a week of high intensity of aerobic activity (for example, running, tennis, aerobics). It is also recommended to perform strength exercises at least twice a week to strengthen the muscles.
  • The choice of physical activity: It is important to choose physical activity, which brings pleasure and corresponds to physical capabilities. Older people are recommended to start with moderate intensity of activity and gradually increase its duration and intensity. Before starting physical activity, it is recommended to consult a doctor.
  • Examples of physical activity for the elderly: Walking, swimming, cycling, yoga, ta-chi, dancing, gardening, household chores.

• Refusal of smoking: Refusal of smoking is one of the most important decisions that can be made to improve heart health. Smoking damages blood vessels, increases blood pressure and blood coagulation, and also reduces the level of “good” cholesterol. Refusal of smoking reduces the risk of developing coronary heart disease, stroke and other SVDs. There are various methods of assistance in refusaling smoking, such as nicotin replacement therapy, medicines and consultations.

• Weight control: Maintaining a healthy weight helps to reduce the risk of arterial hypertension, dyslipidemia, diabetes and other risk factors of the SVD. It is recommended to strive for body weight index (BMI) in the range of 18.5-24.9 kg/m2. Weight control is achieved using healthy nutrition and regular physical activity.

• Stress management: Chronic stress can increase blood pressure, blood cholesterol and blood coagulation, which increases the risk of CVD. It is important to learn how to effectively manage stress. There are various stress management methods, such as meditation, yoga, tai-chi, breathing exercises, communication with friends and family, hobbies and nature walks.

• Sufficient sleep: The lack of sleep can increase blood pressure, blood sugar and inflammation, which increases the risk of CVD. It is recommended to sleep at least 7-8 hours a day. It is important to create comfortable conditions for sleep, such as a quiet, dark and cool room.

• Regular medical examinations: Regular medical examinations allow you to identify and control the risk factors of the CVD, such as arterial hypertension, dyslipidemia and diabetes. It is recommended to regularly measure blood pressure, take blood tests for cholesterol and sugar, as well as undergo electrocardiography (ECG) and other examinations for the appointment of a doctor.

2.2 Control of risk factors:

Control of risk factors is an important part of the CSZ prevention. If you change your lifestyle is not enough to control risk factors, drug therapy may be required.

• Treatment of arterial hypertension: Treatment of arterial hypertension reduces the risk of coronary heart disease, stroke, heart failure and other CVDs. The purpose of the treatment is to maintain blood pressure below 140/90 mm Hg, and in patients with diabetes or CBP sugar – below 130/80 mm Hg. There are various classes of drugs for the treatment of arterial hypertension, such as diuretics, beta-blockers, ACE inhibitors, antagonists of angiotensin II receptors and calcium channel blockers. The choice of the drug depends on the individual characteristics of the patient and the presence of concomitant diseases.
• Treatment Dyslipidemia: The treatment of dyslipidemia reduces the risk of atherosclerosis and SSZ. The purpose of the treatment is to reduce the level of “bad” cholesterol (LDL) and increase the level of “good” cholesterol (HDL). The most effective drugs to reduce LDL level are statins. There are also other drugs for the treatment of dyslipidemia, such as fibrates, niacin and ezetimib. The choice of the drug depends on the individual characteristics of the patient and the level of lipids in the blood.
• Treatment of diabetes sugar: Treatment of diabetes reduces the risk of CVD. The purpose of treatment is to maintain blood sugar within the normal range. Treatment of diabetes includes diet, physical activity and drug therapy. There are various classes of drugs for the treatment of diabetes, such as metformin, sulfonylmochevin, thiazolidindyons, DPP-4 inhibitors and SGLT2 inhibitors. The choice of the drug depends on the individual characteristics of the patient and blood sugar.
• Antitrombotic therapy: Antitrombotic therapy (for example, aspirin or clopidogrel) can be prescribed to patients with a high risk of SVD to prevent blood clots and reduce the risk of myocardial infarction and stroke. However, antitrobotic therapy is also associated with the risk of bleeding, so it should be prescribed only according to strict indications and under the control of a doctor.

2.3 Other preventive measures:

In addition to changing the lifestyle and control of risk factors, there are other preventive measures that can help maintain heart health in old age.

• Vaccination: Vaccination from influenza and pneumococcal infection can reduce the risk of SVD. Influenza and pneumonia can cause inflammation and increase the risk of blood clots, which can lead to myocardial infarction and stroke.
• Reception of vitamins and minerals: Some vitamins and minerals (for example, vitamin D, vitamin K2, magnesium and potassium) can have a positive effect on the health of the cardiovascular system. However, before taking vitamins and minerals, it is recommended to consult a doctor.
• Rehabilitation after cardiovascular events: Rehabilitation after myocardial infarction, stroke or heart surgery helps restore the function of the heart, improve the quality of life and reduce the risk of repeated cardiovascular events. The rehabilitation program usually includes physical exercises, teaching a healthy lifestyle and psychological support.
• Screening for aortic aneurysm: Aortic aneurysm is an expansion of the wall of the aorta, which can lead to its gap and sudden death. Screening for aorta aneurysm is recommended for men aged 65-75, who have ever been smoked.
• Timely seeking a doctor when the symptoms of SSZ appear: It is important to consult a doctor in a timely manner when the SSZ symptoms appear, such as chest pain, shortness of breath, heartbeat, dizziness, swelling on the legs and weakness. Early diagnosis and treatment of SSZ can significantly improve the prognosis.

Section 3: Features of prevention in geriatric patients

Prevention of SSZ in geriatric patients (over 75 years old) has its own characteristics associated with the presence of multiple concomitant diseases, polypragmasia (taking a large number of drugs), a decrease in functionality and cognitive disorders.

3.1 Risk assessment and benefits:

When planning preventive measures in geriatric patients, it is necessary to carefully evaluate the ratio of the risks and benefits of each intervention. It is important to consider not only the impact on the cardiovascular system, but also the impact on the general state of health, functional capabilities and quality of life.

• Assessment of the expected life expectancy: In patients with a limited expected life expectancy (for example, due to severe concomitant diseases), aggressive preventive measures can be inappropriate. In such cases, priority should be given to measures aimed at alleviating symptoms and improving the quality of life.
• Functional status assessment: In patients with a pronounced decrease in functional status (for example, with difficulties when walking or self -service), it is necessary to adapt preventive measures to their capabilities. For example, instead of intense physical exercises, moderate walking or physiotherapy exercises can be recommended.
• Assessment of cognitive functions: In patients with cognitive disorders (for example, with Alzheimer’s disease), there may be difficulties in compliance with recommendations for a change in lifestyle and medication. In such cases, it is necessary to involve relatives or guardians to care for the patient.

3.2 Adaptation of preventive measures:

Preventive measures must be adapted to the individual needs and capabilities of each geriatric patient.

• Drug therapy: When prescribing drugs, it is necessary to take into account the interaction with other drugs taken by the patient, as well as the risk of side effects. It is recommended to start with low doses and gradually increase them under the supervision of a doctor. It is important to regularly review the list of drugs and cancel inexpedient drugs.
• Life change change: Recommendations for a change in lifestyle should be realistic and take into account the habits and preferences of the patient. It is necessary to support the patient and help him overcome difficulties. You can attract relatives or social workers to the help.
• Physical activity: Physical activity should be safe and correspond to the physical capabilities of the patient. It is recommended to start with short walks and gradually increase their duration and intensity. You can engage in physical activity under the guidance of an instructor in physiotherapy exercises.
• Nutrition: Power should be balanced and take into account the patient’s needs for nutrients. It is recommended to consume a sufficient amount of protein, vitamins and minerals. You can consult with a nutritionist.

3.3 Communication with the patient and his relatives:

It is important to maintain open and trusting communication with the patient and his relatives. It is necessary to explain in detail the goals and risks of preventive measures, as well as listen to the patients and wishes of the patient. It is recommended to use simple and understandable terms, as well as provide written materials.

3.4 Interdisciplinary approach:

The prevention of SVD in geriatric patients requires an interdisciplinary approach with the participation of doctors of various specialties (cardiologist, geriatricat, therapist, endocrinologist), nurses, social workers, psychologists and nutritionists. This approach allows you to take into account all aspects of the patient’s health and develop the most effective and safe preventive program.

Section 4: New directions in the prevention of cardiovascular diseases

Scientific research constantly expands our knowledge about risk factors and mechanisms for the development of SVD, which allows you to develop new and more effective methods of prevention.

• Targeted therapy of inflammation: Inflammation plays an important role in the development of atherosclerosis. New drugs are being developed aimed at suppressing inflammatory processes in the walls of arteries. For example, the drug Kanakinumab (Interleukin-1β inhibitor) showed a reduction in the risk of CVD in patients with a myocardial infarction.
• PCSK9 inhibitors: PCSK9 inhibitors are a new class of drugs that significantly reduce the level of “bad” cholesterol (LDL). They block the PCSK9 protein, which is involved in the regulation of LDL levels in the blood. PCSK9 inhibitors are effective in patients with a high risk of CVD in whom statins do not allow to achieve the target level of cholesterol.
• RNA therapy: RNA therapy is a promising direction in the treatment and prevention of SSZ. It is based on the use of small interface RNA (Mirn) to suppress the expression of genes involved in the development of atherosclerosis and other SVDs.
• Gene therapy: Gene therapy is another promising direction in the treatment and prevention of SVD. It is based on the introduction of genes encoding proteins into the body, which have a protective effect on the cardiovascular system.
• Personalized medicine: Personalized medicine involves the development of individual programs for the prevention and treatment of SVD based on a genetic profile, lifestyle and other risk factors for the patient. The development of genomic technologies and bioinformatics allows you to get more and more information about the genetic characteristics of each person and use this information to improve the prevention and treatment of SVD.
• Artificial intelligence and machine learning: Artificial intelligence and machine learning can be used to identify patients with a high risk of CVD, predicting the effectiveness of treatment and developing new prevention methods. For example, machine learning algorithms can analyze ECG data, blood tests and other patient parameters to identify signs of SVD in the early stages.
• Telemedicine: Telemedicine allows remote monitoring of patients with SVD, advise them on prevention issues and monitor the effectiveness of treatment. Telemedic technologies can be especially useful for patients living in remote areas or having limited movement opportunities.
• Digital technologies for changing lifestyle: Various digital applications and devices are developed that help people change their lifestyle and observe recommendations on healthy nutrition, physical activity and rejection of smoking. These technologies can provide personalized recommendations, motivate patients and track their progress.

The development and implementation of new methods of the prevention of SSZ requires large -scale clinical research and evaluating their effectiveness and safety. However, new technologies open up great prospects for improving the health of the cardiovascular system in old age and reduce the risk of the development of SVD.