Prevention of cardiovascular diseases: recommendations of doctors

Prevention of cardiovascular diseases: recommendations of doctors

Chapter 1: Risk factors for cardiovascular diseases (SSZ)

1. 1 Modified risk factors:

   1. 1. 1 Arterial hypertension (high blood pressure):

      2. 1. 1. 1 Determination: constant increased pressure in the arteries, usually defined as 140/90 mm Hg. or higher.
      3. 1. 1. 2 Pathophysiology: High blood pressure exerts an additional load on the heart and blood vessels, leading to their damage and thickening of the walls. This can contribute to the formation of atherosclerotic plaques, increasing the risk of a heart attack and stroke. Increased pressure can also cause hypertrophy of the left ventricle, increasing the need for oxygen and increasing the risk of arrhythmias.
      4. 1. 1. 3 Diagnostics: regular measurement of blood pressure. To confirm the diagnosis, several measurements made at different times are usually required. Daily monitoring of blood pressure (SMAD) can be useful for assessing pressure fluctuations during the day and night.
      5. 1. 1. 4 Treatment and prevention:
         2. 1. 1. 1. 1 Life change change:
            2. 1. 1. 1. 1. 1 Diet: Reducing the consumption of sodium (salt) to less than 2300 mg per day, an increase in potassium, magnesium and calcium consumption. Diet Dash (Dietary Approaches to Stop Hypertension), rich in fruits, vegetables, low -powered dairy products and whole grain products. Limiting the consumption of saturated and trans fats.
            3. 1. 1. 1. 1. 2 Physical activity: Regular aerobic exercises, such as walking, running, swimming or cycling, at least 150 minutes a week of moderate intensity or 75 minutes a week of high intensity. Strength training is also recommended at least twice a week.
            4. 1. 1. 1. 1. 3 Weight loss: Maintaining a healthy weight (BMI 18.5-24.9 kg/m²) can significantly reduce blood pressure.
            5. 1. 1. 1. 1. 4 Alcohol consumption restriction: Moderate alcohol consumption (no more than one drink per day for women and no more than two drinks per day for men).
            6. 1. 1. 1. 1. 5 Refusal of smoking: Smoking increases blood pressure and increases the risk of cardiovascular diseases.
         3. 1. 1. 1. 2 Medication: If a change in lifestyle is not enough to control blood pressure, the doctor may prescribe medications. Common classes of antihypertensive drugs include:
            2. 1. 1. 1. 2. 1 Tiazide diuretics: Increase the excretion of sodium and water from the body, reducing blood volume and blood pressure.
            3. 1. 1. 1. 2. 2 Angiotensin -converging enzyme (IAC) inhibitors: The formation of angiotensin II, hormone, which narrows blood vessels, block the formation of.
            4. 1. 1. 1. 2. 3 Angiotensin II (sconces) receptor blockers: The action of angiotensin II on the receptors in blood vessels is blocked.
            5. 1. 1. 1. 2. 4 Beta blockers: Reduce the frequency of heart contractions and the strength of contractions, reducing blood pressure.
            6. 1. 1. 1. 2. 5 Calcium channel blockers: Relax blood vessels and reduce heart rate.

   2. 1. 2 Dyslipidemia (high cholesterol):

      2. 1. 2. 1 Definition: Anomalous level of lipids (fats) in the blood, including a high level of total cholesterol, LDL (low density lipoproteins, “poor” cholesterol) and triglycerides, as well as low LDP (high density lipoproteins, “good” cholesterol).
      3. 1. 2. 2 Pathophysiology: high level of LDL helps the accumulation of cholesterol in the walls of arteries, leading to the formation of atherosclerotic plaques. These plaques can narrow the arteries, limiting blood flow and increasing the risk of a heart attack and stroke. The low level of HDLs helps to reduce the body’s ability to remove cholesterol from arteries. A high level of triglycerides is often associated with other risk factors, such as obesity, diabetes and metabolic syndrome, and can also increase the risk of cardiovascular diseases.
      4. 1. 2. 3 Diagnostics: blood test for a lipid profile, which includes a measurement of total cholesterol, LDL, HDL and triglycerides. It is recommended to analyze a lipid profile at least once every 5 years for adults over 20 years old, and more often in the presence of risk factors.
      5. 1. 2. 4 Treatment and prevention:
         2. 1. 2. 1. 1 Life change change:
            2. 1. 2. 1. 1. 1 Diet: Reducing the consumption of saturated and trans fats, cholesterol and refined carbohydrates. An increase in the consumption of soluble fiber contained in oats, apples, citrus and legumes. The inclusion in the diet of products rich in omega-3 fatty acids, such as fatty fish (salmon, tuna, sardines).
            3. 1. 2. 1. 1. 2 Physical activity: Regular aerobic exercises can help increase the level of HDL and reduce the level of LDL and triglycerides.
            4. 1. 2. 1. 1. 3 Weight loss: Weight loss can significantly improve a lipid profile.
            5. 1. 2. 1. 1. 4 Refusal of smoking: Smoking reduces the level of HDL.
         3. 1. 2. 1. 2 Medication: If a change in lifestyle is not enough to control the level of cholesterol, the doctor may prescribe medications. Common classes of drugs that reduce cholesterol include:
            2. 1. 2. 1. 2. 1 Statin: The most commonly used drugs that reduce the level of LDL by blocking the enzyme necessary for the production of cholesterol in the liver.
            3. 1. 2. 1. 2. 2 Cholesterol absorption inhibitors (ezetimib): Reduce intestinal cholesterol absorption.
            4. 1. 2. 1. 2. 3 Sequestrants of bile acids: Binded bile acids in the intestines, forcing the liver to produce more bile acids using cholesterol.
            5. 1. 2. 1. 2. 4 Fibrates: Reduce the level of triglycerides and increase the level of HDL.
            6. 1. 2. 1. 2. 5 PCSK9 inhibitors: The new class of drugs that significantly reduce the level of LDL, blocking the PCSK9 protein, which regulates the level of LDL receptors in the liver.

   3. 1. 3 Diabetes sugar:

      2. 1. 3. 1 Determination: chronic disease characterized by an increased level of blood glucose due to insulin deficiency or the inability of the body is effective to use insulin. There are two main types of diabetes: type 1 diabetes (an autoimmune disease in which the body does not produce insulin) and type 2 diabetes (the body becomes resistant to insulin or does not produce enough insulin).
      3. 1. 3. 2 Pathophysiology: a high level of blood glucose damages blood vessels, accelerating the process of atherosclerosis and increasing the risk of heart attack, stroke, peripheral arterial diseases and other cardiovascular complications. Diabetes also increases the risk of other risk factors of the SVD, such as arterial hypertension and dyslipidemia.
      4. 1. 3. 3 Diagnostics: blood test for the level of glucose on an empty stomach, glycated hemoglobin (HBA1C) or oral glucosotolerant test (PGTT). It is recommended to screening for diabetes in all adults over 45 years old, as well as in people with risk factors, such as overweight, family history of diabetes, low physical activity and arterial hypertension.
      5. 1. 3. 4 Treatment and prevention:
         2. 1. 3. 1. 1 Life change change:
            2. 1. 3. 1. 1. 1 Diet: A balanced diet with a limitation of consumption of simple sugars, refined carbohydrates and saturated fats. Increasing the consumption of fiber, fruits, vegetables and whole grains.
            3. 1. 3. 1. 1. 2 Physical activity: Regular aerobic exercises and strength training helps improve insulin sensitivity and control blood glucose.
            4. 1. 3. 1. 1. 3 Weight loss: Weight loss can significantly improve blood glucose control and reduce the risk of cardiovascular complications.
         3. 1. 3. 1. 2 Medication: To control the level of glucose in the blood, various classes of drugs can be prescribed, including:
            2. 1. 3. 1. 2. 1 Metformin: Reduces the production of glucose in the liver and improves insulin sensitivity.
            3. 1. 3. 1. 2. 2 Sulphonilmochevin: They stimulate the pancreas to the production of insulin.
            4. 1. 3. 1. 2. 3 Thiazolidindyons (grocery zones): Improve insulin sensitivity.
            5. 1. 3. 1. 2. 4 Ingibitor Deepeptidilpepitalatia-4 (DPP-4): Increte, hormones that stimulate insulin production and reduce the production of glucagon.
            6. 1. 3. 1. 2. 5 Sodium-glucose coter transporter 2 (SGLT2): Increase the excretion of glucose in urine.
            7. 1. 3. 1. 2. 6 Insulin: It is used for type 1 diabetes and in some cases of type 2 diabetes, when other treatment methods are not effective enough.

   4. 1. 4 Obesity and overweight:

      2. 1. 4. 1 Definition: a state characterized by excess accumulation of fat in the body. Obesity is usually defined as a body mass index (BMI) 30 kg/m² or higher, and overweight-as BMI 25-29.9 kg/m².
      3. 1. 4. 2 Pathophysiology: obesity is associated with an increased risk of many SVD risk factors, such as arterial hypertension, dyslipidemia, diabetes mellitus and metabolic syndrome. Excess fat in the abdomen (visceral fat) is especially dangerous, since it is metabolically active and distinguishes substances that contribute to inflammation and insulin resistance.
      4. 1. 4. 3 Diagnostics: measurement of BMI, waist circles and other indicators of body composition.
      5. 1. 4. 4 Treatment and prevention:
         2. 1. 4. 1. 1 Life change change:
            2. 1. 4. 1. 1. 1 Diet: Reducing the calorie content of the diet and the consumption of saturated and trans fats, sugar and refined carbohydrates. Increased consumption of fruits, vegetables, whole grain products and low -fat protein.
            3. 1. 4. 1. 1. 2 Physical activity: Regular aerobic exercises and strength training help burn calories, increase muscle mass and improve metabolism.
            4. 1. 4. 1. 1. 3 Behavioral therapy: Helps change food habits and lifestyle.
         3. 1. 4. 1. 2 Medication: In some cases, drugs can be prescribed to reduce weight.
         4. 1. 4. 1. 3 Surgical treatment (bariatric surgery): It is considered for people with severe obesity (BMI 40 kg/m² or higher) or BMI 35 kg/m² or higher with concomitant diseases such as diabetes or arterial hypertension.

   5. 1. 5 Smoking:

      2. 1. 5. 1 Determination: the use of tobacco products, including cigarettes, cigars, tubes and smokeless tobacco.
      3. 1. 5. 2 Pathophysiology: Smoking damages blood vessels, increases blood pressure, reduces the level of HDLs, increases the level of LDL, increases blood coagulation and helps the formation of atherosclerotic plaques. Smoking also increases the risk of thrombosis and arrhythmias.
      4. 1. 5. 3 Diagnostics: Self -report on smoking.
      5. 1. 5. 4 Treatment and prevention:
         2. 1. 5. 1. 1 Refusal of smoking: The most important step for reducing the risk of cardiovascular diseases. There are various methods of smoking refusal, including:
            2. 1. 5. 1. 1. 1 Nicotin -replacement therapy (NZT): Plaster, chewing gums, candies, inhalers and nasal sprays containing nicotine help reduce the craving for nicotine and symptoms of cancellation.
            3. 1. 5. 1. 1. 2 Medication: Bupropion and Vareniklin – drugs that help reduce the craving for nicotine and symptoms of cancellation.
            4. 1. 5. 1. 1. 3 Consulting and psychotherapy: They help to develop strategies for overcoming smoking and change behavioral habits.

   6. 1. 6 Insufficient physical activity:

      2. 1. 6. 1 definition: lack of regular physical exercises or low level of physical activity.
      3. 1. 6. 2 Pathophysiology: insufficient physical activity is associated with an increased risk of obesity, arterial hypertension, dyslipidemia, diabetes and other risk factors of the CVD. Regular physical exercises help improve the condition of the cardiovascular system, reduce blood pressure, improve lipid profile, control the level of blood glucose and maintain healthy weight.
      4. 1. 6. 3 Diagnostics: Assessing the level of physical activity using questionnaires and activity monitors.
      5. 1. 6. 4 Treatment and prevention:
         2. 1. 6. 1. 1 Regular physical exercises: It is recommended at least 150 minutes a week of moderate intensity or 75 minutes a week of high intensity of aerobic exercises, as well as strength training at least twice a week.

   7. 1. 7 Stress:

      2. 1. 7. 1 definition: physical, chemical or emotional load that causes physical, mental or emotional stress.
      3. 1. 7. 2 Pathophysiology: Chronic stress can lead to an increase in blood pressure, increase the frequency of heart contractions, release of stress hormones, such as cortisols and adrenaline, which can damage blood vessels and contribute to the development of atherosclerosis. Some people react to stress with unhealthy ways, such as smoking, overeating or alcohol abuse.
      4. 1. 7. 3 Diagnostics: Assessment of stress levels using questionnaires and psychological tests.
      5. 1. 7. 4 Treatment and prevention:
         2. 1. 7. 1. 1 Stress management methods:
            2. 1. 7. 1. 1. 1 Meditation: Practice aimed at calming the mind and reducing the level of stress.
            3. 1. 7. 1. 1. 2 Yoga: Practice combining physical poses, breathing exercises and meditation.
            4. 1. 7. 1. 1. 3 Respiratory exercises: Techniques aimed at slowing breathing and reducing stress levels.
            5. 1. 7. 1. 1. 4 Natural walks: Conducting time in nature can help reduce stress and improve mood.
            6. 1. 7. 1. 1. 5 Communication with friends and family: Support from loved ones can help cope with stress.

   8. 1. 8 Inal meals:

      2. 1. 8. 1 Determination: A diet that does not provide the body with a sufficient amount of necessary nutrients or contains an excess of harmful substances.
      3. 1. 8. 2 Pathophysiology: Important nutrition can lead to obesity, arterial hypertension, dyslipidemia, diabetes and other risk factors of the SVD.
      4. 1. 8. 3 Diagnostics: Evaluation of the diet using questionnaires and food diaries.
      5. 1. 8. 4 Treatment and prevention:
         2. 1. 8. 1. 1 Balanced nutrition: Increased consumption of fruits, vegetables, whole grain products, low -fat protein and healthy fats. Limiting the consumption of saturated and trans fats, sugar and refined carbohydrates.

2. 2 Unmodified risk factors:

   1. 2. 1 Age: The risk of cardiovascular diseases increases with age. In men, risk begins to increase after 45 years, and in women – after 55 years.
   2. 2. 2 Floor: In men, the risk of cardiovascular diseases, as a rule, is higher than in women to menopause. After menopause, the risk of women increases and approaches the risk of men.
   3. 2. 3 Family history: The presence of cardiovascular diseases in close relatives (parents, brothers, sisters) increases the risk of developing these diseases.
   4. 2. 4 Race/ethnicity: Some racial and ethnic groups have a higher risk of cardiovascular disease. For example, African Americans have a higher risk of arterial hypertension and stroke, and immigrants from South Asia are a higher risk of diabetes and coronary heart disease.

Chapter 2: Methods of prevention of cardiovascular diseases

1. 1 Primary prevention: Aims to prevent the development of cardiovascular diseases in people who do not yet have these diseases.

   1. 1. 1 Healthy lifestyle:

      2. 1. 1. 1 Proper nutrition:
         2. 1. 1. 1. 1 Diet Dash: Diet, rich in fruits, vegetables, low -powered dairy products, whole grain products and low -fat protein. Restriction of sodium consumption, saturated and trans fats, red meat and sweet drinks.
         3. 1. 1. 1. 2 Mediterranean diet: Diet, rich in fruits, vegetables, whole grain products, legumes, nuts, seeds, olive oil and fish. Limiting the consumption of red meat and dairy products.
         4. 1. 1. 1. 3 Salt consumption restriction: Reduction in sodium consumption to less than 2300 mg per day.
         5. 1. 1. 1. 4 Increase in fiber consumption: Consumption of at least 25-30 grams of fiber per day.
         6. 1. 1. 1. 5 Consumption of a sufficient amount of water: Maintaining the water balance is necessary for the normal functioning of the body.
      3. 1. 1. 2 Regular physical activity:
         2. 1. 1. 2. 1 Aerobic exercises: Walking, running, swimming, cycling and other types of physical activity that increase heart rate and improve the state of the cardiovascular system.
         3. 1. 1. 2. 2 Power training: Lift weights, exercises using your own weight and other types of physical activity that strengthen the muscles.
         4. 1. 1. 2. 3 Recommendations: At least 150 minutes a week of moderate intensity or 75 minutes a week of high intensity of aerobic exercises, as well as strength training at least twice a week.
      4. 1. 1. 3 Maintaining a healthy weight:
         2. 1. 1. 3. 1 BMI calculation: Maintaining BMI in the range of 18.5-24.9 kg/m².
         3. 1. 1. 3. 2 Weight loss: If you have overweight or obesity, the loss of even a small amount of weight (5-10% of the total body weight) can significantly improve health status.
      5. 1. 1. 4 Refusal of smoking:
         2. 1. 1. 4. 1 Advantages of smoking refusal: Refusal of smoking reduces the risk of cardiovascular diseases, lung cancer, chronic lung diseases and other serious diseases.
         3. 1. 1. 4. 2 Methods of smoking refusal: Nicotin -replacement therapy, drug treatment, counseling and psychotherapy.
      6. 1. 1. 5 Stress management:
         2. 1. 1. 5. 1 Methods: Meditation, yoga, breathing exercises, walking in nature, communication with friends and family.
      7. 1. 1. 6 Alcohol consumption restriction:
         2. 1. 1. 6. 1 Recommendations: Moderate alcohol consumption (no more than one drink per day for women and no more than two drinks per day for men).
      8. 1. 1. 7 Regular medical examinations:
         2. 1. 1. 7. 1 Measurement of blood pressure: Regular measurement of blood pressure to detect and control arterial hypertension.
         3. 1. 1. 7. 2 Lipid profile analysis: Regular analysis of the lipid profile for the identification and control of dyslipidemia.
         4. 1. 1. 7. 3 Diabetes screening: Regular screening for diabetes to detect and control diabetes.

   2. 1. 2 Drug prevention: In some cases, medical prevention can be recommended to reduce the risk of cardiovascular diseases.

      2. 1. 2. 1 Aspirin: Low doses of aspirin can be recommended to people with a high risk of cardiovascular diseases to prevent blood clots.
      3. 1. 2. 2 Statin: Statins can be recommended to people with a high risk of cardiovascular diseases to reduce LDL levels.
      4. 1. 2. 3 Antihypertensive drugs: Antihypertensive drugs can be recommended to people with arterial hypertension to reduce blood pressure.

2. 2 Secondary prevention: It is aimed at preventing repeated cardiovascular events in people who already have cardiovascular diseases.

   1. 2. 1 Healthy lifestyle: (The same recommendations as for primary prevention)

   2. 2. 2 Drug therapy:

      3. 2. 2. 1 Antitrombocytic drugs: Aspirin, clopidogrel and other antitromobocytic drugs help prevent blood clots.
      4. 2. 2. 2 Statin: Statins reduce the level of LDL and stabilize atherosclerotic plaques.
      5. 2. 2. 3 Beta blockers: Beta blockers reduce heart rate and blood pressure, reducing the load on the heart.
      6. 2. 2. 4 ACE inhibitors/sconces: ACF and sconces inhibitors reduce blood pressure and protect the heart and kidneys.
      7. 2. 2. 5 Nitrate: Nitrates expand blood vessels and improve the blood flow to the heart.

   3. 2. 3 Rehabilitation:

      3. 2. 3. 1 Heart rehabilitation: A comprehensive program, including physical exercises, educational classes and psychological support, helps patients with cardiovascular diseases recover after a heart attack, heart surgery or other cardiovascular events.

Chapter 3: Specific recommendations on prevention for various population groups

1. 1 Children and adolescents:

   1. 1. 1 Healthy nutrition:

      2. 1. 1. 1 Balanced diet: Increased consumption of fruits, vegetables, whole grain products, low -fat protein and dairy products with low fat. Limiting the consumption of sweet drinks, fast food and processed products.
      3. 1. 1. 2 Healthy nutrition training: Teaching children and adolescents about the importance of healthy diet and how to choose healthy foods.

   2. 1. 2 Physical activity:

      2. 1. 2. 1 Daily exercises: At least 60 minutes a day of moderate or high intensity of physical activity.
      3. 1. 2. 2 Various types of activity: Inclusion of various types of activity, such as games, sports, dancing and walking.
      4. 1. 2. 3 Restriction of the time spent in front of the screen: Limiting the time spent in front of the TV, computer and other screens.

   3. 1. 3 Smoking prevention:

      2. 1. 3. 1 Learning on the dangers of smoking: Teaching children and adolescents about the dangers of smoking and other tobacco products.
      3. 1. 3. 2 Creating an environment free from tobacco: Support for a policy aimed at restricting access to tobacco products and creating an environment free from tobacco.

   4. 1. 4 Weight control:

      2. 1. 4. 1 Healthy lifestyle: Maintaining healthy weight with a healthy diet and regular physical activity.
      3. 1. 4. 2 Screening to obesity: Regular screening for obesity and taking measures to reduce weight if necessary.

   5. 1. 5 Control of blood pressure and cholesterol level:

      2. 1. 5. 1 Regular medical examinations: Regular medical examinations, including the measurement of blood pressure and analysis of the lipid profile in the presence of risk factors.

2. 2 Women:

   1. 2. 1 Specific risk factors:

      3. 2. 1. 1 Menopause: A decrease in estrogen level after menopause increases the risk of cardiovascular diseases.
      4. 2. 1. 2 Pregnancy: Pregnancy complications, such as gestational diabetes and preeclampsia, increase the risk of cardiovascular diseases in the future.
      5. 2. 1. 3 Reception of oral contraceptives: Reception of oral contraceptives can increase blood pressure and cholesterol.

   2. 2. 2 Recommendations:

      3. 2. 2. 1 Healthy lifestyle: The same recommendations as for the general population.
      4. 2. 2. 2 Control of blood pressure and cholesterol level: Regular control of blood pressure and cholesterol, especially after menopause.
      5. 2. 2. 3 Consultations with a doctor: Consultations with a doctor regarding risk factors associated with menopause, pregnancy and oral contraceptive.
      6. 2. 2. 4 Hormonal therapy: Hormone therapy after menopause can be considered in some cases, but it is necessary to take into account the risks and advantages.

3. 3 Elderly people:

   1. 3. 1 Specific risk factors:

      4. 3. 1. 1 Age: The risk of cardiovascular diseases increases with age.
      5. 3. 1. 2 Related diseases: Older people often have concomitant diseases, such as arterial hypertension, diabetes and kidney disease, which increase the risk of cardiovascular diseases.

   2. 3. 2 Recommendations:

      4. 3. 2. 1 Healthy lifestyle: The same recommendations as for the general population, but taking into account physical restrictions and concomitant diseases.
      5. 3. 2. 2 Drug therapy: Adequate treatment of arterial hypertension, diabetes and dyslipidemia.
      6. 3. 2. 3 Rehabilitation: Heart rehabilitation after a heart attack, heart surgery or other cardiovascular events.
      7. 3. 2. 4 Vaccination: Vaccination against influenza and pneumococcal infection, since these infections can