New data on cardiovascular diseases

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New data on cardiovascular diseases: a deep analysis of recent studies and clinical recommendations

I. Epidemiology and prevalence of cardiovascular diseases (SVD): Changing trends

Cardiovascular diseases (SVD) remain a leading cause of mortality around the world, despite significant successes in prevention and treatment. However, the epidemiological picture is constantly changing, which requires constant updating of knowledge and strategies.

A. Global and regional statistics:

  1. The global burden of SSZ: According to the World Health Organization (WHO), the SSZ annually cause about 17.9 million deaths, which is 31% of all cases of death in the world. Coronal heart disease (coronary heart disease) and stroke are the main causes of death from the SVD.
  2. Regional differences: The prevalence of the SVD varies significantly in different regions of the world. High income countries, as a rule, have a lower mortality from SVD due to improved access to medical care and preventive measures. However, in countries with a low and average income, the mortality from the SVD remains high and continues to grow due to insufficient access to medical care, an unhealthy lifestyle and aging of the population.
  3. Age and gender features: The risk of the development of SVAZ increases with age, and in men, risk, as a rule, is higher than in women before menopause. After menopause, the risk of SVD in women increases significantly, approaching the risk of men.

B. New trends in the epidemiology of SSZ:

  1. Growth of incidence among youth: In recent years, there has been an alarming tendency to increase the incidence of SVD among young people. This is due to the growth of the prevalence of risk factors, such as obesity, type 2 diabetes, smoking and a sedentary lifestyle.
  2. Increase in the prevalence of atrial fibrillation (FP): FP is the most common arrhythmia, and its prevalence continues to grow, especially among the elderly. FP significantly increases the risk of stroke, heart failure and death.
  3. Effect of COVID-19 on SSZ: Covid-19 pandemia had a significant impact on the cardiovascular system. Covid-19 can cause myocarditis, thromboembolic complications and exacerbation of the existing SVD. In addition, the pandemic has led to a decrease in access to medical care for patients with the SVD, which will probably lead to an increase in mortality in the future.
  4. The effect of air pollution on the SVD: Air pollution is an important risk factor for the development of SVD. The effects of contaminated air can cause inflammation, oxidative stress and endothelial dysfunction, which increases the risk of IBS, stroke and heart failure.

C. Risk Factors of the SSZ: new discoveries and revaluation:

  1. Traditional risk factors: The traditional risk factors of the SVD include:
    • Arterial hypertension: High arterial pressure is the main risk factor for coronary heart disease, stroke, heart failure and chronic kidney disease.
    • Dyslipidemia: The increased level of low-density lipoproteins (CHC-LPNP) and triglycerides, as well as the low level of high density lipoprotein cholesterol (XC-LPVP) increase the risk of atherosclerosis.
    • Smoking: Smoking is one of the most powerful risk factors of the SSZ. It damages the vascular endothelium, increases blood pressure and LDL cholesterol, and also reduces the level of HDL cholesterol.
    • Diabetes sugar: Diabetes mellitus significantly increases the risk of CVD. It damages the vessels, promotes atherosclerosis and increases the risk of thrombosis.
    • Obesity: Obesity is associated with an increased risk of arterial hypertension, dyslipidemia, diabetes and other risk factors of the SVD.
    • Sedentary lifestyle: A sedentary lifestyle increases the risk of obesity, arterial hypertension, dyslipidemia and diabetes.
    • SSZ family history: The presence of SVD in close relatives increases the risk of SVD.
  2. New and overestimated risk factors:
    • Inflammation: Chronic inflammation plays an important role in the development of atherosclerosis. The high level of inflammation markers, such as C-reactive protein (SRB), is associated with the increased risk of the SVD.
    • Thrombogenic factors: An increased level of blood coagulation factors, such as fibrinogen and fibrinolysis inhibitors, such as plasminogen-1 (IAP-1) activator inhibitor, increase the risk of thrombosis and SVZ.
    • Psychosocial factors: Stress, depression, anxiety and social isolation are associated with the increased risk of SVD.
    • Sleep disorders: The lack of sleep, sleep apnea and other sleep disturbances increase the risk of arterial hypertension, coronary heart disease and stroke.
    • Air pollution: As mentioned above, air pollution is an important risk factor in the SSZ.
    • Microbiotic intestinal: The composition of the intestinal microbiots can affect the risk of the CVD. Some bacteria can contribute to the development of atherosclerosis and other SSZs.
    • Genetic factors: Genetic factors play an important role in the development of SVD. Many genes are identified that are associated with the increased risk of coronary heart disease, stroke and other SSZs.
    • Epigenetic factors: Epigenetic modifications, such as DNA methylation and histone modifications, can affect the expression of genes associated with the SVD.

II. Corporal heart disease (IBS): new approaches to diagnosis and treatment

Coronial heart disease (coronary heart disease) remains the main cause of death from SSZs around the world. Improving the diagnosis and treatment of coronary heart disease is crucial for reducing mortality and incidence.

A. Diagnostics IBS: Modern methods and innovations:

  1. Non -invasive diagnostic methods:
    • Electrocardodiography (ECG): ECG is the main method of diagnosis of coronary artery disease. It can reveal signs of myocardial ischemia, myocardial infarction and arrhythmias.
    • Echocardiography: Echocardiography allows you to evaluate the function of the heart, valve structure and the presence of zones of myocardial contractility. Stress echocardiography allows you to identify myocardial ischemia during physical activity or pharmacological stimulation.
    • Stress tests: Stress tests, such as thread tests and bicycle ergometry, are used to identify myocardial ischemia during physical activity.
    • Radionuclide methods: Radonuclide methods, such as myocardial scintigraphy, allow you to evaluate myocardial perfusion and identify ischemia or heart attack zones.
    • Computed tomography (CT) of the coronary arteries: CT of the coronary arteries allows you to visualize the coronary arteries and identify the presence of stenosis.
    • Magnetic resonance imaging (MRI) of the heart: MRI of the heart allows you to evaluate the function of the heart, myocardial structure and the presence of ischemia or heart attack zones.
  2. Invasive diagnostic methods:
    • Coronary angiography: Coronary angiography is a gold standard for diagnosis of coronary heart disease. It allows you to visualize the coronary arteries and identify the presence of stenosis.
    • Intravascular ultrasound examination (vsuzi): Nusuzi allows you to obtain an image of the coronary artery wall and evaluate the degree of atherosclerotic lesion.
    • Field reserve of blood flow (FRK): The Federal Migration Service allows you to assess the functional significance of the stenosis of the coronary artery.
  3. New diagnostic methods:
    • Computer tomographic angiography with an assessment of the fractional reserve of blood flow (CTF): CTF all allows you to evaluate the functional significance of the stenosis of the coronary artery based on the data of CT of the coronary arteries.
    • Optical coherent tomography (OKT): OKT allows you to obtain an image of the coronary artery wall with high resolution and evaluate the structure of atherosclerotic plaques.
    • Analysis Microornk: Microrm are small RNA molecules that regulate the expression of genes. Analysis of microrm in the blood can be used to diagnose coronary heart disease and predict the risk of cardiovascular events.
    • Proteomics: Proteomy allows you to identify and quantify the proteins in the blood. The analysis of the proteo can be used to diagnose coronary heart disease and predict the risk of cardiovascular events.

B. Treatment of coronary heart disease: drug therapy, invasive procedures and new strategies:

  1. Drug therapy:
    • Antiplans: Aspirin and clopidogrel are used to prevent blood clots.
    • Beta blockers: Beta blockers reduce heart rate and blood pressure, reducing the load on the heart.
    • Angiotensin-reproductive enzyme (IAC) and angiotensin II receptors II (sconces): IACF and sconces reduce blood pressure and improve the function of the endothelium.
    • Statin: Statins reduce LDL cholesterol and stabilize atherosclerotic plaques.
    • Nitrate: Nitrates expand the coronary arteries and reduce chest pain (angina pectoris).
    • PCSK9 inhibitors: PCSK9 inhibitors are a new class of drugs that significantly reduce LDL cholesterol.
  2. Invasive procedures:
    • Coronal coronary angioplasty (ChKA): ChKA includes the expansion of the narrowed coronary artery using a cylinder and the installation of a stent to maintain artery patency.
    • Alcoronarnare shooting (USA): Aksh includes the creation of a bypass path for blood flow around the narrowed coronary artery using an outhenic or arterial shunt.
  3. New treatment strategies:
    • Exercise of myocardial stem cells: The revascularization of myocardial stem cells is a promising method of treatment of coronary heart disease, which is aimed at restoring the damaged myocardium.
    • Gene therapy: Gene therapy can be used to improve endothelium function, reduce inflammation and stimulation of angiogenesis.
    • Personalized medicine: Personalized medicine involves an individual approach to the treatment of coronary heart disease based on genetic, prototing and other patient data.
    • Miniinvasive AKSH Methods: Miniyinvasive AKSH methods allow you to perform surgery through small incisions, which reduces trauma and accelerates the recovery of the patient.
    • Biophantable stents: Biopharynous stents are gradually dissolving in the body after performing their function, which reduces the risk of late thrombosis of the stent.

C. Acute coronary syndrome (ACS): Fast diagnostics and modern treatment protocols:

  1. Diagnostics OXC:
    • ECG: ECG is the main method of diagnosis of ACS. It can reveal signs of elevation of the ST (STEMI) segment, the depression of the ST segment and inversion of the Tube T (NSTEMI/unstable angina pectoris).
    • Troponin analysis: Troponin is a protein that is released into the blood if myocardial is damaged. The increased level of troponin indicates myocardial infarction.
  2. Treatment of ACS:
    • STEMI: Immediate ChKA or thrombolysis is the main treatment for STEMI.
    • NSTEMI/unstable angina pectoris: Treatment of NSTEMI/unstable angina pector includes drug therapy and, if necessary, ChKA.
  3. New approaches to the treatment of ACS:
    • New generation P2Y12 inhibitors: New generation P2Y12 inhibitors, such as prasogrel and thikagrelor, have a faster and more powerful anti -aggregate effect than clopidogrel.
    • Glycoprotein IIb/IIIa: Glycoprotein IIB/IIia inhibitors block the binding of fibrinogen with platelets, preventing platelet aggregation.
    • Biwylirudin: Bivilirudin is a direct thrombin inhibitor, which can be used as an alternative to heparin during ChK.
    • Intravascular visualization for ACS: Intravascular visualization (vsuzi and OKT) can be used to assess the severity of atherosclerotic lesion and optimize the results of the CC with ACS.

III. Heart failure: new classifications, biomarkers and therapeutic capabilities

Heart failure (SN) is a common and severe disease, which is characterized by the inability of the heart to ensure adequate blood supply to organs and tissues.

A. Classification and diagnosis of heart failure: updated criteria and biomarkers:

  1. Classification SN:
    • SN with a low fraction of the release of the left ventricle (SNNFV): Left ventricle emission faction (FVLZH) ≤ 40%.
    • SN with moderately reduced FVLZH (Snuzfv): Fwlfather 41-49%.
    • SN with a saved FVLZH (SNSFV): Fwlj llths ≥ 50%.
  2. Diagnostics SN:
    • Clinical assessment: Assessment of symptoms and signs of CH, such as shortness of breath, swelling, fatigue and orthopnoe.
    • Echocardiography: Echocardiography allows you to evaluate the function of the heart, valve structure and the presence of zones of myocardial contractility.
    • Biomarkers:
      • STRIURETIC PEPTIDS (NUP): NUP, such as BNP and NT-PROBNP, are released into the blood when stretching the walls of the heart. An increased level of NUP indicates SN.
      • Troponin: An increased level of troponin may indicate myocardial damage to CH.
      • ST2: ST2 is a protein that is released into the blood at a mechanical myocardial tension. An increased level of ST2 is associated with the worst forecast for SN.
      • Galap-3: Galeckin-3 is a protein that is involved in myocardial fibrosis. The increased level of galelectin-3 is associated with the worst forecast for SN.

B. Treatment of heart failure: new drugs and devices:

  1. Drug therapy of SNNFV:
    • IAPF or BRA: IACF and sconces reduce blood pressure and improve the function of the endothelium.
    • Beta blockers: Beta blockers reduce heart rate and blood pressure, reducing the load on the heart.
    • Antagonists of mineralocorticoid receptors (AMKR): AMKR, such as spironolactone and eplerenon, block the effect of aldosterone, which reduces fluid retention and improves the function of the heart.
    • Inhibitors of non -obscene and receptors of angiotensin (Inra): Inra, such as Sakubitril/Walsartan, inhibit non -ilizos, an enzyme that breaks down the NUP, and block the II angiotensin receptors.
    • SGLT2 inhibitors: SGLT2 inhibitors, such as dapagliflosine and empagliflosine, reduce blood glucose and have a cardioprotective effect.
  2. Drug therapy of SNSFV:
    • Diuretics: Diuretics are used to reduce fluid retention and alleviate the symptoms of CH.
    • Beta blockers: Beta blockers can be useful for monitoring the frequency of heart contractions and blood pressure.
    • Amkr: AMKR can be useful to reduce myocardial fibrosis.
    • SGLT2 inhibitors: SGLT2 inhibitors showed effectiveness in reducing the risk of hospitalization for SN and cardiovascular death in patients with SNSFV.
  3. Devices for the treatment of CH:
    • Implanted cardiover defibrillator (ICD): ICD is used to prevent sudden heart death in patients with high risk of ventricular arrhythmias.
    • Resinchronizing therapy (PCT): RST is used to improve coordination of left and right ventricles in patients with impaired intraventricular conduction.
    • Auxiliary device of the left ventricle (vulge): The vulge is used to maintain blood circulation in patients with severe CH who are waiting for heart transplantation or not candidates for transplantation.
  4. New approaches to the treatment of SN:
    • Gene therapy: Gene therapy can be used to improve heart function, reduce inflammation and stimulation of angiogenesis.
    • Exercise of myocardial stem cells: The revascularization of myocardial stem cells is a promising method for the treatment of SN, which is aimed at restoring the damaged myocardium.
    • Mitraklip: Mitraclip is a device that is used to correct mitral regurgitation, a common cause of SN.
    • Transcate implantation of mitral valve (TIMK): TIMK is a new method of treating mitral regurgitation, which allows you to replace the mitral valve through the catheter, without the need to conduct an open heart.

IV. Heart rhythm disorders: modern classification, diagnosis and treatment

Disorders of the rhythm of the heart, or arrhythmias, are common cardiovascular diseases, which can lead to serious complications, such as stroke, heart failure and sudden heart death.

A. Classification and arrhythmias: modern approaches:

  1. Classification of arrhythmias:
    • By origin:
      • Atrial arrhythmias: Atrial fibrillation, atrial flutter, atrial tachycardia.
      • Ventricular arrhythmias: Ventricular tachycardia, ventricular fibrillation, extrasystole.
      • Arrhythmias from atrioventricular (AB) node: Av-ultra reciprocal tachycardia, Av-reicing tachycardia with the participation of additional routes.
    • By heart rate:
      • Tachycardia: Heart rate> 100 beats per minute.
      • Bradycardia: Heart rate <60 beats per minute.
    • By regular rhythm:
      • Regular arrhythmias: The rhythm of the heart is regular.
      • Unregular arrhythmias: The rhythm of the heart is irregular.
  2. Arrhythmia mechanisms:
    • Violations of automatism: Violations of automatism are associated with a change in the velocity of spontaneous depolarization of cells of the conducting system of the heart.
    • Conductivity disorders: Violations of conductivity are associated with the blockade of the impulse according to the conducting system of the heart.
    • Re-entry mechanisms (Re-Entry): The mechanisms of re -entry are associated with the formation of a closed circle of impulse.
    • Trigger activity: Trigger activity is associated with the emergence of post -depolarizations that can cause spontaneous impulses.

B. Diagnosis of arrhythmias: new technologies and methods:

  1. Electrocardodiography (ECG): ECG is the main method for diagnosing arrhythmias.
  2. Holter monitoring ECG: Holter monitoring of ECG allows you to register an ECG for 24-48 hours or more, which allows you to identify transient arrhythmias.
  3. ECG Event Monitoring: Event Monitoring ECG allows the patient to independently record the ECG during episodes of symptoms.
  4. Implanted cardiomonitor: The implantable cardiomonitor allows you to monitor the rhythm of the heart for a long time, which is useful for identifying rare and difficult to diagnose arrhythmias.
  5. Electrophysiological study (Efi): Efi is an invasive method that allows you to evaluate the function of the heart system and identify the source of arrhythmias.
  6. Picture of the heart: Picture of the heart allows you to create a three -dimensional model of electrical activity of the heart and accurately localize the source of arrhythmia.
  7. New diagnostic methods:
    • Wearable devices: Wearable devices, such as smart watches and fitness braces, can register ECG and identify arrhythmias.
    • Artificial intelligence (AI): AI can be used to automatically analyze the ECG and the detection of arrhythmias.
    • Genetic testing: Genetic testing can be used to identify hereditary arrhythmias.

C. Treatment of arrhythmias: drug therapy, catheter ablation and device:

  1. Drug therapy:
    • Class I antiarrhythmic drugs: Sodium channel blockers.
    • Class II antiarrhythmic drugs: Beta blockers.
    • Class III antiarrhythmic drugs: Potassium channel blockers.
    • Class IV antiarrhythmic drugs: Calcium channel blockers.
    • Anticoagulants: Anticoagulants are used to reduce the risk of stroke in patients with atrial fibrillation.
  2. Catheter ablation: Cateter ablation is the method of treating arrhythmias, which includes the destruction of the heart tissue causing arrhythmia, using radio frequency energy or cryoablation.
  3. Devices:
    • Pacemakers: Pacemakers are used to treat bradycardia.
    • Implanted cartriders-defibrillators (ICD): ICD are used to prevent sudden heart death in patients with high risk of ventricular arrhythmias.
    • Resinchronizing therapy (PCT): RST is used to improve coordination of left and right ventricular contractions in patients with impaired intravenous conduction and heart failure.
  4. New approaches to the treatment of arrhythmias:
    • Impulse field ablation: Impulse field ablation is a new method for ablation of arrhythmias, which uses electrical impulses to destroy the heart tissue.
    • Neuromodulation: Neuromodulation is the method of treating arrhythmias, which includes stimulation of nerves that control cardiac activity.
    • Gene therapy: Gene therapy can be used to treat hereditary arrhythmias.

V. Diseases of the heart valves: improved diagnostic methods and intervention approaches

Palf diseases of the heart are characterized by impaired function of one or more heart valves, which can lead to heart failure, arrhythmias and other complications.

A. Diagnosis of heart valves diseases: modern visualization methods:

  1. Echocardiography: Echocardiography is the main method of diagnosing heart valves. It allows you to evaluate the structure of valves, the degree of stenosis or regurgitation, as well as the function of the heart.
  2. Transstoracal echocardiography (TTE): TTE is a non -invasive method of echocardiography, which is performed through the chest.
  3. Чрасийщевая echocardiography (CPE): CPE is an invasive method of echocardiography, which is performed through the esophagus. The CCE allows you to get a more detailed image of the heart valves than TTE.
  4. Computed tomography (CT): CT can be used to evaluate the structure of the heart valves and coronary arteries.
  5. Magnetic resonance tomography (MRI): MRI allows you to evaluate the function of the heart, the structure of myocardial and heart valves.
  6. Catheterization of the heart: Catheterization of the heart is an invasive method that allows you to measure pressure in the heart chambers and evaluate the function of the heart valves.
  7. New diagnostic methods:
    • Three -dimensional echocardiography: Three -dimensional echocardiography allows you to obtain a three -dimensional image of the heart valves and more accurately assess the degree of stenosis or regurgitation.
    • Deformation echocardiography (echocardiography): Deformation echocardiography allows you to evaluate myocardial function and identify the early signs of heart damage.
    • 4D echocardiography: 4D echocardiography allows you to get a three-dimensional image of the heart valves in real time.

B. Treatment of heart valves diseases: surgical intervention and transcate technologies:

  1. Surgical treatment:
    • Valve prosthetics: Valve prosthetics include the replacement of the damaged valve with a mechanical or biological prosthesis.
    • Valve plastic: The valve plastic includes the restoration of the damaged valve without replacing it.
  2. Transcate technologies:
    • Transcatheter implantation of the aortic valve (TIAK): The TIAC is the method of treating aortic stenosis, which includes implantation of the aortic valve prosthesis through the catheter, without the need to conduct an open heart.
    • Mitraklip: Mitraclip is a device that is used to correct mitral regurgitation by connecting the mitral valve wings.
    • Transcate implantation of mitral valve (TIMK): TIMK is a new method of treating mitral regurgitation, which allows you to replace the mitral valve through the catheter, without the need to conduct an open heart.
    • Transcatheter annuloplasty of tricuspid valve: Transcatheter annuloplasty of the tricuspid valve is a new method of treating tricuspid regurgitation, which allows you to reduce the size of the tricuspid ring and improve the function of the tricuspid valve through the catheter.
  3. New approaches to the treatment of heart valves diseases:
    • Bioenger valves: Bioenger valves are a new type of heart valves that are created from biological materials and have the ability to self -heal.
    • Robotized surgery: Robotized surgery allows you to perform operations on the heart valves with greater accuracy and less traumatic.

VI. Aortic diseases: modern diagnostic and treatment strategies

Aortic diseases include a wide range of diseases that affect the aorta, the largest artery in the body. These diseases can lead to serious complications, such as the stratification of aorta, aorta aneurysm and aortic gap.

A. Diagnostics of aorta disease: advanced visualization technologies:

  1. Computed tomography (CT) angiography: CT Angiography is the main method of diagnosing aortic disease. It allows you to visualize the aorta and identify the presence of aneurysm, stratification and other pathologies.
  2. Magnetic resonance imaging (MRI) angiography: MRI Angiography is an alternative method for diagnosing aortic disease that does not use ionizing radiation.
  3. Transstoracal echocardiography (TTE): TTE can be used to evaluate the proximal aorta.
  4. Чрасийщевая echocardiography (CPE): The CCE allows you to get a more detailed image of the aorta, especially its ascending department.
  5. Angiography: Angiography is an invasive method that allows you to visualize the aorta using x -rays and contrast agent.
  6. New diagnostic methods:
    • 4D-MRT: The 4D-MRT allows you to get a three-dimensional image of the aorta in real time and evaluate its dynamic characteristics.
    • Positron emission tomography (PET): PET can be used to detect inflammatory diseases of the aorta.
    • Genetic testing: Genetic testing can be used to detect hereditary aortic diseases, such as Martane syndrome and Elers-Danlos syndrome.

B. Treatment of aortic disease: surgical and endovascular methods:

  1. Surgical treatment:
    • Aortic aneurysm resection: The resection of the aorta aneurysm includes removing the damaged section of the aorta and replacing it with a prosthesis.
    • Aortic stratification repair: Repair of the stratification of the aorta includes the restoration of the aorta wall and the prevention of further stratification.
    • Aortic valve Replacing the aortic valve may be necessary when the aortic valve associated with diseases of the aorta can be affected.
  2. Endovascular treatment:
    • Endovascular prosthetics of the aorta (EVPA): EVPA is the method of treatment of aneurysm and the stratification of the aorta, which includes the implantation of the stent-graph into the aorta through the catheter, without the need to conduct an open heart.
  3. New approaches to the treatment of aortic disease:
    • Individualized stents-graphs: Individualized stents-graphs are created taking into account the anatomical characteristics of the patient

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