Coronary artery disease prevention and treatment. What is coronary artery disease and how to treat it? Drugs used in treatment

Coronary artery disease (CHD) - organic and functional myocardial damage caused by a lack or cessation of blood supply to the heart muscle (ischemia). IHD can manifest itself as acute (myocardial infarction, cardiac arrest) and chronic (angina pectoris, postinfarction cardiosclerosis, heart failure) conditions. The clinical signs of ischemic heart disease are determined by the specific form of the disease. IHD is the most common cause of sudden death in the world, including among people of working age.

ICD-10

I20-I25

General information

Ischemic heart disease is a serious problem in modern cardiology and medicine in general. In Russia, about 700 thousand deaths are annually recorded, caused by various forms of coronary artery disease, in the world mortality from coronary artery disease is about 70%. Ischemic heart disease mostly affects men of active age (55 to 64 years old), leading to disability or sudden death. The group of ischemic heart disease includes acutely developing and chronically occurring states of myocardial ischemia, accompanied by subsequent changes in it: dystrophy, necrosis, sclerosis. These conditions in cardiology are considered, among other things, as independent nosological units.

Causes

The vast majority (97-98%) of clinical cases of coronary artery disease is caused by atherosclerosis of the coronary arteries of varying severity: from a slight narrowing of the lumen by an atherosclerotic plaque to complete vascular occlusion. With 75% coronary stenosis, heart muscle cells respond to lack of oxygen, and patients develop exertional angina.

Other causes of coronary artery disease are thromboembolism or spasm of the coronary arteries, usually developing against the background of an already existing atherosclerotic lesion. Cardiospasm aggravates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.

The factors contributing to the onset of ischemic heart disease include:

• hyperlipidemia

Promotes the development of atherosclerosis and increases the risk of coronary heart disease by 2-5 times. The most dangerous in terms of the risk of ischemic heart disease are hyperlipidemias of types IIa, IIb, III, IV, as well as a decrease in the content of alpha-lipoproteins.

Arterial hypertension increases the likelihood of developing coronary artery disease by 2-6 times. In patients with systolic blood pressure \u003d 180 mm Hg. Art. and higher ischemic heart disease occurs up to 8 times more often than in hypotensive patients and people with normal blood pressure.

• smoking

According to various sources, smoking cigarettes increases the incidence of coronary artery disease by 1.5-6 times. Mortality from ischemic heart disease among men 35-64 years old who smoke 20-30 cigarettes daily is 2 times higher than among nonsmokers of the same age group.

• hypodynamia and obesity

Physically inactive people are at risk of developing coronary heart disease 3 times more than people leading an active lifestyle. When hypodynamia is combined with overweight, this risk increases significantly.

• violation of carbohydrate tolerance

• angina pectoris (stress):

1. stable (with the definition of functional class I, II, III or IV);
2. unstable: new-onset, progressive, early postoperative or postinfarction angina pectoris;

• spontaneous angina (syn. special, variant, vasospastic, Prinzmetal's angina)

• large focal (transmural, Q-infarction);
• small focal (not Q-infarction);

6. Violations of cardiac conduction and rhythm (the form).

7. Heart failure (form and stages).

In cardiology, there is the concept of "acute coronary syndrome", which combines various forms of coronary heart disease: unstable angina pectoris, myocardial infarction (with Q-wave and without Q-wave). Sometimes this group includes sudden coronary death caused by coronary artery disease.

CHD symptoms

Clinical manifestations of ischemic heart disease are determined by the specific form of the disease (see myocardial infarction, angina pectoris). In general, ischemic heart disease has an undulating course: periods of stable normal health alternate with episodes of exacerbation of ischemia. About 1/3 of patients, especially those with painless myocardial ischemia, do not feel the presence of coronary artery disease at all. The progression of coronary heart disease can develop slowly over decades; in this case, the forms of the disease, and therefore the symptoms, can change.

Common manifestations of ischemic heart disease include chest pain associated with physical exertion or stress, pain in the back, arm, lower jaw; shortness of breath, increased heart rate, or a feeling of interruption; weakness, nausea, dizziness, blurred consciousness and fainting, excessive sweating. Often, IHD is detected already at the stage of development of chronic heart failure with the appearance of edema in the lower extremities, severe shortness of breath, forcing the patient to take a forced sitting position.

The listed symptoms of ischemic heart disease usually do not occur at the same time, with a certain form of the disease, there is a predominance of certain manifestations of ischemia.

Precursors of primary cardiac arrest in ischemic heart disease can be paroxysmal discomfort behind the sternum, fear of death, psychoemotional lability. In case of sudden coronary death, the patient loses consciousness, respiratory arrest occurs, there is no pulse in the main arteries (femoral, carotid), heart sounds are not heard, pupils dilate, and the skin becomes pale grayish. Cases of primary cardiac arrest account for up to 60% of deaths from coronary artery disease, mainly at the prehospital stage.

Complications

Hemodynamic disorders in the heart muscle and its ischemic damage cause numerous morpho-functional changes that determine the form and prognosis of coronary artery disease. The following mechanisms of decompensation are the result of myocardial ischemia:

• insufficient energy metabolism of myocardial cells - cardiomyocytes;
• "Stunned" and "dormant" (or hibernating) myocardium - forms of impaired contractility of the left ventricle in patients with coronary artery disease, which are transient;
• development of diffuse atherosclerotic and focal postinfarction cardiosclerosis - a decrease in the number of functioning cardiomyocytes and the development of connective tissue in their place;
• violation of the systolic and diastolic functions of the myocardium;
• disorder of the functions of excitability, conduction, automatism and myocardial contractility.

The listed morphological and functional changes in the myocardium in coronary artery disease lead to the development of a persistent decrease in coronary circulation, i.e., heart failure.

Diagnostics

Diagnosis of ischemic heart disease is carried out by cardiologists in a cardiological hospital or dispensary using specific instrumental techniques. When interviewing a patient, complaints and the presence of symptoms characteristic of coronary heart disease are determined. On examination, the presence of edema, cyanosis of the skin, heart murmurs, rhythm disturbances are determined.

Laboratory diagnostic tests involve the study of specific enzymes that increase in unstable angina pectoris and heart attack (creatine phosphokinase (during the first 4-8 hours), troponin-I (for 7-10 days), troponin-T (for 10-14 days), aminotransferase , lactate dehydrogenase, myoglobin (on the first day)). These intracellular protein enzymes are released into the blood during the destruction of cardiomyocytes (resorption-necrotic syndrome). A study of the level of total cholesterol, lipoproteins of low (atherogenic) and high (antiatherogenic) density, triglycerides, blood sugar, ALT and AST (nonspecific markers of cytolysis) is also carried out.

The most important method for diagnosing cardiological diseases, including coronary heart disease, is ECG - registration of the electrical activity of the heart, which allows detecting violations of the normal operation of the myocardium. Echocardiography - a method of ultrasound of the heart allows you to visualize the size of the heart, the state of cavities and valves, to assess myocardial contractility, and acoustic noise. In some cases, with ischemic heart disease, stress echocardiography is performed - ultrasound diagnostics using dosed physical activity, recording myocardial ischemia.

Functional exercise tests are widely used in the diagnosis of coronary heart disease. They are used to detect the early stages of coronary artery disease, when violations cannot yet be determined at rest. As stress tests, walking, climbing stairs, loads on simulators (stationary bike, treadmill), accompanied by ECG-fixation of heart performance indicators, are used. The limited use of functional tests in a number of cases is caused by the impossibility of performing the required load by patients.

CHD treatment

The tactics of treatment of various clinical forms of coronary heart disease has its own characteristics. Nevertheless, it is possible to outline the main directions used for the treatment of coronary artery disease:

• non-drug therapy;
• drug therapy;
• surgical revascularization of the myocardium (coronary artery bypass grafting);
• the use of endovascular techniques (coronary angioplasty).

Non-drug therapy includes measures to correct lifestyle and nutrition. With various manifestations of ischemic heart disease, a restriction of the mode of activity is shown, since during physical activity there is an increase in myocardial demand for blood supply and oxygen. Dissatisfaction with this need of the heart muscle actually causes manifestations of ischemic heart disease. Therefore, in any form of coronary heart disease, the patient's activity regimen is limited, followed by its gradual expansion during rehabilitation.

The diet for ischemic heart disease involves limiting the intake of water and salt with food to reduce the load on the heart muscle. In order to slow the progression of atherosclerosis and combat obesity, a low-fat diet is also prescribed. The following product groups are limited and, if possible, excluded: animal fats (butter, lard, fatty meat), smoked and fried foods, rapidly absorbed carbohydrates (baked goods, chocolate, cakes, sweets). To maintain a healthy weight, a balance must be struck between energy consumption and energy expenditure. If it is necessary to reduce weight, the deficit between consumed and consumed energy reserves should be at least 300 kC per day, taking into account that a person spends about 2000-2500 kC per day during normal physical activity.

Drug therapy for ischemic heart disease is prescribed according to the formula "A-B-C": antiplatelet agents, β-blockers and cholesterol-lowering drugs. In the absence of contraindications, it is possible to prescribe nitrates, diuretics, antiarrhythmic drugs, etc. The lack of effect of the ongoing drug therapy for coronary heart disease and the threat of myocardial infarction are an indication for consulting a cardiac surgeon to resolve the issue of surgical treatment.

Surgical myocardial revascularization (coronary artery bypass grafting - CABG) is resorted to in order to restore the blood supply to the ischemic area (revascularization) in case of resistance to pharmacological therapy (for example, with stable exertional angina pectoris III and IV). The essence of the CABG method is the imposition of an autovenous anastomosis between the aorta and the affected heart artery below the site of its narrowing or occlusion. This creates a bypass vascular bed that delivers blood to the site of myocardial ischemia. CABG operations can be performed using artificial blood circulation or on a beating heart. Percutaneous transluminal coronary angioplasty (PTCA) - balloon "expansion" of a stenotic vessel followed by implantation of a stent frame that maintains a sufficient vessel lumen for blood flow, is a minimally invasive surgical technique for IHD.

Forecast and prevention

Determination of the prognosis for coronary artery disease depends on the relationship of various factors. So the combination of coronary heart disease and arterial hypertension, severe lipid metabolism disorders and diabetes mellitus adversely affects the prognosis. Treatment can only slow down the steady progression of coronary artery disease, but not stop its development.

The most effective prevention of ischemic heart disease is to reduce the adverse effects of threat factors: the elimination of alcohol and tobacco smoking, psychoemotional overload, maintaining optimal body weight, exercise, blood pressure control, healthy eating.

Primary prevention of coronary artery disease must be followed by all people. Special attention should be paid to these measures by persons falling into at least one of the risk groups for this pathology.

IHD can be triggered by various reasons. Primary prevention of disease involves the elimination of modifiable risk factors, the presence of which a person can control. These include:

• high body weight;
• negative eating habits;
• alcohol consumption;
• smoking;
• low level of physical activity;
• hypertension.

Such risk factors apply not only to coronary heart disease, but also to many other diseases of various body systems.

High body weight

Obesity is a provoking factor in many disorders in the body. To control your weight, it is important not only to keep track of the indicators on the scales, but also to take into account the body mass index (BMI).

High body weight is directly related to other risk factors for CHD - dietary habits and physical activity. A hereditary predisposition may also matter, but this circumstance remains unchanged.

To reduce body weight, you need to change your diet and add moderate physical activity. You can contact a nutritionist who will recommend some tests and develop an individual diet.

When normalizing weight, it is important to remember that you cannot starve. All restrictions should be introduced gradually so that the body does not experience stress.

Eating habits

The risk of coronary heart disease is associated with a high amount of calories consumed, which inevitably leads to weight gain. Another risk factor is excessive consumption of animal fats, which leads to high cholesterol levels.

For the prevention of ischemic heart disease, certain rules should be followed:

• Limit daily calorie intake. It must be calculated on an individual basis, taking into account age, weight, height and level of physical activity.
• Eat a balanced diet. The diet should contain 10-15% proteins, 55-60% carbohydrates, 25-35% fats, but mainly of vegetable origin.
• The diet should be based on cereals, vegetables, fruits, dairy products. Moderate consumption of meat, low-fat fish and poultry is important.

Eating habits are reflected in glucose levels, with a constant excess of which there is a risk of diabetes. It can provoke the development of ischemic heart disease. It is necessary to limit the maximum sweets, carbonated drinks, canned food, flour products.

Eating behavior is one of the most important factors affecting health. Proper nutrition is the prevention of most existing diseases of various body systems.

Alcohol

Alcohol abuse carries the risk of developing many diseases, including coronary heart disease. At the same time, the absolute rejection of it, the likelihood of coronary heart disease does not exclude, but serves as the prevention of other diseases.

Moderate alcohol consumption is considered a dosage of up to 30 grams per day. This calculation is for pure ethanol.

It is a well-known fact that dry red wine is good for vessels, but this does not mean its overall benefit. It is permissible to sometimes consume one glass of such a drink.

Smoking

There are thousands of chemicals in tobacco smoke, but a person gets more harm from carbon monoxide and nicotine.

For the prevention of coronary artery disease and many other diseases, smoking should be absolutely excluded. At the same time, it is important to take into account that secondhand smoke, that is, inhalation of smoke, also brings harm.

With low physical activity, the risk of coronary heart disease increases significantly. To prevent the disease, you should enter them at least half an hour a day. It is allowed to arrange one day off.

Physical activity should be moderate. It is useful to jog, swim, ride a bike, ski. Even brisk walking is effective - if there is no time for a walk, then you can walk from work at least part of the way.

It is important to combine physical activity with relaxation. If the work is sedentary, then, if possible, you need to do a warm-up during breaks.

Hypertension

Prevention of hypertension can be classified as both primary and secondary measures. Primary prevention of hypertension consists of eating well, limiting alcohol, quitting smoking, maintaining a healthy weight and moderate physical activity.

If, despite a healthy lifestyle, the pressure still rises, then drug therapy may be required. Its need is determined individually, taking into account the presence of other risk factors for coronary artery disease.

If coronary heart disease is nevertheless diagnosed, then prevention of its progression and development of complications is required. For this purpose, secondary prevention is needed. It implies the following measures:

• lifestyle correction;
• drug therapy;
• slowing down the progression of coronary sclerosis, ensuring, if possible, its partial regression;
• prevention of exacerbation of the disease and its clinical complications.

Some surgical methods can also be considered as secondary prevention.

With diagnosed coronary heart disease, it is especially important to lead a correct lifestyle. It consists in observing the following principles:

• proper and balanced nutrition;
• complete cessation of smoking and alcohol;
• normalization of body weight;
• maintaining normal sugar and cholesterol levels (implied with proper nutrition).

Features of the diet for IHD depend on the presence of concomitant diseases. In some cases, patients need a specific treatment table. A common indication for ischemic heart disease is table # 10.

Treatment table No. 10 is indicated for cardiovascular diseases (compensation stage) and insufficient blood supply. The basic principles of the diet are as follows:

• cut down on fats and carbohydrates;
• give up table salt;
• limit fluid intake;
• give up heavy food;
• eat 5 times a day;
• eat foods high in potassium, magnesium and lipotropic substances.

In the treatment of coronary heart disease, a whole range of drugs is used. Certain medications are important in preventing disease progression and complications. For these purposes, according to the doctor's prescription, it is possible to receive:

• Indirect anticoagulants. They are necessary at risk of vascular complications, including intracardiac thrombosis, thromboembolism, deep vein thrombosis, atrial fibrillation.
• β-blockers. With their help, the risk of recurrent myocardial infarction and death from coronary heart disease is reduced.
• Angiotensin-converting enzyme inhibitors. They are able to slow down the progression of atherosclerosis and have anti-ischemic action. Such drugs are used for concomitant arterial hypertension, diabetes mellitus, signs of heart failure.
• Lipid-lowering drugs. They are indicated in the case of hyperlipidemia, angina pectoris, myocardial infarction. Reception of such funds has a positive effect on the prognosis of life with coronary heart disease.
• Plavix (Clopidogrel). The drug reduces the risk of myocardial infarction, ischemic stroke, sudden death. After stenting, this drug is used to prevent stent thrombosis.

Such a preventive measure means surgery. It allows you to restore blood flow through the arteries of the heart with their stenosis. This measure is necessary for normal blood supply to the heart muscle.

Often, for the purpose of myocardial revascularization, coronary artery bypass grafting or stenting is used. Such techniques are direct operations.

Thrombosis

Most of the possible complications in coronary artery disease are caused by thrombosis. For its prevention, it is necessary to adhere to a healthy lifestyle, which consists in proper nutrition, moderate physical activity and rejection of bad habits.

If there is a risk of thrombus formation, nutrition should be based on cereals, fresh vegetables and fruits, dairy products, lean meat, vegetable oils. It is useful to eat foods rich in Omega-3, vitamin E, flavanoids.

It is also important to prevent any diseases of infectious origin, to prevent severe overheating or hypothermia of the body.

The drug prevention of thrombosis includes the intake of anticoagulants, aniagregants, folic and niacin, B vitamins (6, 12), vitamin E, bioflavonoids. Such therapy should be prescribed by a specialist.

Prevention of thrombosis after surgery should be considered separately. It must be turned on after the operation, regardless of the technique used.

Myocardial infarction

One of the complications of coronary heart disease is myocardial infarction. In cardiology, it is considered an exacerbation and the most severe form of ischemia.

The prevention of myocardial infarction should include the treatment of any existing diseases. Diabetes mellitus and arterial hypertension are of particular importance.

If myocardial infarction has already happened, then drug prevention of ischemic heart disease is necessary. A positive effect is observed when taking drugs with antianginal action: Carbocromen, Intensain, Intenkordin. Other drugs should also be included in prevention:

• β-blockers;
• indirect anticoagulants;
• calcium channel blockers;
• angiotensin-converting enzyme inhibitors.

Blood pressure control is important. If the diastolic reading exceeds 100 mm Hg. Art., then the risk of ischemic heart disease increases. In this case, taking antihypertensive drugs is indicated.

With myocardial infarction, physical rehabilitation is also important. The level of physical activity is selected individually, focusing on the results of the tests performed. They often resort to physical therapy and walking on flat terrain. In this case, a certain speed is recommended. Usually it is 3-4 km / h, that is, 80-100 steps.

It is important to maintain normal cholesterol levels - it is allowed to consume up to 300 mg per day. It is also necessary to limit the consumption of table salt to 5-6 grams per day.

Treatment of such a pathology as heart ischemia is characterized by some features. Non-drug therapy includes:

• regular exercise and the duration of such training is determined by a specialist
• changing the diet involves avoiding salty and fatty foods, as well as limiting water intake to reduce the load on the heart muscle
• elimination of stressful situations and emotional overstrain

1 What is ischemic heart disease and how is it scary?

Ischemic heart disease (ischemic heart disease) is a pathological condition, the characteristic feature of which is the inadequacy of the myocardial demand for oxygen and its delivery. This situation can occur when the lumen of the coronary vessels narrows by atherosclerotic plaques (which is the most common cause of coronary artery disease) or due to spasm of the coronary arteries (occurs less often).

There are modifiable and unmodifiable risk factors for the development of coronary artery disease. The first includes life circumstances that can be changed. With unmodifiable factors, a person is born and remains for the whole life, they cannot be influenced or changed.

Modifiable factors include:

• increased blood cholesterol levels (hypercholesterolemia);
• an increase in blood pressure (arterial hypertension);
• diabetes;
• smoking;
• low physical activity and obesity.

Non-modifiable risk factors for coronary artery disease are:

• male gender;
• age;
• burden of family history of cardiovascular disease.

The concept of coronary heart disease combines a number of pathologies. These include:

1. 1. Angina pectoris.
2. 2. Myocardial infarction.
3. 3. Sudden cardiac death.
4. 4. Small focal cardiosclerosis.
5. 5. Large focal cardiosclerosis.
6. 6. Chronic aneurysm of the heart.

IHD is characterized by high mortality and a number of dangerous complications. The relevance of its prevention is undeniable.

Heart rheumatism: causes, treatment and prevention

Ischemic heart disease (ischemic heart disease) is a pathological condition, the characteristic feature of which is the inadequacy of the myocardial demand for oxygen and its delivery. This situation can occur when the lumen of the coronary vessels is narrowed by atherosclerotic plaques (which is the most common cause of coronary heart disease) or as a result of spasm of the coronary arteries (occurs less often).

3 Quitting smoking

One of the most important prevention goals is smoking cessation. Even a simple advice from the attending physician, conversation helps the patient to stop using cigarettes. If necessary, close family and friends of the patient can be involved to provide support for quitting cigarettes.

In severe cases, when a person cannot cope with the addiction on his own, nicotine replacement therapy can be applied.

One of the most important prevention goals is smoking cessation. Even a simple advice from the attending physician, conversation helps the patient to stop using cigarettes. If necessary, close family and friends of the patient may be involved to provide support in quitting cigarettes.

Myocarditis of the heart: signs of disease, treatment and prevention

The basics of a healthy diet for coronary heart disease prevention

Diet changes should be aimed at getting rid of excess body weight and the concentration of total blood plasma cholesterol.

Basic rules of preventive nutrition:

• consume no more than 2000 kcal per day;
• the presence of cholesterol in food should not be higher than 300 mg per day;
• fats can provide no more than 30% of the energy value of food.

Strict adherence to the prescribed diet can reduce total blood cholesterol by 10-15%. To reduce the content of triglycerides in the blood, the introduction of more fatty fish or omega-3 polyunsaturated fatty acids in the form of food additives in a dose of 1 g per day is suitable. Alcohol is limited to moderate doses - 50 ml of ethyl alcohol per day. In the presence of heart failure, arterial hypertension and diabetes mellitus, abstinence from alcohol is mandatory.

There is a link between obesity and overweight with a high risk of death in patients with cardiovascular disease. Bringing body weight to normal in patients with coronary artery disease along with obesity and overweight leads to a decrease in blood pressure, correction of lipids and blood glucose levels. It is initially recommended to follow a diet that has the following characteristics:

• a decrease in consumption, and sometimes a complete rejection of easily digestible carbohydrates and sugar (due to carbohydrates, 50-60% of calories per day should be covered, for this, vegetables and fruits are more suitable, not counting potatoes and fruits containing a lot of glucose - bananas, apricots , sweet plums, pears, melons, raisins and grapes);

Diet therapy is carried out under the supervision of a physician who takes into account medical indications and contraindications. The patient's weight loss rate should be no more than 0.5-1 kg per week. Drug therapy for obesity is used with a body mass index of at least 30 and if there is no effect from the diet, then pharmacotherapy is carried out in specialized hospitals.

The greatest difficulty in correcting excess body weight is the preservation of the achieved result. Therefore, it is important to achieve high motivation in striving to maintain weight at a normal level throughout life after achieving a positive result. In every weight loss program, physical activity remains the most important aspect.

Strict adherence to the prescribed diet can reduce total blood cholesterol by 10-15%. To reduce the content of triglycerides in the blood, the introduction of more fatty fish or omega-3 polyunsaturated fatty acids in the form of food additives in a dose of 1 g per day is suitable. Alcohol is limited to moderate doses - 50 ml of ethyl alcohol per day. In the presence of heart failure, arterial hypertension and diabetes mellitus, abstinence from alcohol is mandatory.

• correspondence of consumed food and consumed energy during the day;
• adherence to the fat intake limit;
• self-limitation in the use of alcoholic beverages (alcohol is a high-calorie product and reflexively increases appetite);
• a decrease in consumption, and sometimes a complete rejection of easily digestible carbohydrates and sugar (due to carbohydrates, 50-60% of calories per day should be covered, for this, vegetables and fruits are more suitable, not counting potatoes and fruits containing a lot of glucose - bananas, apricots , sweet plums, pears, melons, raisins and grapes);
• restriction in the use of sweets, sugary drinks, hot seasonings and spices.

General rules of eating behavior include food 4-5 times a day: in addition to the three main meals, 2 additional meals are introduced. It is imperative to have breakfast, there should be no more than ten hours between dinner and breakfast. The last time you need to eat no later than two hours before falling asleep. There should be no more than 3-4 hours between meals.

Other measures to normalize eating habits include:

• lack of fluid intake during meals. Water can and should be drunk half an hour before meals and 30 minutes after meals
• food can be eaten not very cold and not very hot, warm
• do not eat if you have no appetite (excluding scheduled meals), do not eat with family members or friends, chew popcorn in the cinema, etc.
• tracking the calorie content of an additional portion during snacks. It should be less than 10 kcal
• do not automatically salt food without tasting it
• avoiding fast food, you need to eat for a minimum of 15-20 minutes, thoroughly chewing what is eaten
• refusal to visit fast foods, in the assortment of which most dishes contain fats, and far from the first roast
• not buying food home when you are hungry
• when buying food, pay attention to the information on the label about the content of fats, carbohydrates, dietary fiber
• do not eat processed foods, which may contain not only unknown fats, but also harmful additives
• try to avoid salting fresh vegetables, eggs, vegetable salads, boiled potatoes
• refusal to use crackers, chips, all kinds of snacks, even salted peanuts
• restriction in the diet of canned meat and fish, because they contain a lot of salt
• gradually reduce the amount of salt in the diet
• cook so that there is a minimum amount of fat in the dishes. The following methods of processing food are preferred: baking, simmering, boiling, cooking in the microwave, grilling

Breakfast should account for about 25% of the calories eaten per day, for second breakfast 15%, for lunch about 35%, for afternoon tea only 10%, for dinner about 15%. This is due to certain physiological rhythms of the secretion of hormones and enzymes, levels of physical activity during the day and night. Calories received in the late evening and night hours are not completely processed by the body.

Calorie calculation of the daily diet

When compiling a diet, it is necessary to maintain a balance of energy with food and daily physical activity to maintain and maintain normal body weight (body mass index in the range of 18.5-24.9 kg / m2). To reduce body weight, the daily calorie requirement should be reduced, but not dramatically.

The opinion of all experts on alcohol is unanimous: drinking it is not recommended if you want to eat healthy. In the case of its use, it is desirable to reduce the amount in terms of absolute alcohol to 30 g / day for men and 20 g for women. The choice should be stopped on dry red wines.

The hypercaloric type of nutrition is said if a person's body weight has increased in 3 months. This means that more calories were taken from food than consumed. Therefore, even if the diet is balanced in terms of nutrient composition, their number should be reduced due to high-calorie foods and dishes. In order for body weight to begin to decrease with overweight and obesity, it is necessary to subtract 300-500 kcal from the number of daily calories calculated according to the formula, adhere to such a daily caloric intake for a long time, but in no case resort to fasting or mono-diets. During fasting days, the daily calorie content should be at least 900-1000 kcal in 24 hours, and not zero, as many are mistaken!

The WHO CINDI program for the integrated prevention of noncommunicable diseases formulates 12 principles of healthy eating. These include eating foods that are plant-based. Food of animal origin is acceptable, but in smaller quantities. Several times a day you need to eat grain products, healthy bread (for example, whole grains), rice.

Also, according to the above recommendations, you need to control the consumption of fats, it is better to replace saturated fats with unsaturated vegetable oils. Instead of fatty meats (for example, pork), you can eat beans, beans, lentils, fish, chicken. With regard to dairy products, the WHO CINDI Program for the Integral Prevention of Noncommunicable Diseases says to choose foods that are low in fat and salt.

Preference is given to products with a minimum amount of sugar; refined sugar should be avoided, while minimizing sugary drinks, cakes and other sweets. Choose foods that are low in salt. Your total salt intake should be no more than one teaspoon (6 g) per day, including salt found in bread and processed, dried, smoked, or canned foods. The best way to cook food is steam, you can use a microwave oven. Children need to be taught to eat right from an early age.

In primary and secondary prevention of ischemic heart disease, the antiatherogenic nature of nutrition is considered a priority. Every day you need to include the following foods in your diet:

• sea \u200b\u200bfish
• 1-2 tbsp. tablespoons of vegetable oils
• legumes
• more than 400 g per day of vegetables, herbs and fruits
• soybeans and products from it
• plant foods high in fiber, with pectin

Eating 40-50 g of sea fish at least 3-4 times a week reduces the risk of thrombosis, myocardial infarction and stroke. Water-soluble dietary fiber reduces the absorption of cholesterol in the intestine.

5 Physical activity

Comparison of the maximum heart rate calculated during exercise tests and during daily activities is beneficial. Patients who have had myocardial infarction and are recovering physical activity, especially need information on the dosage of physical activity. Specialized physical rehabilitation is safe and significantly improves the quality of life.

With angina pectoris, it is recommended to take nitroglycerin out of turn before the expected load. This often helps to avoid a pain attack.

Exercise has a positive effect on carbohydrate and lipid metabolism, therefore, dosed physical activity is especially necessary for persons with overweight, obesity and diabetes mellitus.

All patients who have been diagnosed with coronary heart disease, after consultation with their doctor, can walk daily at an average pace for 30-40 minutes.

Causes

The causes of cardiac ischemia are also divided into two types, these are causes that can be eliminated and which cannot.

Removable causes include:

• improper nutrition. Getting rid of bad eating habits, such as overeating, eating a lot of fat, fried and salty foods, and so on, can save you from developing a pathological condition;
• endocrine diseases, especially diabetes mellitus (insufficient or complete absence of insulin in the body);
• regular increase in blood pressure;
• stress;
• tobacco smoking.

Fatal reasons include:

• age. The older the person, the more likely it is to develop coronary heart disease;
• gender, often pathology is diagnosed in males;
• genetic predisposition.

If you are engaged in the prevention of removable causes, adhere to all medical recommendations, then you can reduce the risk of ischemia to a minimum.

All causes are eliminated to save life.

Diet

The diet takes a leading place in the prevention and control of ischemic heart disease. It aims to optimize the supply of nutrients that have a positive effect on overall metabolism. The intake of simple carbohydrates, animal fats, table salt is rationally excluded. With excess body weight, the calorie intake of the diet decreases.

Specialists regarding the daily diet give the following recommendations:

1. It is necessary to limit as much as possible (but it is not recommended to exclude) the consumption of animal fats (lard, fatty meat, butter).
2. Try not to eat food that has been cooked by frying.
3. Limit the use of confectionery.
4. Increase the content of minimally processed cereals in the diet (does not apply to people with gluten intolerance (celiac disease)).
5. Provide the bulk of the diet to fruits, vegetables and other fresh plant foods.
6. The presence of omega-3 fatty acids (sea fish, fish oil) is required. It is recommended to eat sea fish or other seafood three times a week.

So, eating a hot dog, pizza, and two plates of salted borsch a day, a person consumes about 15 g of salt. Recently, the World Health Organization (WHO) adopted a norm of up to 5 g of salt per day, recognizing that in modern society it is impossible to consume less. Think about whether it is always worth adding salt to food?

CHD risk factors

Potential risk factors for coronary heart disease fall into two groups: those that can be modified and those that are not. The second group includes the following:

• age
• family history of the disease

Dyslipidemia is modifiable. These are abnormalities in the blood lipid profile. This group also includes low physical activity, smoking cigarettes and cigars, arterial hypertension, overweight and obesity, a disease such as diabetes.

As for age: the older a person, the more pronounced atherosclerotic changes in his body, which leads to a high incidence of ischemic heart disease. Up to 55 years of age, the incidence of coronary artery disease in men is higher than in women. After 55 years, almost equal number of men and women with this diagnosis.

Family history. The risk of developing coronary heart disease is higher in those with relatives who have the same diagnosis. Especially if the degree of kinship is first: brothers and sisters, mom and dad, sons and daughters. The risk of diagnosing coronary artery disease is high if relatives develop this disease at a relatively young age.

Smoking speeds up the heartbeat, increases the activity of the sympathoadrenal system. Because of it, local vasospasms occur, the likelihood of arrhythmias increases, etc. In smokers with experience, atherosclerosis of the coronary arteries is strongly pronounced, especially in comparison with nonsmokers.

High blood pressure significantly increases the risk of coronary artery disease. Another worrying factor is high pulse pressure in older people.

Low physical activity leads to abnormalities in metabolism. Body weight increases, abdominal obesity occurs, which is reflected in an increase in blood pressure. It should be noted that life expectancy is generally longer in physically active people. And obese individuals have a high chance of getting any kind of heart disease.

The risk of cardiovascular disease increases by 10% with an increase in body weight by 5-10%. Obesity increases the relative risk of type 2 diabetes by 2 to 8 times.

Metabolic syndrome and diabetes mellitus

With the so-called metabolic syndrome, the amount of visceral fat increases, hyperinsulinemia develops, fat and carbohydrate metabolism is disturbed, etc. Metabolic syndrome is a risk factor for the development of coronary artery disease, stroke, and myocardial infarction. The sensitivity of tissues to insulin is influenced by factors such as unhealthy food, old age, extra pounds, smoking, drinking alcohol, fasting, mono diets, etc. Early detection of metabolic syndrome is essential.

Unhealthy type of food

An increased risk of coronary artery disease arises if a person eats foods that are high in saturated fat, simple sugars, while eating foods with a high glycemic index. The Eskimos of Greenland, according to research, rarely get heart disease due to their diet. Eskimos consume a small amount of salt (compared to the inhabitants of Europe and the CIS countries), feed mainly on fish and meat of sea animals. For them, arterial hypertension and obesity are atypical.

In the CIS countries, the calorie content of the diet of many people exceeds the norm, they consume a lot of sweets. A deficiency in the diet of vegetables also affects atherogenesis. This must be taken into account when drawing up measures for the prevention of coronary heart disease.

According to research, this includes an increased content of lipoprotein, C-reactive protein, homocysteine. With a deficiency of estrogen in women, atherosclerosis and coronary heart disease occur. Before menopause, they have higher levels of HDL cholesterol in their blood than men of a similar age. During the postmenopausal period, the protective effect of estrogen decreases, which increases the risk of coronary heart disease.

Assessment of risk factors involves recording and measuring their levels. Early detection of arterial hypertension is important. Even asymptomatic hypertension is dangerous to humans. The fact of smoking is recorded when at least one cigarette is smoked per day. Only those who have not smoked a single cigarette in a year are considered non-smokers.

This criterion is adopted by the WHO. Why exactly a year later? Since the risk of developing CVD is statistically significantly reduced only 12 months after the complete cessation of smoking. The degree to which cigarettes affect the body depends on how much a person smokes a day. The degree of tobacco dependence is determined by the Fagerstrom test.

Assessment of physical activity. The doctor, with the help of a conversation, clarifies the patient's attitude to physical activity, both in everyday life and as physical education or sports. According to standards, for example the European guidelines for the prevention of CVD, which were adopted in 2008, physical activity should be at least 30-40 minutes every day, at least 4 times a week.

Overweight assessment. To assess body weight, doctors are guided by body mass index - the ratio of body weight (kg) to height (m2). An index in the range of 18.5-24.9 is considered the norm. Excess body weight is recorded at 25-30, and obesity at 30 or more. Visceral obesity is also assessed: it is recorded with a waist circumference of more than 102 cm in men and more than 88 cm in women.

Assessment of actual nutrition. Nutrition is assessed in different ways. The 24-hour method makes it possible to assess the patient's nutrition over the past day. All food eaten is coded in arbitrary units. With the help of tables and programs, information is obtained on the daily intake of energy, proteins, fats, carbohydrates, dietary fiber, vitamins and minerals.

The frequency-based assessment method provides information about a person's nutrition for the last 3 months before the survey. Simpler methods include the calculation of the healthy eating pyramid and the rapid nutrition assessment method. For the latter, the standard questionnaire is used. The advantages of the method are that results can be obtained in a very short time.

Nutrition diary. When using this method, the person himself / herself daily records the number and names of foods and dishes eaten. The timing of meals is also indicated, and sometimes the reasons for the meal. After the patient's nutrition has been assessed, it can be adjusted or a new daily diet prepared, taking into account the following factors:

• body mass index
• age
• food preferences.

Assessment of the total risk of coronary heart disease. With the help of special epidemiological studies over several years, it is possible to calculate how often or less often coronary heart disease occurs in a cohort of people with any risk factor, relative to a cohort of people without the analyzed risk factor. For example, smokers and non-smokers. This indicator is called relative risk.

To prioritize primary and secondary prevention of CHD, it is important to assess the overall risk. If several factors are combined, it can multiply significantly. Therefore, experts have created riskmeters, dividing patients into high-risk groups, medium and moderate.

In recent years, a new European model of risk metrics has been proposed, developed according to the 5SOKE project. This model is used to calculate the probability of fatal cardiovascular events in the next 10 years in people without coronary artery disease. This risk-metric model is recommended by the VNOK. Parameters that are taken into account when calculating the risk:

• age
• smoking
• blood level of cholesterol
• systolic blood pressure

Risk factors are predisposing causes that increase the likelihood of a disease developing or worsening. Risk factors for coronary heart disease are classified into two groups. One of them includes inevitable causes that cannot be eliminated. Fatal factors of coronary heart disease include:

• age, people over 40 are more susceptible to heart disease;
• gender, the risk group includes mainly men;
• heredity, the disease in most cases is inherited.

The second group includes factors that can be regulated:

• smoking;
• excess of the norm of cholesterol in the blood;
• excessive alcohol consumption;
• obesity;
• sedentary lifestyle;
• high blood pressure.

To reduce the risk of developing the disease, it is necessary, if possible, to reduce or completely eliminate the factors that make up the second group. This will significantly reduce the possibility of developing ischemia.

IHD risk factors are divided into two groups: those that can be changed, and those that are not. The second group includes gender, age, family history of this disease.

1. The older a person becomes, the brighter the manifestation of atherosclerotic changes, which leads to an increased incidence of ischemic heart disease. Until the age of 55, men are more likely to suffer from this pathology. After this age, the number of men and women who become ill with it becomes equal.
2. The risk of coronary artery disease in those whose relatives had a similar diagnosis is much higher. This is especially true of the first degree of relationship: parents - children. The risk is increased if the disease occurs in relatives at a young age.

The first group of factors contributing to the development of coronary artery disease include changes in the lipid profile of the blood, low physical activity, smoking, arterial hypertension, diabetes mellitus, and overweight.

• Smoking speeds up the heartbeat, activates the sympathoadrenal system. It causes the occurrence of local vasospasms, increases the likelihood of arrhythmias, etc. Smokers with experience are faced with atherosclerosis of the coronary arteries.
• High blood pressure significantly increases the risk of developing the disease. A factor that is important to pay attention to is the increased pulse pressure in the elderly.
• Abnormalities in metabolism are caused by insufficient physical activity. Weight increases, abdominal obesity appears, which causes an increase in blood pressure. It is important to note that life expectancy is longer for people who are active. Cardiac pathologies "love" obese people. A 5-10% increase in body weight increases the risk of cardiovascular disease by 10%. Obesity increases the risk of developing type 2 diabetes mellitus up to 8 times.
• The risk of developing coronary artery disease is associated with the consumption of food that is saturated with fats, sugars, with a preference for foods with a high glycemic index.
• Unconventional factors include excessive levels of lipoprotein, homocysteine, and C-reactive protein. Atherosclerosis and coronary artery disease occur in women in case of estrogen deficiency.

Diagnostics

Diagnostics consists of a number of laboratory and instrumental examination methods

Diagnosis of ischemic heart disease is carried out using special instrumental techniques. When talking with the patient, complaints and the presence of symptoms characteristic of such a disease are revealed. The analysis of the life history involves the identification of risk factors for the development of coronary artery disease, and the presence of such a heart disease in one of the relatives is also found out.

During a physical examination, wheezing and heart murmurs are detected in the lungs, blood pressure is measured, and signs of hypertrophy are diagnosed.

To identify cardiac ischemia, the following diagnostic tests are prescribed:

• a complete blood count helps to identify signs of an inflammatory process in the human body
• a general urine test allows you to diagnose an increased concentration of protein, erythrocytes, leukocytes and identify pathologies that may be a complication of heart ischemia
• analysis of specific enzymes is carried out for acute coronary syndrome and suspected myocardial infarction

What other diagnostic methods can identify the disease:

1. coagulogram
2. echocardiography
3. electrocardiography
4. chest x-ray
5. stress - echocardiography
6. coronary angiography

Doppler ultrasound of peripheral vessels makes it possible to diagnose atherosclerotic changes in the vessels of the lower extremities, neck, kidneys and head. With pronounced changes in such vessels, one can suspect the same transformations in the cardiac vessels.

Stressful situations

Stress is one of the strongest factors today that become the causes of disease. Stress ulcers, diabetes mellitus, arterial hypertension and other illnesses are caused by a simple daily reaction to irritating or oppressive circumstances.

First of all, you need to learn to control your emotions and reactions to the environment, even if it does not live up to expectations. It is appropriate to mention the types of temperament - choleric people will have the hardest time, but, in the end, the person decides for himself: to be nervous or to explain the situation to himself in a different way.

Stressful situations need to be taken under control. They are always there, but it is important to react to them to learn correctly. Do not allow stress to take over, otherwise the chances of getting sick become very high.

In any situation, you need to look for something good, positive. Even if you get sick - start to recover, at the same time, read books in parallel, develop, spend time with benefit.

Especially susceptible to it are people who perform work with increased responsibility (medical workers, operators of the railway and aviation transport spheres), residents of megalopolises and large cities.

If the causative factors continue to act, a disease will form - chronic fatigue syndrome - damage to the regulatory zones of the central nervous system, depletion of nerve mediators, which is manifested by a disorder of mental behavior (depression, apathy, neurosis, aggression, etc.).

To protect yourself and your loved ones, familiarize yourself with the causes of coronary artery disease.

In this state, the body is most susceptible to stress, and the harm from it is great, since the body's resistance is reduced. It is necessary to get rid of this disease-causing background.

When a person does not plan anything, he often faces such problems:

• unforeseen situations that require a rush to make decisions that require unreasonably large efforts;
• at the last moment you have to finish something with emotional stress;
• constant tension in trying to keep everything in the head;
• being late for meetings, late at work;
• criticism from colleagues, friends, relatives.

All this entails regular experiences that turn into chronic stress.

It's important to be able to make a plan for anything. It can be of different duration (for a year, month, week, etc.), but it should always have priority. Well-defined priorities are the key to confident performance.

Keep your posture

Posture means a lot more than people are used to thinking. Poor posture leads to a change in blood flow in the vertebral arteries and blood vessels of the brain, overstrain of certain muscle groups.

This depletes the flow of oxygen, which provokes a bad mood, inattention, forgetfulness, headaches. After all, it turns out a vicious circle!

In addition to other situations where a person does not monitor his posture, people slouch and due to negative emotions. The worse a person's mood, the less he thinks about posture - he becomes even more hunched over and drooping.

You need to straighten your head, shoulders and keep your posture in any mood. You should understand how serious the consequences can be and control your posture.

Gymnastics

Regular dosed physical activity has many positive effects on the human body:

• reduction in excess body weight;
• normalization of insulin sensitivity;
• normalization of lipid metabolism;
• reduction of psychological and physical stress, adaptation to stress;
• normalization of vascular tone and blood pressure.

1. Take three deep breaths.
2. Rub the ears vigorously (horizontally, then vertically).
3. Make an expression of grin, several times intensively make chewing movements of large amplitude, without banging your teeth against each other.
4. Rub the cheeks and wings of the nose.
5. Massage the back of the head, run your hands several times along the eyebrows outward.
6. Massage your face with both palms.
7. Put the palms together, raise them to the height of the face, with the fingers of one hand grasp the tips of the fingers of the other, then vice versa.
8. Fold your palms at chest level, spread your fingers, press the palms and fingers of opposite hands towards each other, while springing with your fingers.
9. Raise your hands at face level, palms towards you, bending fingers alternately, starting with the thumb of the right hand, unbend in the opposite order.
10. Massage each finger separately.

Other exercise programs should take into account the person's age and the presence of comorbidities.

The desire for revenge creates chronic stress. When they say that the person we hate has power over us, they say correctly. He owns our thoughts, we think about him.

You need to take this calmly, you should not take revenge - nothing good usually comes of it. You need to understand that there is an opportunity to see a person in a certain situation, and he showed himself. It's good that in this situation, and not when a lot depended on him.

You need to be able to forgive, and everyone will receive what they deserve. If you cannot forgive your enemies, love yourself at least. Everyone is responsible for his life, and so is the one who spends it on hatred.

Religion also speaks about it. People are so arranged that they very quickly forget all the good things, and one offense can block all the positive that a person has done.

This is what affects health most of all, or rather, first on its mental component, and then on its physical one. Each person lives his own life, and if it is not limited, then full.

Everyone can help himself, and everything depends on himself. "There is nothing worse than good that was not asked for" - an expression that, unfortunately, is often true.

Good is a voluntary act. If so, then the person experiences joy that should be enjoyed. This is gratitude, and the rest is related attributes.

A person spends about 20 years of his life in a dream. Everyone needs their own sleep duration. When a person develops insomnia, they become anxious, suppressing sleep even more.

If this is a psychological reason, for example, debts, taxes, you need to pay them back as soon as possible. When the body calms down, sleep will appear. Experts recommend going to bed before you get tired and getting up in the morning, and not, for example, at lunchtime.

The question of material status is not inferior to the previous ones in terms of its role in the formation of chronic psychological exhaustion and a decrease in stress resistance.

You should be smart about spending on pleasure. Everyone wants to relax, get more from life, but debts, including loans, do not make anyone happier. You need to learn to treat money with care and responsibility and teach this to your children.

Under the lying stone ... you know. Look for a wide variety of options for earning and part-time work. This is good even if you do not earn very much at first - there will be less time for worries.

In the end, if even with all the efforts made it is not possible to improve the material condition, it is better to take pity on your health and stop worrying and poisoning yourself from the inside. You need to be on the lookout, but there will be an option - just do not miss it.

Doctors believe that alcohol and coronary heart disease should not be combined. Therefore, consider taking at least a portion of alcohol several times if you have been diagnosed with this.

Overweight and high blood pressure are often the cause of coronary artery disease. Dangerous habits become enemies for the heart: alcohol in large quantities and nicotine addiction. If a person often experiences stress, nervous shocks, falls into depression, then the heart suffers.

Causes of heart disease

The factors influencing the onset of coronary artery disease are divided into two categories. The first includes those with which it is impossible to fight:

• Age, because people over 45 years old are susceptible to heart disease.
• Gender, men are at risk.
• Hereditary predisposition - the disease is often transmitted genetically.

• Smoking habit.
• High cholesterol.
• Body weight is much higher than normal.
• Frequent drinking.
• High pressure.
• Low physical activity.

To prevent ischemia, factors that belong to the second category should be reduced, and ideally completely removed. This will significantly reduce the risk of heart ischemia and heart failure.

Unrecoverable

This group of causes includes those that cannot be eliminated from a person's life, but you can only reduce their harmful effects.

1. Age. As a person ages, the functions of blood vessels are disrupted, blood supply to tissues deteriorates. Additionally, atherosclerotic plaques or blood clots can form in the vessels.
2. Floor. It is noted that myocardial ischemia in men develops more often than in women.
3. Heredity. If close relatives suffer from coronary artery disease, then the risk of developing the disease increases significantly.

But this does not mean that the disease will necessarily appear. Proper nutrition, moderate physical activity and rejection of bad habits will minimize the risk of coronary artery disease.

Principles of IHD Prevention

Prevention of coronary artery disease consists of a set of specific measures, the purpose of which is to prevent the disease, its progression, the development of dangerous complications, including cardiac arrest.

Prevention methods

Prevention of heart failure is indicated for both sick and healthy elderly people and those who are at risk. The likelihood of developing the disease is increased in those people who have at least one unavoidable factor and two modifiable causes from the listed ones. If there are more than three reasons from both categories, then the risk of ischemia increases several times.

Prevention of ischemic heart disease is primary or secondary. With the primary, all measures are aimed at preventing the occurrence of ischemia. And secondary prevention is designed to prevent an exacerbation of the disease.

Unrecoverable

Very often, the appearance of ischemic heart disease is provoked by the patient himself and by bad habits.

1. Smoking and alcohol. These bad habits provoke vasospasm and impair blood circulation.
2. Poor nutrition. An excess of animal fats in the diet and a lack of vegetables and fish provoke a violation of vascular patency.
3. Complication of diseases. Untimely treatment of diabetes mellitus, arterial hypertension and some other diseases leads to a deterioration in blood flow and the appearance of ischemia in tissues.
4. Physical inactivity. A sedentary lifestyle is often the cause of congestion and poor circulation.
5. Obesity. Excess weight puts additional stress on blood vessels and the heart, making it difficult for them to function normally.
6. Frequent stress. Stressful situations increase vascular tone and increase heart rate. If this condition occurs often, then there is a risk of insufficient tissue nutrition, in the first place, vital organs - the brain and heart - suffer.

To improve coronary blood flow and prevent complications, patients with a preventive purpose, depending on the severity of the disease, can be prescribed:

1. Nitroglycerin preparations. Nitrosprays and Nitroglycerin tablets are recommended for the patient to take in case of chest pain caused by an attack of angina pectoris. The medication has a relaxing effect on the vascular wall, improves blood flow and slightly reduces blood pressure.
2. Aspirin. Regular intake of small doses of acetylsalicylic acid has a blood-thinning effect. Aspirin is prescribed to all patients to prevent blood clots. A contraindication for taking acetylsalicylic acid will only be a tendency to bleeding.
3. Beta-blockers are used when a person is prone to developing tachycardia. But all beta-blockers have a hypotensive effect and must be taken with caution at normal or low blood pressure.
4. ACE (angiotensin converting enzyme) inhibitors. A group of medications prescribed for heart failure and arterial hypertension. They help to normalize the volume of cardiac output and eliminate vascular spasms.
5. Cholesterol-lowering agents. Drugs that help eliminate atherosclerotic plaques and lower cholesterol are used for high cholesterol levels.
6. Sugar-lowering medicines. Tablets or insulin injections can be used to correct glucose levels in diabetes mellitus. The dose and drug are selected by the endocrinologist individually, after examining the patient.

But medications for prevention are used only when there is a risk of complications or an attack of angina pectoris, the main method of treatment and prevention is the elimination of provoking factors.

It is recommended to start preventive measures for the development of coronary heart disease as early as possible: even a child by their example, parents can instill a habit of a healthy lifestyle and rejection of bad habits. It should be noted that it is better to prevent the occurrence of ischemia of the heart muscle than to treat the disease for a long time.

Coronary artery disease is a disease that is a violation of the blood circulation of the myocardium. It is caused by a lack of oxygen, which is carried through the coronary arteries. Manifestations of atherosclerosis prevent its entry: narrowing of the lumens of blood vessels and the formation of plaques in them. In addition to hypoxia, that is, a lack of oxygen, tissues are deprived of some of the beneficial nutrients necessary for the normal functioning of the heart.

IHD is one of the most common diseases that causes sudden death. It is much less common among women than among men. This is due to the presence in the body of the fairer sex of a number of hormones that prevent the development of vascular atherosclerosis. With the onset of menopause, the hormonal background changes, so the possibility of developing coronary artery disease increases dramatically.

What it is?

Coronary artery disease is a lack of blood supply to the myocardium (heart muscle).

The disease is very dangerous - for example, with acute development of ischemic heart disease immediately leads to myocardial infarction, which is the cause of death in middle-aged and elderly people.

Causes and risk factors

The overwhelming majority (97-98%) of clinical cases of coronary artery disease is caused by atherosclerosis of the coronary arteries of varying severity: from a slight narrowing of the lumen by an atherosclerotic plaque to complete vascular occlusion. With 75% coronary stenosis, heart muscle cells respond to lack of oxygen, and patients develop exertional angina.

Other causes of coronary artery disease are thromboembolism or spasm of the coronary arteries, usually developing against the background of an already existing atherosclerotic lesion. Cardiospasm aggravates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.

The factors contributing to the onset of ischemic heart disease include:

1. Hyperlipidemia - contributes to the development of atherosclerosis and increases the risk of coronary heart disease by 2-5 times. The most dangerous in terms of the risk of ischemic heart disease are hyperlipidemias of types IIa, IIb, III, IV, as well as a decrease in the content of alpha-lipoproteins.
2. Arterial hypertension - increases the likelihood of developing coronary artery disease by 2-6 times. In patients with systolic blood pressure \u003d 180 mm Hg. Art. and higher ischemic heart disease occurs up to 8 times more often than in hypotensive patients and people with normal blood pressure.
3. Smoking - according to various sources, smoking cigarettes increases the incidence of coronary artery disease by 1.5-6 times. Mortality from ischemic heart disease among men 35-64 years old who smoke 20-30 cigarettes daily is 2 times higher than among nonsmokers of the same age group.
4. Physical inactivity and obesity - physically inactive people run the risk of developing coronary artery disease 3 times more than people leading an active lifestyle. When hypodynamia is combined with overweight, this risk increases significantly.
5. Diabetes mellitus, incl. latent form, increases the risk of ischemic heart disease 2-4 times.

The factors that pose a threat to the development of ischemic heart disease should also include burdened heredity, male gender and elderly patients. With a combination of several predisposing factors, the degree of risk in the development of coronary heart disease increases significantly. The causes and speed of ischemia development, its duration and severity, the initial state of the cardiovascular system of an individual determine the occurrence of one or another form of coronary heart disease.

CHD signs

The disease in question can proceed quite secretly, therefore, it is recommended to pay attention to even minor changes in the work of the heart. Alarming symptoms are:

• intermittent feeling of lack of air;
• feeling anxious for no apparent reason;
• general weakness;
• recurrent chest pain, which can radiate (radiate) to the arm, shoulder blade or neck;
• feeling of tightness in the chest;
• a burning or heavy feeling in the chest;
• nausea and vomiting of unexplained etiology.

Ischemic heart disease symptoms

IHD is the most extensive pathology of the heart and has many of its forms.

1. Angina pectoris. The patient develops pain or discomfort behind the sternum, in the left side of the chest, heaviness and a feeling of pressure in the region of the heart - as if something heavy was put on the chest. In the old days they said that a person had "angina pectoris". The pain can be of different nature: pressing, squeezing, stabbing. It can give (irradiate) to the left hand, under the left shoulder blade, lower jaw, stomach area and be accompanied by the appearance of severe weakness, cold sweat, and a feeling of fear of death. Sometimes during exercise there is not pain, but a feeling of lack of air, passing at rest. The duration of an angina attack is usually several minutes. Since pain in the region of the heart often occurs when moving, the person is forced to stop. In this regard, angina is figuratively called "the disease of the window viewers" - after a few minutes of rest, the pain usually goes away.
2. Myocardial infarction. A formidable and often disabling form of coronary artery disease. With myocardial infarction, there is a strong, often tearing pain in the region of the heart or behind the sternum, radiating to the left shoulder blade, arm, and lower jaw. The pain lasts more than 30 minutes, when taking nitroglycerin it does not completely go away and only decreases for a short time. There is a feeling of lack of air, cold sweat, severe weakness, a decrease in blood pressure, nausea, vomiting, and a feeling of fear may appear. Taking nitro drugs does not help. The area of \u200b\u200bthe heart muscle, deprived of nutrition, dies, loses strength, elasticity and the ability to contract. And the healthy part of the heart continues to work with maximum tension and, contracting, can rupture the dead area. It is no coincidence that in common parlance, a heart attack is called a heart attack! As soon as a person makes even the slightest physical effort in this state, he is on the verge of death. Thus, the point of treatment is to heal the rupture site and allow the heart to continue working normally. This is achieved both with the help of medication and with the help of specially selected physical exercises.
3. Sudden cardiac death or coronary death is the most severe of all forms of coronary artery disease. It is characterized by high lethality. Death occurs almost instantly or within the next 6 hours from the onset of an attack of severe chest pain, but usually within an hour. The causes of such a cardiac catastrophe are various kinds of arrhythmias, complete blockage of the coronary arteries, and pronounced electrical instability of the myocardium. Alcohol intake is a provoking factor. As a rule, patients are not even aware of the presence of coronary artery disease, but they have many risk factors.
4. Heart failure. Heart failure is manifested by the inability of the heart to provide a sufficient supply of blood to the organs by reducing the contractile activity. The heart failure is based on the violation of the contractile function of the myocardium, both due to its death in a heart attack, and in violation of the rhythm and conduction of the heart. In any case, the heart contracts inadequately and its function is unsatisfactory. Heart failure manifests itself as shortness of breath, weakness during exertion and at rest, edema of the legs, enlarged liver and swelling of the cervical veins. The doctor may hear wheezing in the lungs.
5. Heart rhythm and conduction disorders. Another form of ischemic heart disease. It has a large number of different types. They are based on a violation of the conduction of the impulse through the conducting system of the heart. It is manifested by sensations of interruptions in the work of the heart, a feeling of "fading", "bubbling" in the chest. Violations of heart rhythm and conduction can occur under the influence of endocrine, metabolic disorders, with intoxication and drug effects. In some cases, arrhythmias can occur with structural changes in the conducting system of the heart and myocardial diseases.

Diagnostics

First of all, the diagnosis of ischemic disease is carried out based on the patient's feelings. Most often they complain of burning and chest pain, shortness of breath, excessive sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, irregular heartbeat and rhythm. If ischemia is suspected, electrocardiography is mandatory.

Echocardiography is a research method that allows you to assess the state of the myocardium, to determine the contractile activity of the muscle and blood flow. Blood tests are done. Biochemical changes can detect coronary heart disease. Functional testing involves exercising the body, such as walking up stairs or exercising on a simulator. Thus, it is possible to identify pathologies of the heart in the early stages.

How is coronary artery disease treated?

First of all, the treatment of coronary heart disease depends on the clinical form. For example, although some general principles of treatment are used for angina pectoris and myocardial infarction, nevertheless, the tactics of treatment, the selection of the mode of activity and specific drugs can be radically different. However, there are some general directions that are important for all forms of coronary artery disease.

Drug treatment

There are a number of groups of drugs that can be indicated for use in one form or another of ischemic heart disease. In the USA, there is a formula for the treatment of coronary artery disease: "A-B-C". It involves the use of a triad of drugs, namely antiplatelet agents, β-blockers and cholesterol-lowering drugs.

1. β-blockers. Due to the action on β-arenoreceptors, adrenergic blockers reduce the heart rate and, as a consequence, the consumption of oxygen by the myocardium. Independent randomized studies confirm an increase in life expectancy with the use of β-blockers and a decrease in the frequency of cardiovascular events, including recurrent ones. It is currently impractical to use the drug atenolol, since it does not improve the prognosis according to randomized trials. β-blockers are contraindicated in case of concomitant pulmonary pathology, bronchial asthma, COPD. The following are the most popular β-blockers with proven prognosis-improving properties in coronary artery disease.
2. Antiplatelet agents. Antiplatelet agents prevent the aggregation of platelets and erythrocytes, reduce their ability to stick together and adhere to the vascular endothelium. Antiplatelet agents facilitate the deformation of erythrocytes when passing through the capillaries, improve blood flow.
3. Fibrates. They belong to a class of drugs that increase the antiatherogenic fraction of lipoproteins - HDL, with a decrease in which mortality from coronary heart disease increases. They are used to treat dyslipidemia IIa, IIb, III, IV, V. They differ from statins in that they mainly reduce triglycerides and can increase the HDL fraction. Statins predominantly lower LDL and have no significant effect on VLDL and HDL. Therefore, a combination of statins and fibrates is required for the most effective treatment of macrovascular complications.
4. Statins. Cholesterol-lowering drugs are used to reduce the rate of development of existing atherosclerotic plaques and prevent the emergence of new ones. Proven to have a positive effect on life expectancy, these drugs also reduce the frequency and severity of cardiovascular events. The target cholesterol level in patients with IHD should be lower than in those without IHD and equal to 4.5 mmol / L. The target LDL level in patients with coronary artery disease is 2.5 mmol / l.
5. Nitrates. The drugs in this group are derivatives of glycerol, triglycerides, diglycerides and monoglycerides. The mechanism of action is the influence of the nitro group (NO) on the contractile activity of vascular smooth muscles. Nitrates mainly act on the venous wall, reducing the preload on the myocardium (by dilating the vessels of the venous bed and depositing blood). A side effect of nitrates is lower blood pressure and headaches. It is not recommended to use nitrates at blood pressure below 100/60 mm Hg. Art. In addition, it is currently reliably known that taking nitrates does not improve the prognosis of patients with coronary artery disease, that is, does not lead to an increase in survival, and is currently used as a drug for relieving symptoms of angina pectoris. Intravenous drip of nitroglycerin allows you to effectively combat the symptoms of angina pectoris, mainly against the background of high blood pressure numbers.
6. Lipid-lowering drugs. The effectiveness of complex therapy of patients with coronary heart disease using policosanol (20 mg per day) and aspirin (125 mg per day) has been proven. As a result of therapy, a persistent decrease in LDL levels, a decrease in blood pressure, and weight normalization were noted.
7. Diuretics Diuretics are designed to reduce the load on the myocardium by reducing the volume of circulating blood due to the accelerated removal of fluid from the body.
8. Anticoagulants. Anticoagulants inhibit the appearance of fibrin filaments, they prevent the formation of blood clots, help stop the growth of blood clots that have already arisen, and enhance the effect on blood clots of endogenous enzymes that destroy fibrin.
9. Loop diuretics. They reduce the reabsorption of Na +, K +, Cl- in the thick ascending part of the Henle loop, thereby reducing the reabsorption (reabsorption) of water. They have a fairly pronounced rapid action, as a rule, they are used as emergency drugs (for the implementation of forced diuresis).
10. Antiarrhythmic drugs. Amiodarone belongs to the III group of antiarrhythmic drugs, has a complex antiarrhythmic effect. This drug acts on Na + and K + channels of cardiomyocytes, and also blocks α- and β-adrenergic receptors. Thus, amiodarone has antianginal and antiarrhythmic effects. According to the data of randomized clinical trials, the drug increases the life expectancy of patients who regularly take it. When taking tablet forms of amiodarone, the clinical effect is observed after about 2-3 days. The maximum effect is achieved after 8-12 weeks. This is due to the long half-life of the drug (2-3 months). In this regard, this drug is used for the prevention of arrhythmias and is not an emergency aid.
11. Angiotensin-converting enzyme inhibitors. Acting on the angiotensin-converting enzyme (ACE), this group of drugs blocks the formation of angiotensin II from angiotensin I, thus preventing the realization of the effects of angiotensin II, that is, leveling vasospasm. This ensures that the target blood pressure numbers are maintained. Drugs in this group have nephro- and cardioprotective effects.

Other treatments for ischemic heart disease

Other non-drug treatments:

1. Hirudotherapy. It is a method of treatment based on the use of the antiplatelet properties of leech saliva. This method is an alternative and has not been clinically tested for compliance with the requirements of evidence-based medicine. Currently, it is used relatively rarely in Russia, is not included in the standards of medical care for coronary artery disease, is used, as a rule, at the request of patients. The potential positive effects of this method are in the prevention of blood clots. It is worth noting that when treated according to approved standards, this task is performed using heparin prophylaxis.
2. Stem cell therapy. When stem cells are introduced into the body, it is calculated that pluripotent stem cells that have entered the patient's body will differentiate into missing myocardial cells or vascular adventitia. Stem cells actually have this ability, but they can turn into any other cell in the human body. Despite the numerous statements of supporters of this method of therapy, it is still far from practical application in medicine, and there are no clinical studies that meet the standards of evidence-based medicine, which would confirm the effectiveness of this technique. WHO notes this method as promising, but does not yet recommend it for practical use. In the overwhelming majority of countries of the world, this technique is experimental, and is not included in the standards of medical care for patients with coronary artery disease.
3. Shock wave therapy method. Exposure to low power shock waves leads to myocardial revascularization. An extracorporeal source of a focused acoustic wave allows a remote effect on the heart, causing "therapeutic angiogenesis" (vascular formation) in the zone of myocardial ischemia. The effect of SWT has a double effect - short-term and long-term. First, the vessels dilate and blood flow improves. But the most important thing starts later - new vessels appear in the affected area, which provide long-term improvement. Low-intensity shock waves cause shear stress in the vascular wall. This stimulates the release of vascular growth factors, triggering the growth of new vessels that feed the heart, improving myocardial microcirculation and reducing the symptoms of angina pectoris. Theoretically, the results of such treatment are a decrease in the functional class of angina pectoris, an increase in exercise tolerance, a decrease in the frequency of attacks and the need for drugs.
4. Quantum therapy. It is a therapy by exposure to laser radiation. The effectiveness of this method has not been proven, an independent clinical study has not been conducted. Equipment manufacturers claim that quantum therapy is effective for almost all patients. Drug manufacturers report studies that prove the low effectiveness of quantum therapy. In 2008, this method is not included in the standards of medical care for coronary artery disease, it is carried out mainly at the expense of patients. It is impossible to assert the effectiveness of this method without an independent open-label randomized trial.

Nutrition for ischemic heart disease

The menu of a patient with diagnosed coronary heart disease should be based on the principle of a balanced diet, balanced consumption of foods with a low content of cholesterol, fat and salt.

It is very important to include the following products in the menu:

• red caviar, but not in large quantities - a maximum of 100 grams per week;
• seafood;
• any vegetable salads with vegetable oil;
• lean meats - turkey, veal, rabbit;
• lean fish varieties - pike perch, cod, perch;
• fermented milk products - kefir, sour cream, cottage cheese, fermented baked milk with a low percentage of fat;
• any hard and soft cheeses, but only unsalted and mild;
• any fruits, berries and dishes from them;
• chicken egg yolks - no more than 4 pieces per week;
• quail eggs - no more than 5 pieces per week;
• any cereals except semolina and rice.

It is necessary to eliminate or significantly reduce the use of:

• meat and fish dishes, including broths and soups;
• pastry and confectionery;
• sahara;
• dishes from semolina and rice;
• animal by-products (brains, kidneys, etc.);
• spicy and salty snacks;
• chocolate;
• cocoa;
• coffee.

With diagnosed coronary heart disease, you need to eat fractionally - 5-7 times a day, but in small portions. If there is excess weight, then it is imperative to get rid of it - this is a heavy load on the kidneys, liver and heart.

Traditional methods of treatment of ischemic heart disease

For the treatment of the heart, traditional healers have made up a lot of different recipes:

1. 10 lemons and 5 heads of garlic are taken per liter of honey. Lemons and garlic are ground and mixed with honey. The composition is kept for a week in a dark cool place, after insisting, take four teaspoons once a day.
2. Hawthorn and motherwort (1 tablespoon each) are placed in a thermos and filled with boiling water (250 ml). After a couple of hours, the product is filtered. How is cardiac ischemia treated? It is necessary to drink 2 tbsp half an hour before breakfast, lunch and dinner. spoons of infusion. It is advisable to additionally brew a rosehip decoction.
3. Mix 500 g of vodka and honey and heat until foam forms. Take a pinch of motherwort, marsh dryweed, valerian, knotweed, chamomile. Boil the herb, let it stand, strain and mix with honey and vodka. Take in the morning and evening, first a teaspoon, a week later - in the dining room. The course of treatment is a year.
4. Mix a spoonful of grated horseradish and a spoonful of honey. Take one hour before meals and drink water. The course of treatment is 2 months.

Traditional medicine will help if you follow two principles - regularity and strict adherence to the recipe.

Surgery

With certain parameters of coronary heart disease, there are indications for coronary artery bypass grafting - an operation in which the blood supply to the myocardium is improved by connecting the coronary vessels below the site of their lesion with external vessels. The best known is coronary artery bypass grafting (CABG), in which the aorta is connected to the segments of the coronary arteries. For this, autografts (usually a large saphenous vein) are often used as shunts.

It is also possible to use balloon dilatation of vessels. In this operation, the manipulator is inserted into the coronary vessels through the puncture of the artery (usually femoral or radial), and the vessel lumen is expanded by means of a balloon filled with a contrast agent, the operation is, in fact, bougienage of the coronary vessels. Currently, "pure" balloon angioplasty without subsequent stent implantation is practically not used, due to its low efficiency in the long term. In case of incorrect movement of the medical device, a lethal outcome is possible.

Prevention and lifestyle

To prevent the development of the most severe forms of coronary heart disease, you need to adhere to only three rules:

1. Leave your bad habits in the past. Smoking and drinking alcohol is like a blow, which will definitely lead to a worsening of the condition. Even an absolutely healthy person does not get anything good from smoking and drinking alcohol, let alone a sick heart.
2. Move more. Nobody says that you need to set Olympic records, but it is necessary to abandon the car, public transport and the elevator in favor of walking. You cannot immediately load your body with kilometers of traveled roads - let everything be within reason. In order for physical activity not to cause deterioration of the condition (and this happens with ischemia!), Be sure to consult your doctor about the correctness of the exercise.
3. Take care of your nerves. Try to avoid stressful situations, learn to calmly react to troubles, do not succumb to emotional outbursts. Yes, it's tough, but this tactic can save lives. Talk to your doctor about the use of sedatives or herbal teas with a calming effect.

Ischemic heart disease - not only recurrent pain, long-term violation of the coronary circulation leads to irreversible changes in the myocardium and internal organs, and sometimes to death. Treatment of the disease is long-term, sometimes it involves a lifetime of taking drugs. Therefore, heart disease is easier to prevent by introducing some restrictions in your life and optimizing your lifestyle.

Prevention of ischemic heart disease in clinical practice

In 1998, the European Heart Journal, Atherosclerosis and Journal of Hypertension published the recommendations of the second joint working group of the European Society of Cardiology, the European Society of Atherosclerosis and the European Society of Hypertension "Prevention of coronary heart disease in clinical practice." These data will undoubtedly be of interest to the general medical community.

The main idea of \u200b\u200bthe recommendations is to concentrate the efforts of therapists, cardiologists, and general practitioners on reducing the risk of developing coronary heart disease (IHD) and its complications, as well as other clinical manifestations of atherosclerosis. The task is to make the prevention of ischemic heart disease an integral part of the medical and preventive work of a practical doctor. Doctors still pay a lot of attention to the treatment process and do not use enough of the enormous potential that

is incorporated in the prevention of ischemic heart disease. The main principle: ischemic heart disease is a multifactorial disease, therefore, the risk assessment of its development and prevention should be multifactorial.

A key element in the management of patients is the provision on the need to achieve target levels of blood pressure and blood lipids as the main factors determining the risk of developing coronary heart disease and its complications. To achieve the target levels, it is recommended both to change the lifestyle (diet, physical activity, smoking cessation), and the use of lipid-normalizing and antihypertensive medications.

The relationship between drug and non-drug methods and patient management tactics are determined by the level of absolute multifactorial coronary risk. This risk is expressed in the form of the likelihood of clinical manifestations of coronary artery disease, atherosclerotic lesions of other localization, or their complications in

over the next 10 years. The absolute individual risk is determined by five main indicators: age, gender, smoking, systolic blood pressure and total cholesterol levels, taking into account heredity, changes in the lipid spectrum, and the presence of diabetes mellitus. Patients with pre-existing symptoms of coronary artery disease or other atherosclerotic lesions are at very high risk.

Medical priorities. Against the background of well-known general recommendations on reducing smoking, choosing a healthier diet, increasing physical activity, addressed to the entire population as part of a population prevention strategy, the target group for the implementation of the proposed medical approach are patients with clinical manifestations of coronary artery disease, atherosclerotic lesions of other localization, or a high risk of them. development. Patients at greatest risk get the most benefit from prevention. In accordance with this, the following target groups are distinguished, arranged in descending order of priority:

1. Patients with coronary artery disease or other

diseases associated with atherosclerosis (AS).

2. Healthy individuals with a high risk of developing coronary artery disease and other diseases associated with AS, due to a combination of risk factors such as smoking, high blood pressure, lipid metabolism disorders (high levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C) , lowered high-density lipoprotein cholesterol (HDL-cholesterol) and increased triglyceride levels), high blood sugar, early development of coronary artery disease in the family, as well as persons with severe hypercholesterolemia (or other forms of dyslipidemia), hypertension or diabetes mellitus.

3. Close relatives of patients with early development of coronary artery disease or other diseases associated with AS, as well as healthy individuals with a very high risk.

4. Other persons (patients) undergoing examination in the course of routine clinical practice.

Measures in relation to the first group of patients are outlined in the section "Secondary prevention", in relation to

other groups - in the "Primary prevention" section.

Secondary prevention. Lifestyle changes. Success in this direction is determined by the patient's willingness to change the lifestyle. The moment a patient is diagnosed with coronary artery disease or a high risk of its development provides him with an ideal opportunity to revise his lifestyle, and the doctor's advice falls on fertile ground.

To give up smoking. The doctor should recommend the patient to stop smoking in the name of preserving health and life, inform him about the dangers of secondhand smoke, relying on the help of family members. In some cases, at the first stage of smoking cessation, nicotine replacement therapy may be useful, especially in severe nicotine addiction. Quitting smoking from other family members living in the same room as a smoker can help him quit smoking and not return to the habit again.

Changing eating habits:

1. Reduce total fat intake to 30% or less of the total calorie intake; saturated fat to one

a third or less of all fat consumed; cholesterol up to 300 mg per day. Given the nature of the diet of the urban population of Belarus, it is necessary to increase the consumption of fish and other seafood.

2. Increase your intake of fresh vegetables, fruits and grains.

3. Reduce the total caloric intake of the daily diet if weight is increased.

4. Reduce salt and alcohol intake if blood pressure is high.

Increased physical activity. Aerobic exercise (walking, swimming, cycling) for 20 ^ 0 minutes 4 ^ times a week is recommended. It is important that exercise increases the level of high-density lipoproteins (antiatherogenic), reduces triglycerides, the likelihood of thrombosis, and helps to normalize weight.

Overweight and obesity. To assess body weight and identify obesity, the body mass index (BMI) is used, which is calculated by the formula: weight in kg / (height in m2).

Persons who are overweight (BMI\u003e 25 kg / m2) and obese (BMI\u003e 30 kg / m2), especially with

central obesity, have an increased risk of coronary artery disease, therefore, to lose weight, they should be provided with professional help based on an appropriate diet and increased physical activity. Losing weight will also help lower blood pressure, total cholesterol, and blood sugar. Waist measurement is often used as a clinical indicator of obesity and monitoring weight loss. Waist\u003e 94 cm in men and\u003e 80 cm in women indicates that extra pounds should be shed, and if the waist is\u003e 102 cm in men and\u003e 88 cm in women, a professional blood pressure is required. The need to achieve and constantly maintain a target blood pressure level of less than 140/90 mm Hg is emphasized. If, due to lifestyle changes, such a level of pressure cannot be achieved, antihypertensive drugs should be prescribed. In patients with exertional angina, preference is given to p-blockers, and if they are intolerant or insufficiently effective, calcium antagonists are prolonged.

bathroom action. It is advisable to prescribe β-blockers for patients with myocardial infarction, and ACE inhibitors for patients with left ventricular dysfunction.

Blood lipids. The level of total cholesterol must be consistently reduced to 5.0 mmol / L (190 mg / dL) and below, and LDL-C - to 3.0 mmol / L (115 mg / dL) and below. Formally, levels of HDL-C and triglycerides are not considered as criteria for the effectiveness of treatment, but the level of HDL-C<1,0 ммоль/л (40 мг/дл) и триглицеридов >2.0 mmol / L (180 mg / dL) is an indicator of an increased risk of coronary heart disease.

If you are unable to consistently maintain the target LDL-C level through lifestyle changes, drug treatment should be considered. Preference should be given to inhibitors of HMG coenzyme-A reductase (statins), as this class of lipid-normalizing drugs has demonstrated undeniable effectiveness in reducing coronary and general mortality and increasing life expectancy. Statins also significantly reduce the risk of stroke in

patients with coronary artery disease.

Blood sugar. It has not yet been established how much control over blood sugar levels reduces the risk of cardiovascular complications in patients with diabetes and coronary artery disease, but it is known that normoglycemia helps prevent micro- and macrovascular complications in people with diabetes. In type 1 diabetes (insulin-dependent diabetes mellitus), the following target levels should be achieved:

fasting blood sugar - 5.16.5 mmol / l (91 - 120 mg / dl);

blood sugar after meals (peak level) - 7.69.0 mmol / l (136-160 mg / dl);

glycosylated hemoglobin (HbA) - 6.2-7.5%.

In addition, hypoglycemia should be avoided.

For most patients with type 2 diabetes (non-insulin dependent diabetes mellitus), it is necessary to achieve lower levels of these indicators. For some patients, especially the elderly, extreme caution should be exercised in reaching target levels.

Other preventive drug therapy. AT

in addition to non-drug and drug control of blood pressure and blood lipids, it is necessary to take into account the appropriateness of prescribing drugs to patients that reduce the risk of complications and mortality:

Aspirin (at least 75 mg / day) or other drugs that affect platelet aggregation, if possible in all patients.

β-blockers - for patients who have had myocardial infarction.

ACE inhibitors - for patients with a decrease in left ventricular systolic function (ejection fraction< 40) или тем, у кого в период острого инфаркта миокарда были симптомы сердечной недостаточности.

Anticoagulants - for patients after myocardial infarction with an increased risk of thromboembolic complications, including patients with extensive anterior myocardial infarction, left ventricular aneurysm or thrombosis, paroxysmal tachyarrhythmia, chronic heart failure and thromboembolism in history (under the control of prothromostbin) and others.

Primary prevention.

The first step is the determination of coronary risk, which is performed using a special map (Fig. 1, see the paper version of the journal).

To determine the absolute risk of clinical manifestations of coronary artery disease in the next 10 years, you should select a table for the desired sex and its part corresponding to the age and smoking status (smoker, non-smoker) of this person. Then you need to find the cell closest to his (her) systolic blood pressure and cholesterol level, and compare the shading of this cell with the scale at the bottom of the diagram. The charts allow you to assess the impact that changes in cholesterol levels, blood pressure, or smoking status may have on overall risk. Moving to the right through the tables (diagrams), one can trace the influence of the long-term (over decades) action of the risk factor. This can be helpful when discussing the problem with younger people. In patients with diabetes mellitus, familial hyperlipidemia, low HDL-C (<1,0 ммоль/л у мужчин и <1,1 у женщин), имеющих прямых родственников с

early coronary artery disease (men under 55 years old, women under 65 years old), the risk increases by one category compared to that determined on the map. The criterion for high risk is its level\u003e 20% or extrapolated to the age of 60 years, the risk is\u003e 20% in the next 10 years.

For patients in whom coronary risk is assessed as high, intensive measures are recommended to reduce the levels of risk factors using medication as indicated.

Lifestyle. Individuals at high risk of developing coronary artery disease especially need professional support in terms of quitting smoking, choosing the right diet and increasing physical activity. Primary prevention emphasizes the prevention of obesity and weight loss. Lifestyle changes can help avoid the use of medication. The lifestyle recommendations outlined above for patients with coronary artery disease may also be helpful for those at high risk of the disease.

Arterial pressure. It is emphasized that the achievement

targeting blood pressure levels significantly reduces the likelihood of stroke, myocardial infarction, and heart failure in these patients. The decision to use antihypertensive medications is based both on an assessment of the absolute coronary risk and on the level of systolic and diastolic pressure and the presence of target organ lesions (Fig. 2, see the paper version of the journal).

For patients with increased systolic blood pressure (SBP)\u003e 180 mm Hg and / or diastolic blood pressure (DBP)\u003e 100 mm / Hg, persisting despite lifestyle changes, the risk of complications (coronary artery disease, cerebral stroke, heart failure) is so high that drug treatment is required. Drug treatment is also necessary for those patients whose SBP is consistently maintained at 160 - 179 mm Hg. Art. In persons with a more moderate increase in blood pressure (SBP 140-159 and / or DBP 90-94 mm Hg), drug treatment is prescribed for target organ damage or a high risk of coronary artery disease. If at the same blood pressure levels the absolute risk

is not high, then you can do without medication.

When carrying out therapy aimed at lowering the level of blood pressure, it is necessary to determine the target level of reduction and titrate the dose of the drug until the goal is achieved. It is preferable to start treatment with one drug. If necessary, you can add a second or third drug. For primary prevention, the target BP reduction is 140/90 mm Hg. and below. In young people, patients with diabetes mellitus and renal parenchymal diseases, the target blood pressure may be even lower.

The effectiveness of diuretics and β-blockers in reducing morbidity and mortality from cardiovascular disease in persons with arterial hypertension has been well proven. Similar efficacy has recently been found for calcium antagonists and ACE inhibitors. Therefore, for adequate blood pressure control, antihypertensive drugs of various classes can be used with equal success.

Blood lipids. The decision to use lipid-lowering drugs depends on ab-

family risk of coronary artery disease, lipid levels, and early development of coronary artery disease or other atherosclerosis-related diseases (Fig. 3, see paper version of the journal). Patients with familial hypercholesterolemia are at such a high risk of developing coronary artery disease that medical treatment is always necessary. In other cases, the tactics are determined by the level of coronary risk. At a risk of more than 20%, total cholesterol, HDL-C (a-cholesterol), triglycerides, LDL-C are determined. A hypolipidemic diet should be followed with repeated control after 3-6 months. If it is not possible to reduce LDL-C to 3.0 mmol / L (total cholesterol to 5.0 mmol / L), lipid-normalizing drugs are prescribed against the background of constant adherence to a lipid-lowering diet. When using lipid-lowering drugs, it is necessary to titrate the dose of drugs until the target level of cholesterol reduction is reached. Sometimes in people at high risk of developing coronary heart disease, it is not possible to achieve the target level of lipid reduction either through diet or with the help of the maximum dose of lipid-lowering drugs; at

in this case, combined medication is required. Even in those patients who have very high levels of total cholesterol or LDL-C and fail to achieve the target level of lipid reduction, the risk of coronary heart disease can be significantly reduced. The drugs of choice may be drugs of four main groups (statins, fibrates, niacin, bile acid sequestrants), but the evidence for the efficacy and safety of statins is most demonstrative in primary prevention.

Blood sugar. Currently, there is no data on the effectiveness of blood sugar control in reducing the risk of coronary artery disease or other diseases associated with AS in patients with diabetes. However, in persons with both types of diabetes, the risk of developing diseases associated with AS is directly dependent on the degree of hyperglycemia. Controlling blood sugar levels (as defined for patients with coronary artery disease) contributes to the effective prevention of microvascular diseases and other complications associated with diabetes, therefore, it is desirable to achieve an adequate level reduction in all persons with diabetes.

blood sugar. At any level of risk factors (smoking, blood pressure, blood lipids) or any combination of them, the absolute risk of coronary heart disease is much higher in patients with diabetes than without it. Therefore, it is important to achieve a targeted reduction in the level of risk factors in patients with diabetes mellitus.

Examination of close relatives. In close relatives of patients suspected of having familial hypercholesterolemia or other hereditary forms of dyslipidemia, blood lipid levels should be determined.

Prepared by G.I. SIDORENKO, IL KOZLOV (Belarusian Research Institute of Cardiology)

Medical news. - 2000. - No. 8. - S. 34-38.

Healthcare Norway

At the beginning of the XXI century. Norway is an example of a modern democracy, where society as a whole is responsible for the well-being of every citizen. On the territory of about 400 thousand sq. km are home to 4.525 million people. Due to geographical features, the population is unevenly distributed throughout the country: 2/3 live in densely populated areas, 1/3 -

in the coastal areas of the Norwegian Sea. For many Norwegians, fishing is still the main source of income. However, in the mid-60s, oil fields were discovered in Norway, which marked the beginning of the growth and strengthening of the socio-economic well-being of citizens and the state as a whole. This was reflected in the average duration