Ischemic heart disease prevention and treatment. What is coronary heart disease and how is it treated? Drugs used in treatment

Ischemic heart disease (CHD)- organic and functional damage to the myocardium, 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. Clinical signs IHD is determined by the specific form of the disease. IHD is the most common cause in the world sudden death, including people of working age.

ICD-10

I20-I25

General information

Ischemic heart disease is a serious problem of modern cardiology and medicine in general. About 700,000 deaths caused by various forms of coronary artery disease are recorded in Russia every year; in the world, mortality from coronary artery disease is about 70%. Coronary heart disease mostly affects men of active age (from 55 to 64 years), leading to disability or sudden death. The IHD group includes acutely developing and chronically occurring states of myocardial ischemia, accompanied by its subsequent changes: dystrophy, necrosis, sclerosis. These conditions in cardiology are considered, among other things, as independent nosological units.

The reasons

The vast majority (97-98%) of clinical cases of coronary artery disease is due to atherosclerosis of the coronary arteries of varying severity: from a slight narrowing of the lumen by an atherosclerotic plaque to complete vascular occlusion. At 75% coronary stenosis, the heart muscle cells respond to a 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 exacerbates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.

Factors contributing to the occurrence of IHD 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 coronary artery disease are hyperlipidemia 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 = 180 mm Hg. Art. and above, coronary heart disease occurs up to 8 times more often than in hypotensive people and people with normal levels blood pressure.

• smoking

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

• hypodynamia and obesity

Physically inactive people are 3 times more likely to develop coronary artery disease than those who lead an active lifestyle. When physical inactivity is combined with overweight, this risk increases significantly.

• intolerance to carbohydrates

• angina pectoris (load):

1. stable (with definition of functional class I, II, III or IV);
2. unstable: first-time, progressive, early postoperative or post-infarction angina;

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

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

6. Disorders 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, myocardial infarction (with and without Q-wave). Sometimes this group also includes sudden coronary death caused by coronary artery disease.

Symptoms of coronary artery disease

Clinical manifestations of coronary artery 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 state of health alternate with episodes of exacerbation of ischemia. About 1/3 of patients, especially those with silent myocardial ischemia, do not feel the presence of CAD at all. The progression of coronary heart disease can develop slowly, over decades; at the same time, the forms of the disease can change, and therefore the symptoms.

Common manifestations of coronary artery disease include retrosternal pain associated with physical exertion or stress, pain in the back, arm, lower jaw; shortness of breath, palpitations, or a feeling of interruption; weakness, nausea, dizziness, clouding of consciousness and fainting, excessive sweating. Often, coronary artery disease 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 coronary heart disease usually do not occur simultaneously, with a certain form of the disease, there is a predominance of certain manifestations of ischemia.

Harbingers of primary cardiac arrest in coronary heart disease can serve as paroxysmal sensations of discomfort behind the sternum, fear of death, psycho-emotional lability. With sudden coronary death, the patient loses consciousness, breathing stops, there is no pulse on the main arteries (femoral, carotid), heart sounds are not audible, the pupils dilate, 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 morphological and functional changes that determine the forms and prognosis of coronary artery disease. The result of myocardial ischemia are the following mechanisms of decompensation:

• failure energy metabolism myocardial cells - cardiomyocytes;
• "stunned" and "sleeping" (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 post-infarction cardiosclerosis - a decrease in the number of functioning cardiomyocytes and the development of connective tissue in their place;
• violation of systolic and diastolic functions of the myocardium;
• disorder of the functions of excitability, conduction, automatism and contractility of the myocardium.

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

Diagnostics

Diagnosis of coronary artery disease is carried out by cardiologists in a cardiological hospital or dispensary using specific instrumental techniques. When questioning the patient, complaints and the presence of symptoms characteristic of coronary heart disease are clarified. Examination reveals edema, cyanosis skin, heart murmurs, rhythm disturbances.

Laboratory diagnostic tests involve the study of specific enzymes that increase with unstable angina and heart attack (creatine phosphokinase (during the first 4-8 hours), troponin-I (on days 7-10), troponin-T (on days 10-14), 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). Also, a study of the level of total cholesterol, low (atherogenic) and high (antiatherogenic) density lipoproteins, triglycerides, blood sugar, ALT and AST (nonspecific markers of cytolysis) is being carried out.

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

Functional stress tests are widely used in the diagnosis of coronary heart disease. They are used to detect early stages of coronary artery disease, when disorders cannot yet be determined at rest. Walking, climbing stairs, exercise equipment (exercise bike, treadmill) are used as stress tests, accompanied by ECG recording of heart performance indicators. The limited use of functional tests in some cases is caused by the inability of patients to perform the required amount of load.

IHD treatment

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

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

Non-drug therapy includes measures to correct lifestyle and nutrition. With various manifestations of coronary artery disease, a restriction of the activity regimen 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 coronary artery disease. Therefore, in any form of coronary heart disease, the patient's activity mode is limited, followed by its gradual expansion during rehabilitation.

The diet for coronary 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 fight obesity, a low-fat diet is also prescribed. The following food groups are limited, and, if possible, excluded: animal fats (butter, lard, fatty meat), smoked and fried foods, quickly absorbed carbohydrates (baking pastries, chocolate, cakes, sweets). To maintain a normal weight, it is necessary to maintain a balance between consumed and expended energy. If it is necessary to reduce weight, the deficit between consumed and expended energy reserves should be at least 300 kC daily, taking into account that a person spends about 2000-2500 kC per day during normal physical activity.

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

Surgical myocardial revascularization (coronary bypass grafting - CABG) is used to restore blood supply to the ischemic area (revascularization) in case of resistance to ongoing pharmacological therapy (for example, with stable angina III and IV FC). The essence of the CABG method is the imposition of an autovenous anastomosis between the aorta and the affected artery of the heart 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 cardiopulmonary bypass or on a beating heart. Minimally invasive surgical techniques for IHD include percutaneous transluminal coronary angioplasty (PTCA) - balloon "expansion" of a stenotic vessel with subsequent implantation of a frame-stent that retains a vessel lumen sufficient for blood flow.

Forecast and prevention

Determining the prognosis for coronary artery disease depends on the relationship of various factors. So the combination of coronary heart disease and arterial hypertension, severe disorders of lipid metabolism 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 coronary artery disease is to reduce the adverse effects of threat factors: the exclusion of alcohol and tobacco smoking, psycho-emotional overload, maintaining optimal body weight, physical education, blood pressure control, healthy nutrition.

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

IHD can be caused various reasons. Primary prevention of the 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 monitor the indicators on the scales, but also take into account the body mass index (BMI).

High body weight is directly related to other risk factors for CHD - dietary habits and level of physical activity. A hereditary predisposition may also have a value, 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 can not starve. All restrictions should be introduced gradually so that the body does not experience stress.

Food habits

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

For the prevention of coronary artery disease, certain rules should be followed:

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

Eating habits are reflected in the level of glucose, with a constant excess of which there is a risk of diabetes. It can provoke the development of coronary artery disease. It is necessary to limit sweets, carbonated drinks, canned food, flour products as much as possible.

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 does not exclude the possibility of coronary artery disease, but serves as a prevention of other diseases.

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

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

Smoking

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

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

With low physical activity, the risk of coronary heart disease increases significantly. To prevent the disease, they should be administered at least half an hour a day. One day off is allowed.

Physical activity should be moderate. Useful for jogging, swimming, cycling, skiing. Even brisk walking is effective - if there is no time for a walk, then from work you can walk at least part of the way.

It is important to combine physical activity with rest. 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 proper nutrition, limiting alcohol, not smoking, maintaining a normal weight, and moderate exercise.

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 still diagnosed, then prevention of its progression and development of complications is required. To this end, secondary prevention is needed. It includes the following measures:

• lifestyle modification;
• 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 interventions may 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 levels of sugar and cholesterol (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 coronary heart disease is table number 10.

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

• reduce fats and carbohydrates;
• refuse table salt;
• limit fluid intake;
• refuse 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 are used. Certain medications are important in preventing the progression of the disease and the development of complications. For these purposes, as prescribed by a doctor, it is possible to receive:

• Anticoagulants of indirect action. They are necessary at the risk of vascular complications, including intracardiac thrombosis, thromboembolism, deep vein thrombosis, atrial fibrillation.
• β-blockers. With their help, they reduce the risk of recurrent myocardial infarction and death from coronary artery disease.
• Angiotensin-converting enzyme inhibitors. They are able to slow down the progression of atherosclerosis, differ in anti-ischemic action. Such drugs are used for concomitant arterial hypertension, diabetes mellitus, signs of heart failure.
• lipid-lowering agents. They are indicated in case of hyperlipidemia, angina pectoris, myocardial infarction. The intake of such funds has a positive effect on the prognosis of life with coronary artery 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 surgical intervention. It allows you to restore blood flow through the arteries of the heart with their stenosis. Such a measure is necessary for the normal blood supply to the heart muscle.

Often, in order to revascularize the myocardium, coronary artery bypass grafting or stenting is used. Such techniques are direct operations.

Thrombosis

The cause of most possible complications in coronary artery disease is thrombus formation. For its prevention, it is necessary to maintain a healthy lifestyle, which consists in proper nutrition, moderate physical activity and the rejection of bad habits.

At the risk of thrombosis, nutrition should be based on cereals, fresh vegetables and fruits, dairy products, lean meat, vegetable oils. It is useful to use foods rich in Omega-3, vitamin E, flavonoids.

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

Drug prevention of thrombosis includes taking anticoagulants, antiaggregants, folic and nicotinic acid, B vitamins (6, 12), vitamin E, bioflavonoids. Such therapy should be prescribed by a specialist.

Separately, it is worth considering the prevention of thrombosis after surgery. It must be included 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.

Prevention of myocardial infarction should include the treatment of any existing diseases. Of particular importance is diabetes mellitus and arterial hypertension.

If myocardial infarction has already happened, then medical prevention of coronary artery disease is necessary. A positive effect is observed when taking drugs with antianginal action: Carbocromen, Intensain, Intencordin. Other drugs should also be included in the prevention:

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

Blood pressure control is important. If the diastolic index exceeds 100 mm Hg. Art., then the risk of coronary artery disease increases. In this case, the use of antihypertensive drugs is indicated.

In case of myocardial infarction, physical rehabilitation is also important. The level of physical activity is selected individually, focusing on the results of the tests. More often resort to physiotherapy exercises and walking on level ground. 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 - up to 300 mg per day is allowed. It is also necessary to limit the consumption of table salt to 5-6 grams per day.

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

• regular physical education and the duration of such training is determined by a specialist
• a change in diet involves the rejection of 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 coronary artery disease and why is it scary?

IHD (coronary heart disease) is a pathological condition, the characteristic feature of which is a discrepancy between myocardial oxygen demand 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 artery disease) or due to spasm of the coronary arteries (occurs less frequently).

There are modifiable and non-modifiable risk factors for developing coronary artery disease. The first includes the circumstances of life that can be changed. With non-modifiable factors, a person is born and remains for life, it is impossible to influence or change them.

Modifiable factors include:

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

Non-modifiable risk factors for coronary artery disease are:

• male gender;
• age;
• burdened family history of cardiovascular diseases.

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

1. 1. Angina.
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.

Rheumatism of the heart: causes, treatment and prevention

Coronary artery disease (IHD) is a pathological condition, the characteristic feature of which is a discrepancy between myocardial oxygen demand 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 artery disease) or due to spasm of the coronary arteries (occurs less frequently).

3 Smoking cessation

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

In severe cases, when a person cannot cope with addiction on their own, nicotine replacement therapy can be used.

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

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

Fundamentals of a healthy diet for the prevention of coronary artery disease

Changes in the diet should be aimed at getting rid of excess body weight and the concentration of total plasma cholesterol.

Basic rules of preventive nutrition:

• consume no more than 2000 kcal per day;
• the presence of cholesterol in food should not exceed 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, it is suitable to introduce more fatty fish or omega-3 polyunsaturated fatty acids into the diet in the form food additives at a dose of 1 g per day. Alcohol is limited to moderate doses - 50 ml per day of ethyl alcohol. In the presence of heart failure, arterial hypertension and diabetes - the rejection of alcohol is mandatory.

Obesity and overweight are associated with a high risk of death in patients with cardiovascular disease. Bringing to normal body weight in patients suffering from coronary artery disease, along with obesity and overweight, leads to a decrease in blood pressure, correction of lipid and glucose levels in the blood. Initially, it is recommended to follow a diet that has the following characteristics:

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

Diet therapy is carried out under the supervision of a doctor who takes into account medical indications and contraindications. The rate of weight loss of the patient 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 the correction of overweight is the preservation of the achieved result. Therefore, it has importance to achieve high motivation in the desire to maintain weight at a normal level throughout life after achieving a positive result. In every program that involves weight loss, 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 into the diet in the form of food supplements at a dose of 1 g per day is suitable. Alcohol is limited to moderate doses - 50 ml per day of ethyl alcohol. In the presence of heart failure, arterial hypertension and diabetes - the rejection of alcohol is mandatory.

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

The general rules of eating behavior include eating 4-5 times a day: in addition to the three main meals, 2 additional ones are introduced. Be sure to have breakfast, between dinner and breakfast should not be more than ten hours. The last time you need to eat no later than two hours before falling asleep. Between meals should not be more than 3-4 hours.

Other measures to improve eating habits include:

• lack of fluid intake during meals. Water can and should be drunk half an hour before a meal and 30 minutes after a meal.
• food can be eaten not too cold and not too hot, warm
• do not eat if there is no appetite (does not apply to scheduled meals). Do not eat in company with family members or friends, chew popcorn out of habit at the cinema, etc.
• tracking the calorie content of an additional portion during snacks. It should be less than 10 kcal
• don't salt food automatically without tasting it
• avoiding fast food, you need to eat for a minimum of 15-20 minutes, chewing thoroughly
• refusal to visit fast foods, in the assortment of which most dishes contain fats, and far from the first frying
• don't buy food to take home when you're hungry
• when buying food, pay attention to the information on the label about the content of fats, carbohydrates, dietary fiber
• do not eat semi-finished products that may contain not only unknown fats, but also harmful additives
• try to avoid salting fresh vegetables, eggs, vegetable salads, boiled potatoes
• refusal to eat 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 the dishes have a minimum amount of fat. The following food processing methods are preferred: baking, poaching, boiling, microwave cooking, grilling

Breakfast should account for about 25% of the calories eaten per day, 15% for lunch, about 35% for lunch, only 10% for afternoon tea, and about 15% for dinner. This is due to certain physiological rhythms of the release 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.

Daily calorie calculation

When compiling a diet, it is necessary to maintain a balance of energy when eating food and daily physical activity in order 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 must be reduced, but not drastically.

The opinion of all experts on alcohol is unanimous: its use 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.

They say about the hypercaloric type of nutrition if the body weight of a person has increased in 3 months. This means that more calories were taken in than were expended. 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 by the formula, adhere to such a daily caloric intake for a long time, but in no case resort to hunger strike or mono-diets. At fasting days daily calorie content should be at least 900-1000 kcal per 24 hours, and not zero, as many are mistaken!

The WHO CINDI Program for Integral Prevention of Noncommunicable Diseases articulates 12 principles healthy eating. They include the intake of food, which is of plant origin. 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 ones. vegetable oils. Instead of fatty meats (for example, pork), you can eat beans, beans, lentils, fish, chicken. With regard to dairy products, WHO's CINDY program for the integral prevention of noncommunicable diseases states to choose foods that are low in fat and salt.

Preference is given to products with the minimum amount sugar, you should avoid refined sugar, minimizing sugary drinks, cakes and other sweets. Choose foods low in salt Total salt intake should be no more than one teaspoon (6 g) per day, including salt found in bread and processed, cured, smoked, or canned foods. Food is best cooked with a steam method, you can use a microwave oven. Children need to be taught proper nutrition from an early age.

In primary and secondary prevention of coronary artery disease, the anti-atherogenic nature of nutrition is considered a priority. Every day you need to include in the diet the following foods:

• sea ​​fish
• 1-2 tbsp. tablespoons of vegetable oils
• legumes
• more than 400 g per day of vegetables, herbs and fruits
• soy and its products
• 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

It is useful to compare the maximum heart rate calculated during exercise tests and during daily exercise. Patients who have had a myocardial infarction and are recovering motor activity especially need information about 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 people with overweight, obesity and diabetes.

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

The reasons

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 amount or complete absence of insulin in the body);
• regular increase in blood pressure;
• stress;
• smoking.

Unrecoverable causes include:

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

If you engage in the prevention of preventable causes, adhere to all medical recommendations, you can reduce the risk of ischemia to a minimum.

To save life, all causes are eliminated.

Diet

Diet occupies a leading place in the prevention and control of coronary artery disease. It aims to optimize the income nutrients, which positively affect the overall exchange (metabolism). The intake of simple carbohydrates, animal fats, salt is rationally excluded. With excess body weight, the calorie content of the diet decreases.

Experts, 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 use of animal fats (lard, fatty meat, butter).
2. Avoid fried foods.
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 with fruits, vegetables and other fresh plant foods.
6. Be sure to have omega-3 fatty acids (sea fish, fish oil). It is recommended to use three times a week sea ​​fish or other seafood.

So, eating a hot dog, pizza, and two plates of salted borscht in 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 you can't use less. Think about whether you should always add salt to food?

Risk factors for coronary artery disease

Probable risk factors for coronary heart disease are divided into two groups: those that can be changed and those that cannot be modified. The second group includes:

• age
• family history of the disease

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

As for age: the older a person is, the stronger atherosclerotic changes are expressed in his body, which leads to a high incidence of coronary artery disease. Before the age of 55, the incidence of coronary artery disease in men is higher than in women. After 55 years, there is an almost equal number of men and women with this diagnosis.

Family history. The risk of developing coronary heart disease is higher in those whose relatives have the same diagnosis. Especially if the degree of relationship is the first: brothers and sisters, mom and dad, sons and daughters. The risk of being diagnosed with coronary artery disease is high if relatives have 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 non-smokers.

High blood pressure greatly increases the risk of developing coronary artery disease. Also an exciting factor is the high pulse pressure in older people.

Low physical activity leads to deviations 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 people have a high chance of getting some kind of heart disease.

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

Metabolic syndrome and diabetes

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

unhealthy diet

An increased risk of coronary artery disease occurs if a person eats food that is high in saturated fat, simple sugars, when eating foods with a high glycemic index. The Eskimos of Greenland, according to studies, rarely develop heart disease, which is associated with their diet. The Eskimos consume a small amount of salt (compared to the inhabitants of Europe and the CIS countries), eat mainly fish and the meat of sea animals. Arterial hypertension and obesity are atypical for them.

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

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

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

This criterion has been adopted by WHO. Why exactly in a year? 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 per day. The degree of tobacco dependence is determined by the Fagerstrom test.

Assessment of physical activity. The doctor, with the help of a conversation, finds out the patient's attitude to physical activity, both at home and as physical education or sports. According to standards, such as the European recommendations 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.

Assessment of excess body weight. To assess body weight, doctors are guided by the body mass index - the ratio of body weight (kg) to height (m2). The norm is an index in the range of 18.5-24.9. Excess body weight is fixed at an indicator of 25-30, and obesity - at 30 or more. Visceral obesity is also assessed: it is fixed at 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 evaluate the patient's nutrition over the past day. All food eaten is coded in conventional units. With the help of tables and programs, information is obtained on the daily intake of energy, proteins, fats, carbohydrates, dietary fiber, vitamins and mineral elements.

The frequency method of assessment provides information on a person's nutrition for the last 3 months prior to the survey. Among the simpler methods: the calculation of the pyramid of healthy eating and the express method of assessing nutrition. For the last named, a standard questionnaire is used. The advantage of the method is that the results can be obtained in a very short time.

Food diary. When using this method, the person himself daily writes down the number and names of foods and dishes eaten. The time of meals is also indicated, and sometimes the reasons for eating. After the patient's nutrition is assessed, it can be adjusted or a new daily diet can be made, taking into account such 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 an analyzed risk factor. For example, smokers and non-smokers. This indicator is called relative risk.

In order to prioritize interventions for primary and secondary prevention of coronary artery disease, it is important to assess the overall risk. If several factors are combined, it can multiply significantly. Therefore, experts have created riskometers, dividing patients into high-risk, medium and moderate risk groups.

In recent years, a new European model of risk metrics has been proposed, developed under the 5COKE project. This model calculates the probability of fatal cardiovascular events in the next 10 years in individuals without coronary artery disease. This model of riskometry is recommended by the VNOK. Parameters that are taken into account when calculating the risk:

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

Risk factors are predisposing causes that increase the likelihood of a disease or its exacerbation. Risk factors for coronary heart disease are divided into two groups. One of them includes inevitable causes that cannot be eliminated. Risk factors for 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 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 getting ischemia.

Risk factors for coronary artery disease are divided into two groups: those that can be changed and those that are not. The second group includes gender, age, family history of the disease.

1. The older a person becomes, the brighter the manifestation of atherosclerotic changes, which leads to an increased incidence of coronary artery disease. Before the age of 55, men are more likely to suffer from this pathology. After this age, the number of men and women who fell ill with it levels off.
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 kinship: parents - children. The risk increases if the disease occurs in relatives at a young age.

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

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

Diagnostics

Diagnosis consists of a number of laboratory and instrumental methods of examination

Diagnosis of coronary artery 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. An analysis of the history of life 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 medical examination, wheezing and heart murmurs are detected in the lungs, blood pressure is measured, and signs of hypertrophy are diagnosed.

To detect cardiac ischemia, the following diagnostic studies are prescribed:

• a general blood test helps to identify signs of an inflammatory process in the human body
• general urinalysis allows diagnosing an increased concentration of protein, erythrocytes, leukocytes and identify pathologies that may be a complication of cardiac ischemia
• analysis of specific enzymes is performed in acute coronary syndrome and suspected myocardial infarction

What other diagnostic methods can detect the disease:

1. coagulogram
2. echocardiography
3. electrocardiography
4. radiography chest
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 heart vessels.

stressful situations

Stress is one of the strongest factors today that cause diseases. Stress ulcers, diabetes mellitus, hypertension and other diseases are caused by a simple daily reaction to annoying 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 whether to be nervous or explain the situation to himself in a different way.

Stressful situations need to be brought under control. They are always there, but it is important to learn how to respond to them correctly. You can’t let stress take over you, 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 recovering, at the same time, read books in parallel, develop yourself, and spend time with benefit.

Particularly susceptible to it are people who perform work with increased responsibility (medical workers, operators of the railway and aviation transport sectors), residents of megacities 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, read the causes of IHD.

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 pathogenic background.

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

• unforeseen situations requiring hasty decision-making 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 your head;
• late for meetings, delays at work;
• criticism from colleagues, friends, relatives.

All this entails regular experiences, turning into chronic stress.

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

keep your posture

Posture means much more than a person used to believe. Violation of posture leads to a change in blood flow in the vertebral arteries and vessels of the brain, overstrain of certain muscle groups.

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

Among other situations, when a person does not follow his posture, people slouch due to negative emotions. The worse a person's mood is, the less he thinks about his posture - he becomes even more hunched and downcast.

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 of 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 intensively (horizontally, then vertically).
3. Make a grin expression, intensively make chewing movements of large amplitude several times, without hitting 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 outwards.
6. Massage your face with both palms.
7. Put your palms together, raise them to face height, grasp the fingertips of the other with the fingers of one hand, 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 your fingers.
9. Raise your hands at face level, palms facing you, bending your fingers alternately, starting with your thumb. right hand, unfold in reverse order.
10. Massage each finger individually.

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

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

You need to take it calmer, you should not take revenge - nothing good usually comes out of this. You need to understand that it became possible 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 get what they deserve. If you cannot forgive your enemies, at least love yourself. Everyone responsible for his life, and the one who spends it on hatred - too.

Religion also speaks of this. People are so arranged that they quickly forget all the good things, and one misconduct can block all the positive things that a person has done.

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

Everyone can help himself, and everything depends on him. “There is nothing worse than goodness that was not asked for” is an expression that, unfortunately, is often true.

Kindness is a voluntary act. If this is so, then the person experiences joy, which should be enjoyed. This is gratitude, and the rest are related attributes.

A person spends about 20 years of his life in a dream. Everyone needs an individual amount of sleep. When a person has insomnia, he begins to worry, suppressing sleep even more.

If this psychological reason, for example, debts, taxes, you need to pay them off as soon as possible. When the body calms down, sleep will appear. Experts recommend going to bed before the onset of fatigue and getting up in the morning, and not, for example, in the afternoon.

The question of the financial situation 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 out of life, but debts, including loans, do not make anyone happier. You need to learn to treat money carefully and responsibly and teach this to your children.

Under a lying stone ... you know. Look for a 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 regret your health and stop worrying and poisoning yourself from the inside. You need to be on the alert, but there will be an option - just do not miss it.

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

The cause of IHD is often overweight and high blood pressure. 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

Factors influencing the onset of coronary disease fall 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 eliminated. 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 it is only possible to reduce their harmful effects.

1. Age. As a person ages, the functions of blood vessels are disrupted, blood supply to tissues worsens. 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 definitely appear. Proper nutrition, moderate exercise and the rejection of bad habits will minimize the risk of developing coronary disease.

Principles of coronary heart disease prevention

Prevention of coronary 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 inevitable factor and two modifiable causes of the listed. If there are more than three reasons from both categories, then the risk of ischemia increases several times.

Prevention of coronary artery disease can be primary or secondary. In the primary, all measures are aimed at preventing the occurrence of ischemia. And secondary prevention is designed to prevent exacerbation of the disease.

Unrecoverable

Very often, the appearance of coronary artery disease provokes the patient himself and bad habits.

1. Smoking and alcohol. These bad habits provoke spasms of blood vessels and worsen blood circulation.
2. Irrational 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 the tissues.
4. Physical inactivity. A sedentary lifestyle often causes congestion and poor blood circulation.
5. Obesity. Excess weight puts additional stress on the blood vessels and heart, making it difficult for them to function properly.
6. Frequent stress. Stressful situations contribute to an increase in vascular tone and increased heart rate. If such a condition occurs frequently, then there is a risk of tissue malnutrition, first of all, vital organs - the brain and heart - suffer.

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

1. Nitroglycerin-containing drugs. Nitrosprays and Nitroglycerin tablets are recommended for the patient to take in case of pain behind the sternum caused by an attack of angina pectoris. The drug 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 thrombosis. 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 should be taken with caution at normal or reduced pressure.
4. ACE inhibitors (angiotensin converting enzyme). A group of medicines 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 reduce the amount of cholesterol are used for elevated cholesterol levels.
6. Hypoglycemic medications. To correct glucose levels in diabetes, tablets or insulin injections can be used. The dose and drug is selected by the endocrinologist individually, after examining the patient.

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

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

Ischemic heart 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. The manifestations of atherosclerosis prevent its entry: narrowing of the lumen of the 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 atherosclerosis of blood vessels. With the onset of menopause, the hormonal background changes, so the possibility of developing coronary disease increases dramatically.

What it is?

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

The disease is very dangerous - for example, in acute development, coronary heart disease immediately leads to myocardial infarction, which causes death in middle-aged and elderly people.

Causes and risk factors

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

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 exacerbates the obstruction of the coronary vessels and causes manifestations of coronary heart disease.

Factors contributing to the occurrence of IHD 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 coronary artery disease are hyperlipidemia 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 = 180 mm Hg. Art. and above, coronary 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, cigarette smoking increases the incidence of coronary artery disease by 1.5-6 times. Mortality from coronary heart disease among men aged 35-64 who smoke 20-30 cigarettes daily is 2 times higher than among non-smokers of the same age group.
4. Physical inactivity and obesity - physically inactive people are 3 times more likely to develop coronary artery disease than those who lead an active lifestyle. When physical inactivity is combined with overweight, this risk increases significantly.
5. Diabetes mellitus, incl. latent form, increases the risk of coronary heart disease by 2-4 times.

Factors posing a threat to the development of coronary artery disease should also include aggravated heredity, male gender and advanced age of patients. With a combination of several predisposing factors, the degree of risk in the development of coronary heart disease increases significantly. The causes and rate of development of ischemia, its duration and severity, the initial state of the cardiovascular system of the individual determine the occurrence of one form or another of coronary heart disease.

Signs of coronary artery disease

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

• intermittent feeling of lack of air;
• feeling anxious for no apparent reason;
• general weakness;
• recurrent chest pain that may radiate to the arm, shoulder blade, or neck;
• feeling of tightness in the chest;
• burning sensation or heaviness in the chest;
• nausea and vomiting of unknown etiology.

Symptoms of coronary heart disease

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

1. Angina. The patient develops pain or discomfort behind the sternum, in the left half of the chest, heaviness and a feeling of pressure in the region of the heart - as if something heavy had been placed on the chest. In the old days they said that a person has "angina pectoris". The pain can be different in nature: pressing, squeezing, stabbing. It can give (radiate) to the left hand, under the left shoulder blade, lower jaw, the area of ​​​​the stomach and be accompanied by the appearance of severe weakness, cold sweat, a feeling of fear of death. Sometimes, during exercise, it is not pain that occurs, but a feeling of lack of air, passing at rest. The duration of an angina attack is usually a few minutes. Since pain in the region of the heart often occurs when moving, a person is forced to stop. In this regard, angina pectoris is figuratively called "the disease of shop window observers" - after a few minutes of rest, the pain, as a rule, disappears.
2. Myocardial infarction. Terrible 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, extending to the left shoulder blade, arm, lower jaw. The pain lasts more than 30 minutes, when taking nitroglycerin, it does not completely disappear and only briefly decreases. There is a feeling of lack of air, cold sweat, severe weakness, lowering blood pressure, nausea, vomiting, a feeling of fear may appear. Reception of nitropreparations does not help or assist. The part of the heart muscle deprived of nutrition becomes dead, loses its strength, elasticity and ability to contract. And the healthy part of the heart continues to work with maximum tension and, contracting, can break the dead area. It is no coincidence that a heart attack is colloquially referred to as a heart rupture! It is only in this state that a person has to make even the slightest physical effort, as he is on the verge of death. Thus, the meaning of the treatment is that the place of the rupture is healed and the heart is able to work normally further. This is achieved both with the help of medications and with the help of specially selected physical exercises.
3. Sudden cardiac or coronary death is the most severe of all forms of CAD. It is characterized by high mortality. 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, severe electrical instability of the myocardium. The causative factor is alcohol intake. As a rule, patients do not even know that they have coronary artery disease, but they have many risk factors.
4. Heart failure. Heart failure is manifested by the inability of the heart to provide sufficient blood flow to the organs by reducing contractile activity. The basis of heart failure is a violation of the contractile function of the myocardium, both due to its death during 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 is manifested by shortness of breath, weakness during exertion and at rest, swelling of the legs, enlargement of the liver and swelling of the jugular veins. The doctor may hear wheezing in the lungs.
5. Cardiac arrhythmias and conduction disorders. Another form of IBS. It has a large number various kinds. They are based on a violation of the conduction of an impulse along the conduction system of the heart. It is manifested by sensations of interruptions in the work of the heart, a feeling of "fading", "gurgling" in the chest. Heart rhythm and conduction disturbances can occur under the influence of endocrine, metabolic disorders, intoxication and drug exposure. In some cases, arrhythmias can occur with structural changes in the conduction system of the heart and myocardial diseases.

Diagnostics

First of all, the diagnosis of coronary disease is carried out on the basis of the patient's feelings. Most often they complain of burning and pain in the chest, shortness of breath, excessive sweating, swelling, which is a clear sign of heart failure. The patient experiences weakness, palpitations and rhythm disturbances. Be sure to perform electrocardiography if ischemia is suspected.

Echocardiography is a research method that allows you to assess the state of the myocardium, determine the contractile activity of the muscle and blood flow. Blood tests are performed. Biochemical changes can reveal coronary heart disease. Conducting functional tests involves physical activity on the body, for example, walking up the stairs or doing exercises on the simulator. Thus, it is possible to identify pathologies of the heart at an early stage.

How to treat ischemic heart disease?

First of all, the treatment of coronary heart disease depends on the clinical form. For example, although some drugs are used for angina and myocardial infarction general principles treatment, however, the tactics of treatment, the selection of an activity regimen and specific drugs can radically differ. However, there are some general areas that are important for all forms of coronary artery disease.

Medical treatment

There are a number of groups of drugs that can be indicated for use in one form or another of coronary artery disease. In the US, 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 hypocholesterolemic drugs.

1. β-blockers. Due to the action on β-arenoreceptors, blockers reduce the heart rate and, as a result, myocardial oxygen consumption. Independent randomized trials confirm an increase in life expectancy when taking β-blockers and a decrease in the frequency of cardiovascular events, including repeated ones. At present, it is not advisable to use the drug atenolol, since, according to randomized trials, it does not improve the prognosis. β-blockers are contraindicated in concomitant pulmonary pathology, bronchial asthma, COPD. The following are the most popular β-blockers with proven prognostic 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 anti-atherogenic fraction of lipoproteins - HDL, with a decrease in which increases mortality from coronary artery disease. 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 do not significantly affect VLDL and HDL. Therefore, for maximum effective treatment macrovascular complications require a combination of statins and fibrates.
4. Statins. Cholesterol-lowering drugs are used to reduce the rate of development of existing atherosclerotic plaques and prevent the occurrence of new ones. These drugs have been proven to have a positive effect on life expectancy, and these drugs reduce the frequency and severity of cardiovascular events. The target cholesterol level in patients with coronary heart disease should be lower than in those without coronary artery disease, and equal to 4.5 mmol/l. The target level of LDL 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 expanding the vessels of the venous bed and depositing blood). side effect nitrates is to lower blood pressure and headaches. Nitrates are not recommended for use with blood pressure below 100/60 mm Hg. Art. In addition, it is now reliably known that the intake of 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 to relieve symptoms of angina pectoris. Intravenous drip of nitroglycerin allows you to effectively deal with the symptoms of angina pectoris, mainly against the background of high blood pressure.
6. lipid-lowering drugs. The effectiveness of complex therapy of patients suffering from coronary heart disease with the use of policosanol (20 mg per day) and aspirin (125 mg per day) has been proven. As a result of therapy, there was a persistent decrease in LDL levels, a decrease in blood pressure, and normalization of weight.
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 threads, they prevent the formation of blood clots, help stop the growth of already existing blood clots, increase the effect of endogenous enzymes that destroy fibrin on blood clots.
9. loop diuretics. Reduce the reabsorption of Na +, K +, Cl - in the thick ascending part of the loop of Henle, thereby reducing the reabsorption (reabsorption) of water. They have a fairly pronounced fast action, as a rule, they are used as emergency drugs (for 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 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 approximately 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 in the prevention of arrhythmias and is not a means of emergency care.
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 effects of angiotensin II, that is, leveling vasospasm. This ensures that the target blood pressure figures are maintained. The drugs of this group have a nephro- and cardioprotective effect.

Other treatments for coronary artery disease

Other non-drug treatments:

1. Hirudotherapy. It is a method of treatment based on the use of 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, it is not included in the standards of medical care for coronary artery disease, it is used, as a rule, at the request of patients. The potential positive effects of this method are the prevention of thrombosis. It should be noted that when treated according to approved standards, this task is performed using heparin prophylaxis.
2. Stem cell treatment. When stem cells are introduced into the body, it is expected that the pluripotent stem cells that have entered the patient's body will differentiate into the missing cells of the myocardium or vascular adventitia. Stem cells actually have this ability, but they can turn into any other cells in the human body. Despite numerous statements by 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 vast majority of countries in the world, this technique is experimental, and is not included in the standards of medical care for patients with coronary artery disease.
3. The method of shock wave therapy. The impact of shock waves of low power leads to myocardial revascularization. An extracorporeal source of a focused acoustic wave allows you to influence the heart remotely, causing "therapeutic angiogenesis" (vascular formation) in the area of ​​myocardial ischemia. The impact of UVT has a double effect - short-term and long-term. First, the vessels dilate, and blood flow improves. But the most important thing begins later - new vessels appear in the affected area, which provide a long-term improvement. Low-intensity shock waves induce shear stress in the vascular wall. This stimulates the release of vascular growth factors, starting the process of growth of new vessels that feed the heart, improving myocardial microcirculation and reducing the effects of angina pectoris. The results of such treatment are theoretically 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 on 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 randomized study.

Nutrition for IHD

The menu of a patient with diagnosed coronary heart disease should be based on the principle rational nutrition, balanced consumption of foods low in 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 meat;
• skinny varieties of fish - pike perch, cod, perch;
• fermented milk products - kefir, sour cream, cottage cheese, fermented baked milk with a low percentage of fat content;
• any hard and soft cheeses, but only unsalted and mild;
• any fruits, berries and dishes from them;
• egg yolks - no more than 4 pieces per week;
• quail eggs - no more than 5 pieces per week;
• any cereals, except for semolina and rice.

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

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

Eating with diagnosed coronary heart disease should be fractional - 5-7 times a day, but in small portions. If there is excess weight, then you must definitely get rid of it - this is a heavy burden on the kidneys, liver and heart.

Alternative methods of treatment of coronary artery disease

For the treatment of the heart, traditional healers 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 crushed 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 poured with boiling water (250 ml). After a couple of hours, the product is filtered. How to treat ischemia of the heart? It is necessary half an hour before breakfast, lunch and dinner to drink 2 tbsp. spoons of infusion. It is advisable to additionally brew a decoction of wild rose.
3. Mix 500 g of vodka and honey and heat until foam forms. Take a pinch of motherwort, marsh cudweed, valerian, knotweed, chamomile. Brew the grass, let it stand, strain and mix with honey and vodka. To accept in the morning and in the evening at first on a teaspoon, in a week - on 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.

Funds traditional medicine 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 bypass surgery - 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 segments of the coronary arteries. For this, autografts (usually the great saphenous vein) are often used as shunts.

It is also possible to use balloon dilatation of blood vessels. In this operation, the manipulator is introduced into the coronary vessels through a puncture of the artery (usually the 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 low efficiency in the long term. In case of incorrect movement of the medical device, a fatal outcome is possible.

Prevention and lifestyle

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

1. Leave your bad habits in the past. Smoking and drinking alcohol is like a blow that will definitely lead to a worsening of the condition. Even absolutely healthy man does not get anything good from smoking and drinking alcohol, to say nothing of 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 can’t immediately load your body with kilometers of roads traveled - let everything be within reason. In order for physical activity not to cause a deterioration in the condition (and this happens with ischemia!), be sure to get advice from your doctor about the correctness of the exercises.
3. Take care of your nerves. Try to avoid stressful situations, learn to calmly respond to troubles, do not succumb to emotional outbursts. Yes, it's hard, but it is this tactic that can save a life. Talk to your doctor about taking sedatives medicines or decoctions of medicinal plants with a calming effect.

Ischemic heart disease is not only a recurring pain, a 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, sometimes involves lifelong medication. Therefore, heart disease is easier to prevent by introducing some restrictions into your life and optimizing your lifestyle.

Prevention of coronary heart disease in clinical practice

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

The main idea of ​​the recommendations is to concentrate the efforts of therapists, cardiologists, general practitioners on reducing the risk of developing coronary heart disease (CHD) and its complications, as well as other clinical manifestations of atherosclerosis. The task is to make the prevention of coronary artery 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 huge potential that

incorporated in the prevention of coronary artery disease. Main principle: IHD is a multifactorial disease, so risk assessment and prevention should be multifactorial.

A key element of patient management is the provision on the need to achieve target levels of blood pressure and blood lipids as the main factors that determine the risk of developing coronary artery disease and its complications. To achieve the target levels, both lifestyle changes (diet, physical activity, smoking cessation) and the use of lipid-normalizing and antihypertensive medications are recommended.

The relationship between drug and non-drug methods and the tactics of patient management are determined by the level of absolute multifactorial coronary risk. This risk is expressed as the probability of occurrence 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 CAD or other atherosclerotic lesions are at very high risk.

medical priorities. Against the backdrop of famous general recommendations to reduce smoking, choose a healthier diet, increase physical activity, addressed to the entire population as part of a population-based 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 their development. Patients at greatest risk benefit most from preventive measures. 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, elevated level Blood pressure, lipid disorders (elevated total cholesterol and low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides), high blood sugar, cases of 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) being examined as part of routine clinical practice.

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

other groups - in the section "Primary prevention".

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

To give up smoking. The doctor should advise the patient to stop smoking in the name of maintaining health and life, inform him about the dangers of passive smoking, while relying on the help of family members. In some cases, nicotine replacement therapy may be useful at the first stage of smoking cessation, especially in severe nicotine dependence. Stopping smoking of other family members who live in the same room with a smoker can help him quit smoking and not return to this habit again.

Changing the nature of nutrition:

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

a third or less of all consumed fats; 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 consumption of fresh vegetables, fruits and grain products.

3. Reduce the total calorie content of the daily diet if the weight is increased.

4. Reduce salt and alcohol intake if you have high blood pressure.

Increasing physical activity. Aerobic physical exercises(walking, swimming, cycling) for 20 ^ 0 min 4 ^ once a week. It is important that exercise increases the level of high-density lipoproteins (anti-atherogenic), 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>25 kg/m2) and obese (BMI>30 kg/m2), especially those with

Centrally obese individuals are at increased risk of coronary artery disease and should be assisted professionally with an appropriate diet and increased physical activity to reduce weight. Weight loss will also help lower blood pressure, total cholesterol, and blood sugar levels. Waist size is often used as a clinical measure of obesity and weight loss monitoring. A waist circumference >94 cm in men and >80 cm in women indicates that you should get rid of extra pounds, and if the waist circumference is > 102 cm in men and >88 cm in women, professional blood pressure is required. It emphasizes the need to achieve and constantly maintain the target level of blood pressure - less than 140/90 mm Hg. If this level of pressure cannot be achieved through lifestyle changes, antihypertensive drugs. In patients with exertional angina, preference is given to p-blockers, and if they are intolerant or insufficiently effective, calcium antagonists of prolongation

bathroom action. Patients with a history of myocardial infarction should be given β-blockers, and patients with left ventricular dysfunction should receive ACE inhibitors.

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, the levels of HDL-C and triglycerides are not considered as criteria for the effectiveness of treatment, however, 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 developing coronary artery disease.

If it is not possible to consistently maintain the target level of LDL-C through lifestyle changes, medical 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 efficacy in reducing coronary and general mortality and increasing life expectancy. Statins also significantly reduce the risk of stroke in

patients with ischemic heart disease.

Blood sugar. It has not yet been established how much blood sugar control reduces the risk of cardiovascular events in patients with diabetes and CAD, but it is known that normoglycemia contributes to the prevention of 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);

postprandial blood sugar (peak) - 7.69.0 mmol/l (136-160 mg/dl);

glycosylated hemoglobin (HNA) - 6.2-7.5%.

In addition, hypoglycemia should be avoided.

For the majority of 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, maximum care should be taken to achieve 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 advisability of prescribing drugs to patients that reduce the risk of complications and mortality:

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

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

ACE inhibitors - 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 - in 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 a history of thromboembolism (under the control of prothrombin and other indicators of hemostasis).

primary prevention.

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

To determine the absolute risk of developing clinical manifestations of coronary heart disease in the next 10 years, you should select the 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 along the tables (diagrams) to the right, one can trace the influence of a long-term (for decades) action of the risk factor. This can be helpful when discussing the issue 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 heart disease (men under 55, women under 65), the risk increases by one category compared to that determined by the card. The criterion for high risk is its level > 20% or risk extrapolated to the age of 60 years > 20% in the next 10 years.

For patients whose coronary risk is assessed as high, intensive measures to reduce the levels of risk factors with the use of medications as indicated are recommended.

Lifestyle. Individuals at high risk of developing CAD especially need professional support to stop smoking, make healthy dietary choices, and increase physical activity. In primary prevention, importance is attached to the prevention of obesity and the reduction of excess weight. Lifestyle changes can help avoid medication. The lifestyle recommendations for patients with CAD outlined above may also be helpful for those at high risk for the disease.

Arterial pressure. It is emphasized that the achievement

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

For patients with an increase in systolic blood pressure (SBP) >180 mm Hg and/or diastolic blood pressure (DBP) > 100 mm/Hg that persists despite lifestyle changes, the risk of developing complications (CHD, cerebral stroke, heart failure) is so high that it requires drug treatment. Drug treatment is also necessary for those patients whose SBP is consistently maintained at 160-179 mm Hg. Art. In individuals 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

low, then you can do without drugs.

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

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

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

absolute risk of developing coronary artery disease, lipid levels and cases of early development of coronary artery disease or other diseases associated with atherosclerosis in the family (Fig. 3, see the paper version of the journal). Patients with familial hypercholesterolemia are at such a high risk of developing coronary artery disease that drug treatment is always necessary. In other cases, 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 lipid-lowering diet should be observed 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 individuals at high risk of developing CAD, the target level of lipid reduction cannot be achieved either with the help of diet or with the help of the maximum dose of lipid-lowering drugs; in

in this case, combined drug treatment 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 developing coronary artery disease can be significantly reduced. There are four main groups of drugs of choice (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 developing coronary artery disease or other diseases associated with AS in patients with diabetes. However, in individuals with both types of diabetes, the risk of developing diseases associated with AS is directly dependent on the degree of hyperglycemia. Blood sugar control (as defined in patients with coronary artery disease) is effective in preventing microvascular disease and other complications associated with diabetes, so it is desirable to achieve adequate blood glucose control in all diabetics.

blood sugar. At any level of risk factors (smoking, blood pressure, blood lipids) or any combination of them, the absolute risk of developing coronary artery 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.

Health care in Norway

At the beginning of the 21st century Norway is an example of a modern democracy where society as a whole is responsible for the welfare of every citizen. On the territory of about 400 thousand square meters. km is 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 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 was the beginning of the growth and strengthening of the socio-economic well-being of citizens and the state as a whole. This affected the average duration