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ISSN: 2690-5760

Journal of Clinical & Community Medicine

Opinion(ISSN: 2690-5760)

How to Reduce Cardiovascular Disease Burden in Population Volume 4 - Issue 2

Farský Štefan*

  • Slovak League against Hypertension, Dom srdca Martin, Slovakia, Europe

Received:January 18, 2022;   Published: February 01, 2022

Corresponding author: Farský Štefan, Slovak League against Hypertension, Dom srdca Martin, Slovakia, Europe

DOI: 10.32474/JCCM.2021.04.000183

 

Abstract PDF

Abstract

Ischaemic heart disease (IHD) and stroke are the world’s biggest killers. The good news is that 80% of cardiovascular diseases can be prevented with healthy lifestyle habits [1,2]. The most effective approach to improve this situation is the wide application of the therapeutic lifestyle changes and the reduction of risk factors levels. Small positive shifts of risk factors, across a whole population consistently leads to greater reductions in disease burden than the huge investment to the new drugs and devices including invasive procedures. Convincing evidence has come from Finland, at the end of previous century, where the significant decrease of cardiovascular mortality was attributed in more than 50% to risk factors reduction and 23% to the treatment investments invasive procedures including [3]. Motivation is a key element of cardiovascular prevention. It means in practice nonsmoking, support for nutrition and behavior changes, regular and effective physical activities and obesity management mainly. The key element is implementation of the programs which support regular cardio training, education concerning right nutrition principles, relaxation, stress and obesity management and sleeping hygiene.

Conclusion

a) Decrease of saFA about to 10% from daily energy intake and their substitution by polyunFA leads to decline cardiovascular risk about 20-30%.

b) 2% increase in energy intake from trans fatty acids increases IHD risk by 23%.

c) 30 g unsalted nuts daily decrease cardiovascular risk about 30%.

d) 7 g/day higher intake of total fiber is associated with a 9% lower risk of IHD and a 10 g/day higher fiber intake is associated with a 16% lower risk of stroke and a 6% lower risk of type 2 diabetes mellitus.

e) Effective physical activities 150 to 300 min. Of moderateintensity exercise or 75 to 150 minutes of vigorous-intensity exercise each week lead to a 31% reduction in all-cause mortality.

f) Secondary prevention ambulatory cardiovascular prevention (ACVR) programs, based on regular exercising, have reduced total mortality 15-28%, cardiovascular mortality 26-31%.

g) Non-inclusion of the patient in the secondary prevention program ACVR has increased mortality 28%.

h) The increase of BMI about 5kg/m2 leads to increase of mortality risk about 30% and about 40% risk of IHD, stroke and other vascular diseases.

Together: 80% of cardiovascular diseases can be prevented with healthy lifestyle habits. To implement this approach to health care system by education programs is not enough effective. For the health care system are needed concrete proposals with the aim to reduce cardiovascular morbidity and mortality and prolong averaged value of healthy life.

Proposed proceeding includes long term monitoring of patient´s risk factors, globally expressed as a HEART SCORE value [4] and basal obesity management in primary care, nurse led preventive cardiology clinics establishment and introducing of positive economic stimulation to decrease levels of risk factors in population by health insurance companies. It means to award the patients who were able to reduce significantly the levels of Heart Score value and to reduce their pharmacotherapy burden. It means also to monitor the Heart Score averaged value of all the patients included in care of GP and to award the GPs who were able to manage their patients to change their lifestyle habits to decrease the levels Heart Score averaged value and so to reduce pharmacotherapy and hospitalization expenses. Proposed secondary prevention tools in the specialized cardiology care include implementation of ambulatory cardiovascular rehabilitation in cardiology stacionairs [5-11].

Programs of ambulatory cardiovascular rehabilitation are key elements of secondary prevention needed for implementation of therapeutic lifestyle changes during second posthospitalization phase after acute coronary syndrome and/or revascularization procedures. They include regular supervised cardio exercise training not only but the complex education and stress management and psych relaxation training too. There are more long-term benefits from physical activity, including improved brain health, reduced risk of eight types of cancer, reduced risk for fall-related injuries in older adults, and reduced risk of excessive weight gain. Physical activity helps manage more chronic health conditions. It can decrease pain for those with osteoarthritis, reduce disease progression for hypertension and type 2 diabetes, reduce symptoms of anxiety and depression, and improve cognition for those with dementia, multiple sclerosis and Parkinson’s disease. In the public health area include changes in food groups taxing according to their health effects and implementation of the clinical excellence centrum to publish official information and advises for both public and experts in the field of the effectivity of preventive medicine practice, the effectivity of food supplements and the effectivity of the new diagnostic and therapeutic procedures.

References

  1. Piepoli MF, Hoes AW, Agewall S, Christian Albus, Carlos Brotons, et al. (2016) European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 37(29): 2315-2381.
  2. Yusuf S, Hawken S, Ounpuu S, Tony Dans, Alvaro Avezum, et al. (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364(9438): 937-952.
  3. Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, et al. (2005) Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. American Journal of Epidemiology 162(8): 764-773.
  4. Marco Ambrosetti, Ana Abreu, Ugo Corra, CH Davos, Dominique Hansen, et al. (2020) Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol DOI: 10.1177/2047487320913379.
  5. Abreu A, Ella Pesah, Marta Supervia, Karam Turk Adawi, Birna Bjarnason Wehrens, et al. (2019) Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries? Eur J Prev Cardiol 26(11): 1131-1146.
  6. Shields GE, Wells A, Doherty P, Anthony Heagerty, Deborah Buck, et al. (2018) Cost-effectiveness of cardiac rehabilitation: A systematic review. Heart 104(17): 1403-1410.
  7. Babu AS, Lopez Jimenez F, Thomas RJ, Wanrudee Isaranuwatchai, Artur Haddad Herdy, et al. (2016) Advocacy for outpatient cardiac rehabilitation globally. BMC Health Services Research 16(1): 471-475.
  8. Davos HC, Rauch B (2020) Evidence for cardiac rehabilitation in the modern era. In: ESC Handbook of Cardiovascular Rehabilitation: A practical clinical guide Edited by Ana Abreu, Jean Paul Schmid, Massimo Piepoli Oxford University Press, USA p. 1-14.
  9. Anderson L, Oldridge N, Thompson DR, Ann Dorthe Zwisler, Karen Rees, et al. (2016) Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol 67(1): 1-12.
  10. Rauch B, Davos CH, Doherty P, Daniel Saure, Maria Inti Metzendorf, et al. (2016) The prognostic effect of cardiac rehabilitation in the era of acute revascularization and statin therapy: Systematic review and meta-analysis of randomized and non-randomized studies-The Cardiac Rehabilitation Outcome Study CROS). Eur J Prev Cardiol 23(18): 1914-1939.
  11. Annett Salzwedel, Katrin Jensen, Bernhard Rauch, Patrick Doherty, Maria Inti Metzendorf, et al. (2020) Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II). Eur J Prev Cardiol 27(16): 1756-1774.
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