Primary and early secondary prevention of cardiovascular diseases. The screeninig investigation of risk factors of ischemic heart disease in students (practical part). Doc. MUDr. Jindra Šmejkalová, CSc.
Non pharmacological treatment of hypertension includes:
Body weight reduction;
Limitation of using the salt (2,3 g Na or 6 g NaCl);
Suplement of potassium and magnesium, calcium;
Limitation of alcohol consumption (less than 25 ml of pure etanol per day)
Reduction of intake of saturated fats;
An increase of intake of poly-non saturated ones;
Increase the physical activity (PA) – aerobic (endurance) PA. At least 3 times a week intensive physical movement, when the pulse rate reaches 70% - 85% of maximum. Exercising lasting at least 20 minutes;
Stress management, mastering the relaxation techniques;
Intervention of other risk factors, namely hypercholesterol e m ie .
Non pharmacological procedures may quite normalize a light hypertension and support the pharmacotherapy of more advanced hypertension.
Blood level of cholesterol represents one of the basic indicators of CVD risk.
Within the life span the level of total blood cholesterol increases from 2,8 mmol/l in small children up to 6,2 in elderly.
Higher LDL cholesterol level represents the risk factor of CVD, an increased HDL cholesterol level on the contrary acts protectively.
Total cholesterol (mmol/l): normal level under 5,2
(better still under 4,1!)
limit level 5,21 – 6,49
high risk above 6,5
In people under 30 years of age we recommend the level being bellow 4,2 mmol/l
The LDL concentration in patients with already present cardiac ischemic disease should not exceed 2,6 mmol/l, in patients without ischemia but with two risk factors present 3,4 mmol/l a nd in others 4,1 mmol/l.
Preventive procedures recommended in primary care:
Assessment of cholesterol blood level should be performed selectively in persons with a found or suspected some other risk. The wholesale screening investigations are not being recommended.
The check ups should be repeated in adults with normal or borderline results within the 5 years intervals. In the Czech health insurance institutions plans the interval are lasting 10 years but if necessary also shorter.
The persons with a high risk are indicated for the preferential investigation. These high risks are:
Xantelasmata occurrence before 50 years of age;
Family history of premature death for coronary episode, myocardial infarction in persons younger than 50 years;
Diabetes or CVD appearance before 65 years of age ;
Persons of middle age with two or more other risk factors: smoking, hypertension, obesity, diabetes, lack of movement.
Each investigation of cholesterol must be completed by a qualified discussion explaining the reason of check up, implication of data found, and recommendation of healthy feeding.
We recommend to restrict the fat intake, so that their share in the whole energetic income was lower than 30 % (even better less than 25%) and from that amount the saturated fatty acids represent only 10%. To cut the daily intake of cholesterol in diet for less than 300 mg.
The comprehensive analysis of lipids spectrum as well as the pharma c otherapy to consider in patients with the total cholesterol level above 7,8 mmol/l and in those with the level above 6,5 mmol/l, whose answer for the diet intervention was not satisfactory during the 3 – 6 months interval.
HDL – transports cholesterol from the peripheral tissues into the liver. The HDL concentration should be 0,9 mmol/l at least. Reasons for lower level of HDL : - after meal (as much as for 10%) - smoking - android type of obesity, - hypertriacylglycerolemia - some drugs (beta blocators) - genetic disposition. To increase the HDL is possible by - Reduction of weight ; - Sufficient movement activity ; - spirits consuming; - some hypolipidemics (statin s , fibrates, nicotin acid). Aterogenic index : ratio between total cholesterol to HDL – it should be < 5,5 mmol/l.
Behaviour with a high activation of neurological system . Inner need to reach ever more and more results with still shorter time intervals.
This behaviour is typical with: high ambitions, competition, vigour, ag g resivity, easily roused hostility, ever lasting feelings of lack of time, permanent time planning and organizing, impatience.
Among the specific manifestations of type A behaviour there belong a fast pace of most of the activities and permanent readiness. Also typical are loud, quick and emphatic speech and strained muscles. In emotional answers irritability, anger and hostility are easy to be traced .
Type A behaviour is a complex reaction and results from a number of personal and social environment components.
Table of coronary risks (see bellow) – estimation of ischemic heart disease risks in patients , who still have no ischemic disease manifestation . This serves to the determination of absolute risk of ischemeic cardiac disease during the next 10 years.
Into the group with the high risk there belong asymptomatic individuals, whose absolute risk reaches 20 % and more within the next 10 years or in the younger age projected into 60 years reaches 22% or more.
In accordance with the fact that ischemic cardiac disease is conditioned multifactorially, the prevention should not stress too much any individual risk factor.
On the basis of assessment of presence and gravity of all the main risk factors to point out the individuals with an increased absolute risk.
Level of risk : low - slightly increased - medium - high - very high