"Myocardial infarction and stroke in Russia have become 10 years younger"
Cardiovascular diseases are rapidly "getting younger" all over the world, said Andrey Pronin, head of the Cardiology department of the Federal Center for Brain and Neurotechnology of the FMBA of Russia, cardiologist, in an interview with Izvestia. In Russia, the average age of patients with such diagnoses is now 40-55 years old, and hypertension is increasingly being detected in people under 35. According to the expert, the increase in morbidity is associated with stress, unhealthy diet, bad habits and low physical activity, as well as the fact that many people consult a doctor already at the stage of severe symptoms. On the eve of World Cardiologist's Day on July 6, Andrey Pronin told Izvestia what factors affect heart health and how to reduce the risk of developing pathologies.
"Hypertension occurs in 40-45% of Russians"
— Which cardiovascular diseases are more often diagnosed in Russians?
— Cardiovascular diseases are an urgent problem both in Russia and around the world. Despite huge progress in diagnosis and treatment, they still significantly affect life expectancy and quality of life. Almost 2/3 of all deaths are related to them. The risk of developing them increases over the years and is especially high in older people.
Hypertension, which is characterized by a persistent increase in blood pressure, occurs in 40-45% of Russians. It is often the beginning of all cardiovascular problems. Among the most common are various types of coronary heart disease, cardiac arrhythmias and conduction disorders, and heart failure.
All these pathologies enhance the progression of each other and increase the likelihood of vascular disasters such as myocardial infarction or stroke. They remain one of the main causes of sudden death.
— And what is the reason for such a high mortality rate?
— This is a combination of risk factors and insufficient attention to them, primarily on the part of the patient himself. For example, many people neglect preventive medical examinations, which make it possible to detect hypertension, diabetes mellitus and other pathologies at an early stage.
As a result, treatment begins untimely or is not carried out in full, the condition worsens, and acute complications appear. At the same time, the development of vascular centers and modern treatment protocols has already reduced mortality from heart attacks and strokes in Russia by 33% over the past two years, and now the course is aimed at further reducing the number of severe outcomes.
At the same time, an increase in the detection of cardiovascular diseases does not always mean that there are more of them. This is more often due to the fact that medicine has become more accessible, and diagnostics have become more accurate and broader.
— What influences the development of cardiovascular diseases?
— Modifiable factors, that is, those that can be adjusted, include a person's lifestyle. But there are also risk factors that we can practically not influence. This is a genetic predisposition, as well as a combination of age and gender.
It is known that cardiovascular diseases in men often manifest 10-15 years earlier than in women, and often immediately in severe, dangerous forms. The average age of morbidity for men is now 40-45 years, for women - 55-60 years.
— According to research, heart diseases are rapidly "getting younger." Why is this happening?
— In recent years, cardiovascular diseases have really begun to occur at an earlier age in Russia and around the world. Hypertension is quite common in people aged 30-35 years. Heart attacks, strokes, heart failure, and cardiac arrhythmias have "rejuvenated" by an average of 5-10 years.
The main reason is ignoring risk factors: prolonged stress, irregular working hours, lack of balance between work and rest, lack of movement, unhealthy diet and bad habits. Many people do not pay attention to the first symptoms of diseases.
For example, a young man in his 20s or 30s with an unstable schedule of work or study, or sometimes both, is already living under constant stress. We will add smoking and periodic consumption of alcohol, fast food, energy products and beverages in excess of the doses specified by the manufacturer. This, he thinks, helps him cope with stress. But in the end, it turns out that the person has already collected almost all the risk factors.
In his case, cardiovascular diseases will probably manifest themselves in 10-15 years. And if there is a hereditary predisposition, they can make their debut much earlier. The youngest heart attack I've seen was in a 22-year-old patient. That's what I just described in the example.
"People go to the doctors when symptoms already appear"
— Do cardiovascular diseases often lead to strokes? In what situations does this happen?
— It happens quite often. In general, ischemic or hemorrhagic brain damage is a complication of the pathology of the cardiovascular system. They cannot be separated from the heart, much less from the vascular system.
Several diseases lead to the appearance of these sometimes fatal complications. For example, vascular atherosclerosis is the deposition of cholesterol in the vessel wall with the gradual growth of plaque and closure of the artery to 100% or rupture of this plaque itself. In its place, a blood clot may form, blocking the vessel or flying into remote areas of the bloodstream in the brain.
Hypertension, especially in combination with diabetes, smoking, and elevated levels of uric acid and cholesterol, gradually damages the walls of the arteries feeding the brain, leading to either blockage or rupture of the vessel. Up to 30-40% of ischemic strokes are of the "cardioembolic subtype" — a blood clot forms in the heart, reaches and clogs the artery of the brain with the blood flow. And the prerequisites for the creation of such blood clots are cardiac arrhythmias.
Increases the risk of stroke and heart failure — a weakening of the pumping function of the heart, which causes blood to slowly circulate through the body, which means it does not deliver nutrients well and takes away waste in all organs and tissues, including the brain.
— If the patient did not go to the doctor on time, then the time has already been lost?
— It is worth repeating that people most often seek medical help when pronounced clinical signs are already appearing. No, this does not mean that time has been lost and now there will only be a negative scenario. But if a person had applied earlier, for the purpose of prevention, then, with a high degree of probability, this stage of the disease would have developed much later, which means that the chances of maintaining both the quality of life and its duration would be higher.
Many new methods and markers have already been developed and are being actively implemented to help predict the development of vascular disasters. Such research is actively underway at the Federal Center for Brain and Neurotechnology of the FMBA. In particular, laboratory parameters are being developed that could indicate the likelihood of stroke and heart attack in a patient after a certain time.
"AI has become an integral part of modern medicine"
— What innovative methods are used in Russia for the diagnosis and treatment of cardiovascular diseases?
— In Russia, there is a wide range of laboratory and instrumental diagnostic methods, the choice of which is determined by the specific situation. Our center uses an integrated approach: along with assessing the state of the cardiovascular system, we study the levels of lipids, thyroid hormones, and other endocrine parameters, if necessary.
To assess the work of the heart, electrocardiography is performed, and, if necessary, one of the stress tests is performed, when cardiac activity is studied under dosed physical activity. They help to assess the endurance of the heart and identify possible blood supply disorders that may precede acute myocardial infarction.
Then, depending on the result, computed tomography of the chest is performed to exclude lung pathologies, or coronary angiography to visualize the volume of damage to the heart vessels. Additionally, other examinations may be prescribed according to the indications, for example, daily blood pressure monitoring.
These methods are highly informative and are performed in many medical institutions. The doctor's escort also plays an important role. He evaluates the need for them and interprets the results.
— Is AI often used in the diagnosis of cardiovascular diseases?
— Artificial intelligence has already become an integral part of modern medicine and cardiology in particular. One of the most developed areas is the analysis and interpretation of instrumental diagnostic methods, such as decoding electrocardiograms and echocardiography. Predicting the course of the disease, selecting therapy, remote monitoring of the patient using AI — all this is already our "today".
And "tomorrow" (I would like to emphasize that this is my personal opinion), there is a high probability of creating a model in which a doctor of a therapeutic specialty, in particular a cardiologist, may simply become unnecessary. Or he will remain as a "process controller".
— How to keep your heart healthy for many years?
— An important role is played by the ratio of work and rest, as well as proper sleep and a balanced diet. It is best to follow the Mediterranean diet (based on fresh vegetables and fruits, legumes, whole grains and dairy products; less often — fish, poultry, red meat and eggs. It is necessary to give up the bad habits of smoking and drinking alcohol. It is necessary to move more during the day, and physical inactivity should not be allowed.
In addition, it is important to undergo preventive examinations for any changes in well-being and even in their absence at least once a year. This makes it possible to detect diseases at an early stage, when they still do not give noticeable symptoms.
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