Heart Disease Can be Prevented, and This is How
The life expectancy of the population has increased considerably in recent decades. Currently, the average years of life are approximately 75 years. This increase is largely due to the eradication of diseases, the reduction in mortality from frequent pathologies, and many changes in customs and daily life, such as improved food control or the generalization of hygiene measures.
Cardiovascular disease has been one of the most advanced fields of medicine. If we look back a couple of decades ago, the stroke or heart attack often involved a fatal outcome. Today, the prognoses have changed and many patients manage to recover and live completely normal.
However, according to WHO data, cardiovascular disease remains the leading cause of death worldwide. Each year cardiovascular diseases are estimated to be directly related to 30% of all registered deaths in the world. Therefore, the development and use of effective preventive measures to reduce these figures in the coming years is essential.
The prevention of cardiovascular diseases is based on the management of cardiovascular risk factors using pharmacological means or changing lifestyle habits; It is also essential to establish a timely diagnosis and adequate treatment for each patient.
Heart Disease Causes
Serum Lipids
Cardiovascular risk increases as serum cholesterol rises, potentiating other risk factors. Lowering serum cholesterol has been shown to be associated with lower cardiovascular mortality. The use of fibrates (drugs that help lower triglyceride levels) help reduce cardiovascular mortality, but does not lead to a reduction in overall mortality. In contrast, studies carried out using statins (hypocholesterolemiants) have demonstrated a reduction in general mortality, both in primary and secondary prevention.
The magnitude of cholesterol reduction probably influences long-term outcomes, as studies have found a close association between the magnitude of cholesterol concentration reduction and the resulting lower mortality. Reductions greater than 25% of initial cholesterol are likely to be associated with significantly better survival. Recent studies have reinforced this concept by showing that aggressive treatment of cholesterol concentrations is equally effective as angioplasty in the long-term management of patients with stable angina.
Arterial Hypertension
Regarding high blood pressure, the results are similar. Various studies have shown an association between the magnitude of the reduction in blood pressure levels and a reduction in mortality. As for cholesterol, there is probably a threshold level of reduction in blood pressure levels required to obtain significant beneficial effects. A 5-6 mmHg reduction in diastolic blood pressure is associated with a 35% lower incidence of vascular accidents and a 25% lower incidence of acute myocardial infarction.
It is likely that the objectives of antihypertensive treatments should be adjusted to reach this optimal value, which should be the one with the best cost-effectiveness ratio. It had been postulated that the type of antihypertensive medication could influence the long-term results of treatment.
Obesity
Abdominal obesity is associated with insulin resistance, hypertriglyceridemia, and hypertension. There is a clear association between excess weight and increased mortality from cardiovascular disease. Weight reduction has an important effect on the survival of patients since it is associated with reductions in serum lipid concentrations and blood pressure. All of these arguments lead to the suspicion that the cost-benefit performance of weight loss programs is probably very important.
“Weight reduction has an important effect on the survival of patients since it is associated with reductions in serum lipid concentrations and blood pressure.”
Sedentary
Another potentially modifiable risk factor in primary and secondary prevention programs is a sedentary lifestyle. Again, it is clearly demonstrated that individuals who have some physical activity, such as walking 30 minutes a day or more, have significantly longer survival than sedentary individuals.
In the elderly, there is concrete evidence that resistance training reduces disability, loss of lean mass, and improves the quality of life. These evidences suggest that physical training reduces coronary mortality, the stimulation of moderate physical activity, such as walking, or the development of physical training programs that use cheap and simple means that can be carried out by clients at home. it will have a positive impact on the quality of life and, probably, on cardiovascular mortality.
Smoking
The deleterious effects of smoking are widely known. In addition, various studies have shown that passive smoking increases the risk by more than 70% in non-smokers and its association with other risk factors has a high statistical significance.
Programs to help patients quit smoking are known to have success rates that range from 5 to 40%, depending on the actions taken. Minimum interventions, in which a health professional detects smoking and recommends quitting during the regular consultation, are successful at 5%, while multidisciplinary programs that include multi-professional teams can achieve the success of around 40%. The use of nicotine replacement therapy, although effective, greatly increases the costs of the programs and decreases their cost-effectiveness. Thus, in prevention programs, it is very important to detect smoking and advise its cessation, although this is the only action taken in this regard.
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Hyperhomocysteinemia
Homocysteine, a circulating sulfur amino acid in very low concentrations, has recently gained importance as an important cardiovascular risk factor. Because detoxification of this amino acid depends on an enzyme that uses folic acid and vitamin B 12 as cofactors, supplementation with these vitamins or food fortification easily reduces their concentrations.
Reduction of homocysteine concentrations has been shown to be associated with an improvement in vascular reactivity in monkeys, suggesting that a reduction in vascular events will eventually be found with folic acid supplementation. If the decision were finally made to reduce homocysteine concentrations as part of cardiovascular prevention programs, fortification of foods with folic acid is likely to be chosen, which has proven to be an efficient way of modifying amino acid concentrations.
Diet Habits
Diet has an effect on cardiovascular risk, which is independent of the effects it may have on serum lipids. Among the most important nutrients that should be mentioned, omega-3 fatty acids and trans fatty acids have a fundamental role.
Omega-3 fatty acids are highly polyunsaturated and mainly come from cold-water fish. These fatty acids have been shown to reduce platelet aggregation and blood pressure values, and have a modest effect on triglyceride levels. More than dietary supplementation with these fatty acids, eating fish two or more times per week has been shown to be associated with a significant reduction in cardiovascular mortality. The consumption of vegetable origin proteins is also recommended.
Trans fatty acids are generated during the industrial hydrogenation of oils, a process widely used for the manufacture of margarines. The spatial conformation of these fatty acids causes changes in membrane function and unfavorably alters HDL and total cholesterol concentrations. Various epidemiological studies have given good arguments to believe that restricting the consumption of these hydrogenated fatty acids and saturated fat is associated with significant reductions in cardiovascular risk.
These data allow us to deduce that dietary modifications not necessarily aimed at reducing cholesterol, pressure, or calorie intake, will also have beneficial effects on cardiovascular mortality when applied in primary or secondary prevention programs.
“eating fish two or more times per week has been shown to be associated with a significant reduction in cardiovascular mortality. The consumption of vegetable origin proteins is also recommended.”
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Sources
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3. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study. Lancet 1994; 344: 1383-1389.
4. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
5. Cardiovascular disease prevention. A challenge for Latin America. Circulation 1998; 98: 2103-2104.