Prevention of Cardiovascular Diseases
Underlying atherosclerosis is developed insidiously in many years, and is usually advanced when symptoms appear. Death from CVD often occurs suddenly, before providing access to healthcare, so many therapeutic interventions are inapplicable or palliative. Mass occurrence of CVD is closely correlated with lifestyle and modifiable physiological and biochemical factors. It has been shown that modification of risk factors reduces CVD morbidity and mortality, especially in high-risk patients. Cardiovascular disease affects both men and women; between the deaths before the age of 75 years in Europe, 42% are due to CVD in women and 38% in males. It was observed that cardiovascular mortality has decreased by 50% if they took measures related to risk factors and 40% by improving the treatment.
Priorities for CVD prevention in clinical practice are patients with atherosclerotic CVD installed; asymptomatic individuals at high risk of CVD by multiple risk factors that result in increased total risk of CVD (CVD mortality risk ≥ 5% at 10 years), those with diabetes mellitus type 2 and type 1 with microalbuminuria in case of the marked increase of a single risk factor, especially if associated with target organ damage; first degree relatives of patients with early atherosclerotic CVD or with very high risk.
CVD prevention goals
They are to help people with low risk of CVD to maintain this status throughout life, and help those with increased total risk of CVD to reduce it; to achieve the characteristics of people who tend to stay healthy: no smoking, choosing a healthy diet, physical activity: 30 minutes of moderate activity per day, BMI (BMI) <25 kg/m2 and avoidance of central obesity, BP values <140/90 mmHg, total cholesterol <5 mmol / L (~ 190 mg / dl), LDL-cholesterol <3 mmol / L (~ 115 mg / dl) glucose <6 mmol / l (~ 110 mg / dl).
Other important concerns in ways which we achieve greater control of risk factors in high-risk patients, especially those with established CVD or diabetes: Blood pressure <130/80 mmHg, if possible; Total cholesterol <4.5 mmol / L (~ 175 mg / dl), optionally <4 mmol / L (~ 155mg/dl), if possible; LDL-cholesterol <2.5 mmol / l (about 100 mg / dl), optionally <2 mmol / L (~ 80 mg / dl), if possible; Fasting plasma glucose <6 mmol / l (~ 110 mg / dL) and HbA1c <6.5%, if possible. To consider cardio-protective drug treatment in these high-risk patients, especially those with atherosclerotic CVD installed.
All persons should be advised on the choice of foods that are associated with a reduced risk of CVD. If possible, the high-risk persons must receive the expert advice on the diet.
Must be consumed a wide variety of foods; it is necessary a caloric intake adjustment to prevent overweight; must be encouraged the consumption of fruits, vegetables, cereals and bread, fish (particularly fatty fish), lean meat, low-fat dairy products. Replacing the saturated fats with the food mentioned above, and polyunsaturated and monounsaturated fat of vegetable or marine origin, for reducing the total lipids to <30% of the energy, of which less than one-third the fat is saturated.
You must reduce the salt intake if blood pressure is increased, by avoiding adding salt to meals, in cooking and by choosing fresh foods or frozen unsalted. Many processed and prepared foods, including bread, have a high salt content. Increased body weights is associated with increased mortality and total morbidity and through CVD, mediated in part by high blood pressure and cholesterol, reduced HDL-cholesterol and increase the probability of developing diabetes. Weight loss is recommended for obese individuals (BMI ≥ 30 kg/m2) and should be considered in overweight people (BMI ≥ 25 and <30 kg/m2). Men with a waist circumference of 94-102 cm and women with a waist circumference of 80-88 cm extra weight must not increase. A waist circumference over 102 cm in men and over 88 cm in women weight loss is recommended. Reducing total caloric intake and regular exercise is essential for weight control. Perhaps that improving fat metabolism through exercise center just before weight loss occurs. Any increase in the level of physical activity has positive effects on health; small efforts have an additive effect; there are opportunities to make exercise even at work, for example climbing stairs instead of using the elevator. Try to find leisure activities that are enjoyable and have a positive effect.
Moderate exercise 30 minutes 5 days / week will reduce the risk and increase stamina. Making exercise with the family tends to increase motivation; additional benefits including a good state, weight loss and feeling better about yourself; continued encouragement and support may be useful in the long-term.
People find it difficult to change their lifestyle for many reasons: low socio-economic status, including low educational level and low-income is a barrier to adopt a different lifestyle; social isolated people who live alone are more prone to unhealthy lifestyle habits; stress at work and at home makes it difficult to adopt and maintain healthy habits; negative emotions, depression, anxiety and hostility prevents changing your lifestyle; complex or confusing advice. Better awareness of these factors by physicians facilitates the empathy, counseling and provision of comprehensive recommendations, simple and explicit.
To facilitate the prevention of cardiovascular disease in practice, simple, clear and credible guidelines are needed, enough time spent with the patient, positive and useful government policy (defining prevention strategies related resources and incentives, including pay for prevention as well as treatment) , educational policies that facilitate the patient adherence counseling.