2023-07-24 07:21:45
Why is it useful to move a lot in the park, but harmful at work? Cardiologist Alexei Erlikh analyzes the main misconceptions regarding cardiovascular diseases.
Alexey Erlikh
“Just took and died”
– Many people around me are afraid not so much of cardiovascular diseases as of oncological ones.
– Probably because regarding cancer for a long time it was believed that it was incurable. This word was pronounced with absolute doom. Plus, the attitude towards heart disease was a little bit romantic – it seems like it’s something noble, sublime.
Now it is quite clear that there are different heart diseases that manifest themselves in different ways. Unfortunately, with some of them it happens like this – a person took and died. In fact, this is the worst. It is with such situations that doctors try to fight especially actively and aggressively, because “he took and died” is premature death. No matter how much they say: “I just want to fall asleep and not wake up.” In what situation will he put his loved ones with unfinished business, with an unfinished life, with undergrown children?
And for the state, this situation is no better, because premature death is the withdrawal from the activity of a person who works, benefits, and pays taxes.
Sudden death is very bad, and everyone has an interest in fighting it.
Other heart diseases, on the contrary, bring suffering to patients no less than with cancer, only of a slightly different kind. It seems to us that cancer is pain, and heart disease is shortness of breath.
“Looks like crap, no big deal.
– How to say. In the modern world, a person successfully survives heart diseases, from which he would have taken and died in the 60–70s, but following a heart attack, he encounters severe heart failure, which severely limits mobility. There are many studies on how soon patients with a diagnosis of cancer and a diagnosis of heart failure die. This is regarding the same figure.
Some cancers are even milder than heart failure, and the five-year survival rate for some cancers is better.
Therefore, heart disease is a serious problem for the family, society as a whole, and for the health care system.
“I move a lot – I run all day at work”
– And prevention – do not drink, do not smoke, play sports?
– Just not sports. A question of terminology. Experts of the European Society of Cardiology or the American Heart Association, telling patients regarding primary and secondary prevention of cardiovascular diseases, say that this is 30-60 minutes a day of moderate physical activity in addition to regular. Walk to the store, walk your dog in the park. It is not necessary to wear sweatpants and cut circles around the house.
– Running from a heart attack, as they once said.
– No, if you like to run, then please. Especially if you know to what pulse you need to bring the load so that it is adequate and useful for preventing the disease. With the help of modern gadgets, you can easily control your heart rate and not be overloaded. In general, this is not a sport or physical education, but an increase in physical activity.
In general, we all move very little right now – even those who think they move a lot. Sometimes you hear from patients: “I run all day at work, I won’t sit down.” There have been studies that have shown that if a person moves a lot at work and does not move additionally, then on the contrary, this exacerbates his cardiovascular risks.
– Smoking – in any case?
– In no case. Drop it right now. So far, there is nothing to suggest otherwise. Smoking is associated with early dying, early atherosclerotic diseases, not to mention cancer.
If a person smokes a pack a day, then his risk of cardiovascular diseases increases tenfold. If he smokes one cigarette a day, this risk is regarding twice that of a non-smoker.
Therefore, zero cigarettes a day, as various experts used to say, is really important.
– Do you welcome such restrictions as scary inscriptions and the fact that cigarettes were removed from the windows?
— I welcome any reasonable restrictions on smoking. For example, in New Zealand, Parliament passed a law that anyone born following 2012 is prohibited from buying cigarettes in the country. They are raising generations of non-smokers.
I must say that Russia almost took the same path. When Veronika Igorevna Skvortsova was our Minister of Health, she and the Ministry of Health wrote such a paper on the development of health for the coming years and proposed a ban on selling cigarettes to everyone who was born following a certain year. It was, of course, a revolutionary decision, but it did not pass the Ministry of Labor, the Ministry of Finance, or something else.
Russia would be a unique country, because no one in Europe has done this before.
We can ban.
“But at the same time, all the restrictions that we introduced 6-8 years ago, in my opinion, do not work very well. Although the number of smokers seems to be decreasing. Perhaps the scary pictures on the packs make sense. Increasing the price of cigarettes definitely works. But the state has different mechanisms of struggle, except for raising prices. You can sell debranded cigarettes – just a pack with the inscription “cigarettes”, without specifying the brand.
Do not write on cigarettes that they are light, so as not to give the impression that some are less harmful than others. Don’t sell thin cigarettes so people don’t think they’re less harmful. Do not sell by the piece (they don’t seem to do this anywhere else), so that the children do not have enough money for them.
What is trans fat and how to eat it
– In Armenia, salt is no longer put on the table in restaurants, you need to specifically ask for it. What foods are harmful in terms of cardiovascular disease?
“Salt restriction is a useful story, although some experts dispute this.
However, the recommendation to limit salt intake is included in all recommendations for people who already have cardiovascular disease, as well as for those who are healthy.
A couple of years ago, at some of the congresses, the results of an experiment in one of the countries of Latin America were reported: in the salt that was sold in stores, they balanced NaCl with KCl so that the taste was the same, and there was less sodium. After a few years, the mean arterial pressure in this region decreased. In our stores, by the way, salt with a reduced sodium content is also sold.
It is often recommended to replace salt with something spicy and spicy, add more spices than salt.
Does sweet have a strong effect on the risk of cardiovascular disease?
– Sugar is not bad in itself, but in the composition of factory confectionery, because there is also fat. Sugar itself is not very high in calories. 1 gram of sugar is 4 kilocalories. 1 gram of fat – 8 kilocalories. To normalize weight, it is necessary to reduce fat rather than sugar. Sugar in marmalade or sugar in jam is healthier and more correct than sugar in cakes.
If we return to the products that I would completely remove from the human diet, then these are the so-called trans fats, a real scourge of modern society. Remember, there was soft butter?
– Yes, sure. Bread and Rama are made for each other.
– That’s exactly right. It is a hydrogenated polyunsaturated fat. Polyunsaturated means not of animal origin; hydrogenated – that is, modified. Atherosclerotic plaques actively grow from it. Trans fats are cheap, so they are used in all industrial cooking. It looks like melted white plasticine. In fast foods, potatoes and chicken are fried on it, plus any freezing – dumplings, meatballs – everything that is done in production is made using trans fats. Therefore, homemade food is better than store bought.
In America, their regulatory body, the FDA, is enforcing a ban on trans fats. This will lead to a rise in the price of products, but their harmfulness will undoubtedly decrease.
About the dangers of medical examinations
– With food, more or less clear. What is the role of planned medical research and general medical examination?
“There is nothing total in this field of medicine. Take, bring the entire population from the age of 18 to the doctor, of course, you can. It will take a lot of money, but there will be no sense.
For the prevention of cardiovascular diseases, there are special rules that are clearly stated.
From the age of 40 for men and from 50 for women, it is necessary to assess cardiovascular risks.
The risk assessment includes indicators of cholesterol, as well as indicators of blood pressure, body weight, bad habits, and medication. As a result, doctors decide which risk group the patient belongs to and how further they need to be examined. If the risk is low, you can invite him to come back next time in five years.
The same with blood pressure. It is believed that from the age of 18 you need to measure your blood pressure at least once. If it is normal, following 5 years you can try once more.
Every year you don’t need to drive everyone in a row. I have come across situations where everyone is measured for blood pressure, cholesterol, body weight – all this is carefully recorded, they say: “You are free.” Then it turns out that the cholesterol level went through the roof and no one did anything.
– High – what is it?
– For different categories of people there are different target indicators of cholesterol and its fractions. If you take total cholesterol, which is not of great importance, a figure above 5 should alert.
But in the modern world, low-density lipoproteins are used as a marker – what used to be called “bad cholesterol” in everyday life. This fraction of cholesterol carries saturated fats, which form the bulk of atherosclerotic plaques.
The level of this low density lipoprotein for a healthy person should ideally be less than 2.6.
For a person who already had some kind of heart disease, for example, he had a heart attack, or he had a stroke, the indicator drops to more stringent numbers – less than 1.4. In general, for high-risk patients, the lower the cholesterol, the better.
– You said that people are undergoing medical examinations, they are told that everything is fine with them, but in reality everything is not so. Why?
– Can you imagine what a dispensary is? 200 people come to the clinic at the same time, they all need to measure something, write it down – this is a conveyor belt.
Medical examination, unfortunately, is done in order to report. And in order to identify diseases, you need to take people at higher risk, let them fill out a simple questionnaire. Then invite someone immediately for examination, and someone later. Everything can be customized. In civilized countries there is no total medical examination, they understand that it is expensive and inefficient.
The state as a source of stress
– Why are men who need to have their heart checked at the age of 40, a greater risk group for a heart attack than women?
– Not certainly in that way. Men at a young age – it’s true, a large risk group. Women following 50 and 55 are catching up and overtaking them. In the cardiology department of the hospital, there are mostly elderly women and relatively middle-aged men.
The simplest explanation is that women up to a certain age are protected by female sex hormones, which in some favorable way affect the function of the endothelium, the inner lining of blood vessels where plaques are deposited. It is believed that the more estrogen, the less the likelihood of plaque deposition.
How much does social stress affect cardiovascular disease? They say that in the 90s there were more of them.
– It depends what you mean by stress: from problems in the family and at work to a large emission of any harmful substances into the atmosphere or political conflicts. Living in the city is stressful in itself. Sleep deprivation too. From each such component, you need to try to get rid of a person. Doctors often say “try to be less nervous,” but how can you follow this advice?
– Have you personally had such a thing following February last year that your heart will beat, then it will stop a little, then it will start beating once more?
Not that, but something else. In some way, we all have experienced it and are experiencing it.
Lack of faith in the future is undoubtedly also stressful. But how it affects directly, no one has ever studied.
There are studies that show that the more different adverse environmental factors that we combine with the word “stress”, the greater the risk of cardiovascular disease.
What should public health do to prevent an increase in cardiovascular disease?
– Many things. On the one hand, probably, the state can help people understand how to eat right, give subsidies to stores for selling more healthy products. We used to come up with prevention programs with Moscow cardiologists, and we had an idea to make discounts for those who buy good and correct products.
Alexey Erlich. Photo: Varvara Lozenko / afisha.ru
The state can introduce an insurance system that would encourage people to be healthier. A smoker must pay more for their insurance than a non-smoker. If you quit smoking, you will pay less.
– I was told regarding a man who said: “My business is to smoke, and the state’s business is to put stents on me at the expense of compulsory medical insurance.” One such operation cost 300 thousand.
– The state should treat its citizens – this is a social contract between citizens and the state, although it is strange to remember this now.
But it should also help people take care of their own health.
For many years of living in the Soviet Union and for many years of living in modern Russia, we are so used to the fact that someone else takes care of our health that we still believe that medicine should be free.
But in fact, it exists on taxes, and it is not we who pay them, but our employer. If we paid it out of our own pocket, consciously choosing an insurance program for ourselves, we would understand that by reducing weight by 10 kilograms and quitting smoking, we would give less money.
“They live with high cholesterol and don’t know it”
— Is it true that Russia occupies one of the first places in Europe in cardiovascular diseases and that the situation has improved in recent years?
– Russia is still included in the cohort of countries with an excess risk of cardiovascular diseases. There is a SCORE-2 risk assessment scale, where the risk of developing a heart attack, stroke or death from it in 10 years is estimated according to various indicators. There are countries with low risk, moderate risk, high risk, and a separate group of countries with excessive risk. Russia is included in this last group.
All men over the age of 50 are automatically considered high-risk patients for cardiovascular diseases, regardless of pressure or cholesterol – just by the fact of living in Russia, unfortunately. Therefore, the problem of cardiovascular disease remains catastrophic.
– How is it “in fact of life in Russia”? The country itself has
– No, just statistically, the incidence is such that no matter how much decline Rosstat shows us, experts – which includes the Russian Association of Cardiology – classify Russia as a country with excessive risk. In our country, every man over 50 years of age has a high risk of heart attack and stroke and die at an early age. Or he will be disabled, and the state will bear heavy financial costs for his treatment.
– But regarding the decline – right? How do you feel it is happening?
“I’m afraid it’s some kind of statistical manipulation.
In the Soviet Union, there was a terrible mortality from hypertension, in the formulation of a post-mortem diagnosis, it was in the first place. In the 70s, they decided to fight it and issued an order: write “heart attack” or “stroke” in the first place. Well, they reported a significant decrease in mortality from hypertension.
It’s hard for me to talk regarding my feelings, but I see how many underestimated high-risk patients. People live with high cholesterol or untreated blood pressure and don’t know they need to see a doctor. Now, working in the outpatient network, I began to see much more such patients. It’s even more depressing than seeing patients in intensive care.
Photo: pexels.com
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