Primary prevention of coronary artery disease includes the following activities. Secondary Prevention of Ischemic Heart Disease ⋆ Heart Treatment

In the treatment of patients with coronary artery disease (CHD), the objectives of the strategic plan are addressed within the framework of the secondary prevention program. These include: prevention of premature death, inhibition of progression and achievement of partial regression of atherosclerosis of the coronary arteries, prevention of clinical complications and exacerbations of the disease, reduction in the number of cases and the duration of hospitalization, especially urgent ones.

The drug component of secondary prevention includes the use of: acetylsalicylic acid (ASA) - aspirin cardio, thrombotic ACC); β-blockers - atenolol, metoprolol, nebivolol, sotalol, timolol; ACE inhibitors - captopril, enalapril, quinapril, lisinopril, moexipril, perindopril, ramipril, cilazapril, fosinopril, etc.); lipid-lowering drugs - statins - lovastatin, simvastatin, atorvastatin calcium, pravastatin, fluvastatin, cerivastatin sodium.

The non-drug part of secondary prevention involves: healthy eating, smoking cessation, increase physical activity(use of training physical exercises), normalization of weight, lowering blood pressure, lowering total cholesterol (cholesterol), lowering low-density lipoprotein (LDL) cholesterol, optimizing blood sugar. However, as shown by the results of a specially conducted study Euroaspire-II, in Europe, these recommendations are not taken into account by everyone. So, every fourth patient with signs of coronary artery disease continues to smoke, every third is overweight. Half of the high-risk patients do not meet their blood pressure and total cholesterol targets with medication. In addition, in most of these diabetic patients, blood glucose levels are not well controlled.

During the next visit of the patient to the doctor on an outpatient basis, it is necessary to assess not only the patient's complaints and his condition, but also the patient's ability to cope with some risk factors, the effectiveness and possible side effects of the therapy.

Secondary prophylaxis drugs

ASA and other antiplatelet agents. ASA - aspirin cardio, thrombotic ACC - today is practically the only antithrombotic drug, the clinical efficacy of which in secondary prevention has been confirmed by numerous controlled studies and meta-analyzes. The mechanism of action of ASA is the irreversible inhibition of platelet cyclooxygenase activity with a subsequent decrease in the synthesis of thromboxane A2 and prostacyclin. ASA blocks the platelet release reaction induced by ATP and norepinephrine. Cyclooxygenase inhibition persists for 7-10 days (platelet lifespan). There are different individual sensitivity to ASA, however, clinical diagnostics and methods for assessing this parameter have not been fully developed.

According to modern international recommendations, all patients with coronary artery disease, in the absence of contraindications, should take aspirin at a dose of 75-325 mg / day, regardless of the presence of cardiac symptoms. It has been proven that prescribing ASA to patients with stable angina pectoris significantly reduces the risk of developing cardiovascular complications (by 33-50%). Suppression of platelet function is apparently accompanied by suppression of thrombus formation, which is manifested by a decrease in the incidence of thrombotic complications of atherosclerosis. Long-term regular treatment with ASA at doses of 75-325 mg / day is accompanied by a 20-40% reduction in the risk of recurrent myocardial infarction. An ASA dose of less than 325 mg has been shown to be equally effective in reducing the risk of other cardiovascular complications in patients with coronary artery disease. At dosages below 75 mg / day, the prophylactic effect decreases, at dosages above 325 mg, the frequency of bleeding increases, especially gastrointestinal. Comparative studies have shown that the effectiveness of ASA in the prevention of recurrent heart attacks is comparable to that of the appointment of indirect anticoagulants. ASA, when administered in the early period after coronary artery bypass grafting, reduces the incidence of graft thrombosis by 50%. Most patients with coronary artery disease should take ASA throughout their lives. For secondary prevention of coronary artery disease, aspirin is prescribed in small doses (75-150 mg / day), with increased risk thrombosis, the dose of the drug is increased to 325 mg / day.

Currently, the dominant point of view is that ASA should be prescribed to all patients with coronary artery disease. ASA is contraindicated in case of peptic ulcer disease, hemorrhagic diathesis, individual intolerance, renal-hepatic failure, in some cases with bronchial asthma.

Ticlopidine (tiklid) affects platelet aggregation by suppressing the binding of adenosine diphosphate (ADP) to its receptor on the platelet, without affecting cyclooxygenase, like aspirin, but by blocking thromboxane synthetase. The bleeding time when taking ticlopidine increases by about 2 times compared with the initial value. After discontinuation of the drug in most patients, platelet functions return to normal values within 7 days. Suppression of platelet aggregation is recorded within two days from the beginning of the use of ticlopidine at a dose of 250 mg twice a day, and the maximum effect is achieved on the 5th day of treatment. The disadvantages of ticlopidine include erosive and ulcerative lesions of the gastrointestinal tract, skin rash, neutropenia, thrombocytopenia and thrombocytopenic purpura. Currently, ticlopidine is being replaced by the drug clopidogrel, which has a lower number of side effects and requiring less stringent monitoring of blood counts during treatment.

Clopidogrel (Plavix)... The safety and efficacy of Plavix in the prevention of ischemic complications in comparison with aspirin has been shown in a number of clinical studies, during which treatment with the drug for 1-3 years led to a decrease in the incidence of myocardial infarction, ischemic stroke and sudden death. With clopidogrel, the amount of bleeding from the gastrointestinal tract was less than with aspirin therapy. Clopidogrel is the most important component of the treatment of patients with stable exertional angina during angioplasty and stenting of coronary arteries in order to prevent stent thrombosis. The patient after angioplasty and stenting should continue treatment with antiplatelet agents for at least six months. CARPIE Study Finds Benefits long-term intake clopidogrel before ASA in severe categories of patients - with myocardial infarction, history of stroke, with atherosclerotic lesions of the arteries of the lower extremities, with diabetes mellitus. The drug was found to be more effective in reducing the combined risk of ischemic stroke, acute myocardial infarction, and cardiovascular death.

Indirect anticoagulants... The prescription of warfarin, both in the form of monotherapy and in combination with aspirin, is justified in patients with a high risk of vascular complications: in the presence of intracardiac thrombosis, episodes of thromboembolic complications in the anamnesis, atrial fibrillation, deep vein thrombosis, when it can be assumed that the appointment of only ASA as secondary prophylaxis will not be enough. At the same time, careful monitoring of the level of the international normalized ratio (INR) is required, which requires repeated laboratory studies.

β-blockers... There have been no reliable randomized trials of β-blockers (atenolol, metoprolol, nebivolol, sotalol, timolol) for stable angina pectoris; therefore, drugs are considered a mandatory component of therapy for all forms of coronary artery disease, if we proceed from their effectiveness in patients with myocardial infarction. A 25% reduction in repeated myocardial infarction and mortality in patients with coronary artery disease was demonstrated against the background of the use of β-blockers.

Lipid-lowering drugs do not literally refer to antianginal drugs, but they should be included in the combination therapy of patients with angina pectoris in most people with hyperlipidemia (HLP), including those who have had myocardial infarction. It has been proven that taking lipid-lowering drugs improves the long-term prognosis of a patient with coronary artery disease. The drugs that mainly reduce the level of LDL cholesterol and total cholesterol include statins (lovastatin, simvastatin, atorvastatin calcium, pravastatin, fluvastatin, cerivastatin sodium) and bile acid sequestrants (colestipol, cholestyramine). These funds are mainly used to correct type IIa SODI, especially in familial hypercholesterolemia, often in combination with drugs of other classes. Drugs that predominantly lower the level of very low density lipoproteins (VLDL) and triglycerides include niacin (enduracin), fibrates (bezafibrate, fenofibrate, ciprofibrate), and fish oil components. They are used in the treatment of HSDD of types IIb, III, IV. Due to the beneficial effect on the level of high density lipoproteins (HDL), they are often combined with drugs, the main effect of which is to reduce the level of LDL and total cholesterol. The indication for taking statins in patients with coronary artery disease is the presence of hyperlipidemia with insufficient effect of diet therapy.

Diet is a must complex therapy hyperlipidemia. The following food composition is recommended: proteins - 15%, carbohydrates - 55%, fats - 30% of daily calories. It is imperative to limit the intake of saturated fatty acids (up to 7-10%), which are part of animal fats. Instead, you need to eat more foods containing vegetable oils, fish fat and seafood rich in monounsaturated and polyunsaturated fatty acids. Such changes in the diet should ensure the consumption of cholesterol with food no more than 200-300 mg / day. The diet should be rich in vegetables and fruits containing vitamins, natural antioxidants, fiber and soluble dietary fiber.

Secondary prophylaxis requires that all high-risk patients receive immediate and consistent treatment with statins, effective drugs with relatively few side effects. Research data show that the most effective strategy for preventing the risk of complications turns out to be if treatment is started already at the age of 40-45. A prerequisite for success is not only immediate and consistent treatment of high-risk patients, but also sufficiently early and targeted statin therapy in individuals with a corresponding combination of risk factors.

A recent large-scale epidemiological and pharmacoepidemiological clinical study of ATP (Angina Treatment Pattern) showed that in most cases, Russian Federation there is no adequate control of lipid metabolism in persons with risk factors for coronary artery disease and in patients with stable angina pectoris, as well as adequate therapy for hyperlipidemia with modern drugs. The therapeutic effect of statins may be associated with the stabilization of atherosclerotic plaques, a decrease in their tendency to rupture, an improvement in endothelial function, a decrease in the propensity of coronary arteries to spastic reactions, and suppression of inflammatory reactions. Statins have a positive effect on a number of indicators that determine the tendency to form blood clots - blood viscosity, platelet and erythrocyte aggregation, fibrinogen concentration.

ACE inhibitors... IN last years indications for the use of ACE inhibitors have been significantly expanded. Today there are no obstacles to the appointment of these drugs to patients with heart failure, in addition, there are grounds for expanding the range of indications. In particular, anti-ischemic properties of drugs of this group have been revealed, experience is accumulating in their use for the treatment of stable angina pectoris with concomitant hypertrophy of the left ventricular myocardium. ACE inhibitors can potentially prevent or even partially reverse these pathological changes. Recently, the potential ability of ACE inhibitors has been shown to slow the progression of atherosclerosis. As you know, the development of the atherosclerotic process is closely related to the angiotensin II - ACE - bradykinin system. ACE inhibitors are able to improve the functional state of the endothelium, which can affect the course of the disease, not only with concomitant arterial hypertension and heart failure.

There is evidence that ACE inhibitors have a positive effect on patients with coronary artery disease without left ventricular dysfunction, with a high risk of developing "coronary events". In addition, a number of studies have shown a significant decrease in the incidence of ischemic heart disease and mortality in patients with diabetes mellitus during treatment with ACE inhibitors. It is assumed that the effect of ACE inhibitors on "coronary events" may be related to the inherent angioprotective and antiproliferative effects of these drugs, including the ability to induce regression and prevent atherosclerosis. ACE inhibitors are indicated in the treatment of patients with coronary artery disease, suffering from arterial hypertension, diabetes mellitus, who have had myocardial infarction or have signs of heart failure of various etiologies. In these patient populations, ACE inhibitors interfere with the process of left ventricular remodeling. While taking ACE inhibitors, the incidence of strokes decreases. In this regard, one should strive to use these drugs in patients with coronary artery disease with stable exertional angina, including those with preserved left ventricular function. A generalization of the results of studies in which ACE inhibitors were used in patients with myocardial infarction revealed a 7% reduction in the risk of death. In addition, a number of studies have shown a significant decrease in the incidence of coronary artery disease and mortality in patients with diabetes mellitus during treatment with ACE inhibitors. ACE inhibitors include: captopril, enalapril, perindopril, fosinopril, lisinopril, quinapril, ramipril, moexipril, cilazapril, etc.

Myocardial revascularization... Long-term therapy of ischemic heart disease is a difficult task for therapists and cardiologists. A number of factors still limit the performance of myocardial revascularization procedures (in Russia, according to the ATR-survey, percutaneous transluminal coronary angioplasty is performed in 1.15% of patients with angina pectoris, coronary artery bypass grafting - in 3.75% of patients), therefore, the main method of treatment of patients angina pectoris remains drug therapy. IN recovery period after revascularization of the myocardium into the complex drugs used for secondary prevention, as a rule, include antiplatelet agents, statins, ACE inhibitors. A patient with exertional angina or who has undergone myocardial revascularization should be aware of how to behave in the event of a sudden return of symptoms of coronary insufficiency.

Non-drug secondary prevention is to combat risk factors. There are a number of risk factors for the development of atherosclerosis and ischemic heart disease, the most serious of which are arterial hypertension, hypercholesterolemia, smoking, diabetes and hereditary predisposition. These factors contribute to damage to the vascular endothelium with the release of free oxygen radicals, damage to the intima, the formation and rupture of atherosclerotic plaques, which ultimately leads to thrombosis of the coronary arteries and various complications. An important part of secondary prevention in coronary artery disease is the impact on the risk factors underlying atherosclerotic coronary artery disease. The reason for the decrease in mortality from ischemic heart disease in certain countries (the United States and a number of Western European countries) in the last 15-20 years is associated with the increased effectiveness of treatment (including surgery), as well as with an increase in population awareness about the causes of cardiovascular diseases, with the elimination of major risk factors (limiting the consumption of animal fats, reducing the number of smokers, the growing popularity of physical activity, etc.). We list the main measures that reduce mortality from cardiovascular diseases, and the percentage of reduction as a result of their implementation:

prevention of arterial hypertension - 35%;
effective therapy for coronary artery disease (secondary prevention) - 31%;
the use of statins for lipid metabolism disorders - 30%;
thrombolytic therapy in acute myocardial infarction (hospital mortality) - 25%;
rehabilitation after acute myocardial infarction - 24%;
angioplasty in acute coronary syndrome (hospital mortality) - 15%;
the use of aspirin after acute myocardial infarction - 13%.

Literature

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Note!

The drug component of secondary prevention includes the use of acetylsalicylic acid (ASA), β-blockers, ACE inhibitors, lipid-lowering drugs.

Every fourth patient with signs of coronary artery disease continues to smoke, every third is overweight.

Prescribing ASA to patients with stable angina pectoris significantly reduces the risk of cardiovascular complications (by 33-50%).

On the background of the use of β-blockers, a 25% reduction in recurrent myocardial infarctions and mortality in patients with coronary artery disease was demonstrated.

D. M. Aronov, Doctor of Medical Sciences, Professor
V.P. Lupanov, Doctor of Medical Sciences
GNITS PM MH RF, Institute of Clinical Cardiology named after A. L. Myasnikova RKNPK Ministry of Health of the Russian Federation, Moscow

According to the WHO, cardiovascular diseases are the most common cause of death in the world's population. In this case, coronary heart disease (IHD) is fatal in 30-50% of cases. Prevention of coronary heart disease is necessary for everyone, since the disease develops in a latent form.

In coronary artery disease, certain factors cause the heart muscle to stop receiving sufficient blood supply. Myocardial damage occurs, in which the amount of oxygen and nutrients supplied to it decreases. Usually the cause of coronary artery disease is damage to the coronary arteries that carry blood to the heart. So, the vessels cease to function normally if they spasm, blockage by a thrombus (with increased blood viscosity) or the deposition of atherosclerotic (cholesterol) plaques on the walls of the artery begins.

Clinical forms of ischemic disease:

Angina pectoris. It is characterized by episodic suffocating and burning pains in the chest, which can respond to shoulder joint or the peritoneal area. It occurs when the myocardium is depleted due to oxygen deprivation.
Myocardial infarction. It occurs when the heart artery is blocked: since the blood ceases to feed the heart muscle, partial death of its tissues begins (necrosis).
Cardiosclerosis. It develops after a myocardial infarction - dead myocardial cells are replaced by connective tissue.
Arrhythmic variant of ischemic disease. Oxygen starvation of the heart muscle leads to conduction disturbances and, accordingly, pathological changes in the heart rhythm.
Heart failure. Symptoms of oxygen deficiency extend to all tissues of the body, peripheral circulation is impaired.
Sudden coronary cardiac arrest. If you do not provide assistance to the victim in a timely manner, it is fatal.

In the early stages of the disease, a person may not be aware of the health problems that have arisen: the body tries to redistribute the load on other systems, and for some time the symptoms of the disease do not appear.

The first signs of myocardial damage:

shortness of breath;
a feeling of interruptions in the work of the heart;
an increase (extremely rarely - a decrease) in blood pressure.

At a later date, the above symptoms are accompanied by pain in the sternum or radiating to the neck, shoulder joint.

Prevention of a disease that has not occurred before is called primary. prevention of coronary heart disease... To achieve it, pay attention to your lifestyle and eliminate sources of negative change.

Factors that increase the risk of coronary heart disease

Genetic predisposition... Consider if you have any relatives who suffer or have died from cardiovascular disease.
Age... Upon reaching 40-50 years of age, once every six months, take tests and undergo an examination (biochemical indicators, ultrasound of the heart, cardiogram, etc.).
Floor... Due to the influence of estrogen, women are less prone to atherosclerosis. After menopause, when hormonal changes occur, the risk of CHD in women increases.
Accompanying illnesses... For example, people suffering from obesity, atherosclerosis, arterial hypertension or diabetes mellitus are more likely to have problems with the cardiovascular system. Therefore, it is imperative to correct the existing pathological conditions.
Bad habits... Smoking, alcohol consumption, and the tendency to overeat affect appearance, health and shatter the work of internal organs.
Insufficient physical activity or excessive physical exercise ... Both physical inactivity and unhealthy hobbies for sports wear out the body. Give preference to moderate cardio loads - cycling, brisk walking, volleyball. Exercise three times a week for 30-40 minutes.
Hyperresponsibility and constant stress ... See a psychotherapist or learn about modern relaxation techniques to improve adaptation to stressful influences (meditation, self-massage, keeping a personal journal).

If at the reception of a cardiologist, problems with the nutrition of the heart muscle were diagnosed or the patient has suffered one of the clinical forms of the disease, secondary prevention of coronary heart disease is prescribed. Come to the aid of pharmaceuticals, physiotherapy, folk methods, in difficult cases- surgical intervention (coronary angioplasty, coronary artery bypass grafting).

Medicines for the prevention and treatment of ischemic heart disease

With the help of medicinal substances, it is necessary to slow down or, if possible, eliminate the process of thrombus formation and deposition of atherosclerotic plaques. You should also restore metabolic processes in the myocardium. Additionally, it is worth prescribing drugs to normalize the heart rate and blood pressure. For this purpose, the following groups of medicines are used:

Group of medicines	Representatives and dosage	Appointment	Contraindications
Anticoagulants	Acetylsalicylic acid- 250 mg, warfarin- 5 mg 2 r / day; ticlopidine- 0.25 g twice a day, clopidogrel- 75 mg.	Makes blood more viscous and prevents blood clots	Ulcerative diseases of the gastrointestinal tract, liver failure, blood clotting disorders
Lipid-lowering drugs	Statins: lovastatin- 80 mg, atorvastatin- 10 mg, fluvastatin- 40 mg twice a day.	Eliminate atherosclerotic plaques and prevent their occurrence	Disorders of the liver and kidneys, diabetes mellitus, osteoporosis
	Fibrates: clofibrate- 5 g up to 4 times a day, fenofibrate- 145 mg.
	Others: cholestyramine- 4 g up to 4 times a day; a nicotinic acid- up to 0.5 g per day.
ß-blockers and other antiarrhythmic drugs	Carvedilol- up to 25 mg per day.	Normalize cardiac conduction	Bronchial asthma, bradycardia, hypotension
ß-blockers and other antiarrhythmic drugs	Amiodarone- 200 mg three times a day.	Normalize cardiac conduction	Bronchial asthma, bradycardia, hypotension
ACE inhibitors, angiotensin receptor blockers	Captopril- 100-150 mg, cilazapril - 500 mg.	Normalize blood pressure	Disorders of the excretory system, pulmonary diseases
ACE inhibitors, angiotensin receptor blockers	Losartan- 50 mg.	Normalize blood pressure	Disorders of the excretory system, pulmonary diseases
Means that restore metabolism in the heart muscle	Trimetazidine- 70 mg, levocarnitine- up to 1 g, creatine phosphate- 1-2 g, mildronate- 500 mg.	Restore myocardial nutrition	Renal or hepatic impairment, drug hypersensitivity
Nitrates	Nitroglycerine- ½ or 1 tab. under the tongue as a means of first aid for an attack of angina pectoris	Expand the coronary vessels	Brain hemorrhage, hypotension, glaucoma
Diuretics	Hypothiazide- 25 mg per day.	Relieves puffiness caused by impaired microcirculation in the limbs	Hypokalemia, renal failure

Note! The article provides approximate dosages for your reference! Women during pregnancy need to coordinate the intake of any medication with a doctor!

Physiotherapy methods

These methods of prevention of coronary heart disease are used according to the testimony of a doctor and only in combination with drug therapy.

shock wave therapy;
enhanced external counterpulsation;
stem cell therapy;
quantum (laser) therapy.

The procedures are aimed at stimulating the regeneration of cardiomyocytes.

With the help of recipes of traditional medicine and herbal remedies, it is possible to correct the patient's condition for initial stages IHD, but in case of serious disorders, one should not count on a complete cure.

Hawthorn fruit

Use infusion and tincture:

To prepare an infusion of 1 tbsp. l. raw materials are poured with a glass hot water and insist in a thermos for two hours. The filtered liquid is taken in 1-2 tbsp. l. before meals.
Alcohol tincture is used in 30-40 drops per glass of water up to 4 times a day.

Motherwort herb

Pour 15 g of motherwort herb with a glass of boiling water and let it brew until cooled. Drink 1/3 cup before meals 3 times a day. You can use a ready-made tincture - dilute 30-50 drops in 1/2 glass of water and drink 3-4 times a day.

Horseradish with honey

Grind horseradish root in a blender and mix with honey in equal proportions. Eat 1 tsp daily. means with water.

Garlic tincture

An average head of garlic (up to 50 g) is crushed and infused in 200 g of vodka. Apply three times a day, diluting 8 drops of the tincture with cool water.

Note! It is necessary to use horseradish and garlic with caution in patients with diseases of the gastrointestinal tract (gastritis, mucosal manifestations).

Royal jelly and pollen

Take 5-10 g before meals twice a day.

Checklist for the prevention of coronary heart disease

Include in your diet foods containing omega-3 unsaturated fatty acids (nuts, fish, olive oil) and potassium (baked potatoes, dried apricots). Limit meals made from offal and fatty meats, and reduce the consumption of butter.
Take vitamin complexes and supplements. Complexes containing omega-3, omega-6 and omega-9 are especially useful.
Give up bad habits.
Observe a sleep and wake schedule.
During the period of remission, gradually, include physical exercises in everyday life to improve microcirculation in the myocardium.

Ischemic heart disease is a chronic disease that can progress with an improper lifestyle. Therefore, take care of your health before the onset of alarming symptoms and take the time to prevent ischemia.

(Ischemic heart disease), along with oncological diseases, is not only medical, but also social problem... Mass studies of the 20th century have identified risk factors for coronary artery disease. These include heredity, age, overweight, physical inactivity, hypertension, diabetes and male sex. Among all the risk factors are manageable, such as smoking, and irreparable.

Prevention of ischemic heart disease is primary and secondary. Under the primary prevention of coronary heart disease understand the prevention of the occurrence and development of risk factors for diseases in people without clinical manifestations. Secondary prevention is aimed at eliminating risk factors, which, under certain conditions, can lead to an exacerbation or recurrence of an existing ischemic heart disease.

CHD risk factors

Everything risk factors coronary heart disease can be classified into disposable(modifiable) and irreparable(unmodifiable).

Fatal risk factors include:

Age (men over 45, women over 55);
Gender (male);
Hereditary predisposition.

Other risk factors can be minimized. They include:

Smoking;
Violation of lipid metabolism (hypercholesterolemia);
Hypodynamia and stress;
Excess nutrition;
Diabetes;
Arterial hypertension.

If a person has at least one risk factor, then the likelihood of developing coronary artery disease increases 2-3 times. With a combination of several factors, from coronary heart disease increases up to 15 times. That is why it is so important prevention of ischemic heart disease.

Primary prevention of coronary heart disease

Primary prevention of ischemic heart disease is carried out among people without clinical manifestations of the disease, that is, practically healthy people. Main directions primary prevention ischemic heart disease include:

organization of rational nutrition,
lowering blood sugar and levels,
weight control,
normalization of blood pressure,
the fight against smoking and physical inactivity, as well as
organization of the correct daily routine and the alternation of work and rest.

That is, prevention is aimed at eliminating modifiable risk factors and is not only a personal, but also a national problem.

At the heart of proper nutrition is the principle of matching the consumed calories with the consumed ones. The approximate diet of a thirty-year-old person of mental labor should contain no more than 3000 kcal, while protein should be 10-15%, carbohydrates (mainly complex) - at least 55-60%. As you age, you need to reduce the number of calories by about 100-150 kcal every 10 years.

Scientists have shown for a long time that decrease in level blood can lead not only to the prevention of the development and ischemic heart disease, but also to some regression of plaques already formed in the vessels. At the initial stage, hypercholesterolemia must be combated through diet, in the absence of an effect, it is possible to use drugs (statins). This is especially important for people with unavoidable risk factors for the development of coronary heart disease. The same goes for maintaining glucose levels blood at normal levels.

To control body weight, doctors and nutritionists use an indicator called body mass index(BMI). This figure is obtained by dividing a person's weight in kilograms by the square of their height in meters. For example, with a height of 170 cm and a weight of 70 kg, the body mass index will be 24. Normal BMI values are in the range of 18.5-25.

Arterial hypertension is an independent risk factor for the development of ischemic heart disease, therefore, at the first signs of an increase in pressure of more than 140/90 mm Hg. it is necessary to consult a cardiologist for the selection of therapy.

Smoking Is not just a bad habit. It has been found that smoking even 1 cigarette per day leads to a 2-fold increase in the risk of coronary heart disease. That is why so many social policy programs are aimed at fighting smoking.

It is not so easy to get a young healthy man to give up, say, smoking or eating fatty foods. Not everyone thinks about the future, and IHD, which can develop in 20-30 years, is not the best motivating factor. To make it easier for the doctor to convey information about primary prevention of coronary heart disease to the population, special tables of the absolute risk of coronary heart disease have been developed. These nomograms allow you to determine the risk of developing coronary insufficiency now and by the age of 60. If in terms of parameters (age, gender, smoking, systolic pressure, blood cholesterol concentration) the risk of developing coronary artery disease reaches 20%, then immediate intervention and correction of risk factors is necessary.

Secondary prevention of ischemic heart disease

The main areas of secondary prevention are:

Addressing risk factors that are not necessarily the same as those to be considered in primary prevention.
Medicinal prophylaxis of spasms of the coronary vessels.
Treatment and prevention of arrhythmias.
Rehabilitation of patients with the help of physical training and medication.
Surgical care for patients, if the need arises.

All of these measures are aimed at preventing repeated exacerbations of coronary artery disease, increasing the duration and quality of life, increasing work capacity and preventing sudden death of patients.

An important role in this is played by the patient himself, who should be an active ally of the doctor in the struggle to preserve his health. To do this, the patient is required to strictly adhere to all medical recommendations, actively participate in rehabilitation plans, and timely information from the doctor about changes in his health.

Prevention must start in childhood

Although the former (IHD) usually appear in people of middle and older age, it begins to develop already in childhood. In addition, most habits, including harmful ones, leading to the emergence of risk factors for coronary artery disease, are established already in childhood and adolescence. According to the WHO, in many countries of the world, children first try to smoke at the age of 6-11 years. Smoking very quickly becomes a habit: at the age of 15, 40% of boys and girls smoke, and by the age of 19 - 50%. Selective studies have shown that at the age of 13, 7% of boys smoke at least three cigarettes per week, at the age of 14 - 30% at the age of 15. - 36% and at the age of 16 - 41.2%, i.e. these figures practically do not differ from those given by WHO. Moreover, in recent years all over the world there has been a tendency towards an increase in the number of girls who smoke.

Eating habits that contribute to obesity and fat metabolism disorders are also established in childhood. Moreover, it was found that the increased level of cholesterol in the blood, revealed in children, persists rather steadily in them in the future.

An increase in blood pressure is also found already in adolescence... Of course, not all children with high blood pressure will become persistent hypertensive patients in the future, but their risk is undoubtedly higher than that of children with normal blood pressure. According to epidemiological studies, in different countries, an increase in blood pressure is detected in 6-8% of adolescents. Moreover, according to observations, in 42% of children in whom high blood pressure was found at the age of 13, it remained high at the age of 18, i.e. these are already real candidates for hypertension.

Currently, in various countries of the world, including Russia, programs are being carried out aimed at combating risk factors for cardiovascular diseases, starting from childhood. Preliminary results show that by teaching the basics healthy way living and advocating for abandonment of bad habits can reduce the prevalence of risk factors for cardiovascular disease. Healthy lifestyles should be promoted in the family, school and by the adolescents themselves. An important role is played by the example of parents: among parents who smoke, children smoke more often, among parents leading a sedentary lifestyle, children are also physically inactive. Eating habits also depend a lot on the parents. Adolescents, especially those in authority among their peers, can successfully promote healthy lifestyles. And often the example of a friend and the desire to be like him have a stronger influence on the behavior of a teenager than the recommendations of the parents.

At the same time, children can positively influence the habits of their parents by promoting healthy lifestyles. Teenagers themselves can actively influence the bad habits of their friends, helping to get rid of them. This is one of the most effective methods impact.

Thus, the primary prevention of cardiovascular diseases is based on the fight against risk factors for these diseases. It is better, of course, to avoid the habits that form these risk factors, but at the same time it is never too late to try to give them up.

If you analyze the essence of the recommended healthy lifestyle, then there is nothing in it, without which it is very difficult to live. To keep your heart healthy, you need to eat rationally (a diet with a moderate amount of calories, salt, fat, cholesterol), monitor body weight, exercise regularly, stop smoking and alcohol abuse, and regularly monitor your blood pressure. As you can see, there is nothing fundamentally new and impossible. Following these simple recommendations will help you avoid many diseases without any limitation of active and pleasant image life.

07.05.2017

Prevention of coronary heart disease is divided into two stages - this is the primary and secondary method of preventive measures.

The primary stage in the prevention of ischemic disease consists in measures that are carried out before the formation of pathology, that is, they affect all possible factors that can lead to progressive atherosclerotic pathology.

A secondary preventive measure is to prevent the rapid development of pathology and prevent serious consequences.

A secondary preventive method is often found, since the primary one is based on a healthy lifestyle, proper nutrition, and so on, but people follow these recommendations.

Prevention of heart ischemia is carried out in combination to prevent the development and progression of the disease, and also to prevent complications that can lead to death.

Not only patients with this diagnosis, but also people who do not want to admit it, are engaged in the prevention of heart ischemia. At risk are those people who have at least one reason for its appearance (we will talk about them a little later). The risk increases with the number of eliminated and non-eliminated causes. But this does not mean that if a person over the age of forty has no reason for the development of coronary heart disease, then he should not take preventive measures. Such people should be examined by a cardiologist at least once or twice a year.

Patients with ischemic heart disease do not undergo drug therapy, that is, they completely or partially exclude all possible development factors, this can be smoking cessation, exercise, balanced diet, if the patient is taking hormonal contraceptives, then they should be completely abandoned. You can also correct factors, such as normalizing blood pressure, lowering the content of bad cholesterol in the blood, and others.

Prevention of ischemic disease is a kind of lifestyle improvement. Addictions in the form of malnutrition, overeating, inactivity, smoking, alcohol abuse can lead to serious pathologies and deviations, and they, in turn, can become chronic.

So, we can conclude that everyone should be engaged in the prevention of ischemic pathology, which is generally available.

Risk factors

Risk factors for cardiac ischemia are divided into two types:

Modifiable.
Modifiable.

Variable factors that can trigger the development of coronary artery disease include:

tobacco smoking. During smoking, a person's heart rate accelerates and the sympathoadrenal system is activated. Because of smoking, local vasospasms occur, increasing the likelihood of arrhythmias (heart rate is disturbed). Patients who have smoked for a long time are diagnosed with coronary artery atherosclerosis.
patients with constant high blood pressure are prone to ischemic heart disease. A factor that requires special attention is a rapid heart rate in older people;
impaired metabolism can lead to insufficient physical activity. As a result, body weight increases, abdominal obesity is observed (fat accumulates in the tissues of the upper body), namely, this affects the fact that blood pressure rises regularly. It is worth noting that people who are physically active live longer. All heart diseases are more often diagnosed in obese people. If the patient's body weight is 10% higher than the norm, then the risk of coronary heart disease increases by 10%;
also the appearance of ischemia is influenced by nutrition, namely food that contains a lot of sugar, fat;
in female representatives, atherosclerotic disease develops due to an insufficient amount of estrogen in the body;

Modifiable factors include:

age. Atherosclerotic changes are more pronounced in older people, which increases the incidence of heart ischemia. Up to 60 years of age, the disease is diagnosed in men more often, after 60 men and women are on equal terms;
genetic predisposition also plays an important role. The chances of the appearance of pathologists increase in those people whose family had similar diseases, especially if the parents had the disease. The risk also increases if the parents' pathology was diagnosed in their youth.

If the patient has at least two provoking factors, then the risk increases two to three times. When more than two factors are noticed, the probability of death increases 13 times. Therefore, one should not neglect preventive measures.

Causes

The causes of cardiac ischemia are also divided into two types; these are causes that can be eliminated and which cannot.

Removable causes include:

improper nutrition. Getting rid of bad eating habits, such as overeating, eating a lot of fats, fried and salty foods, and so on, can save you from developing a pathological condition;
endocrine diseases, especially diabetes mellitus (insufficient or complete absence of insulin in the body);
regular increase in blood pressure;
stress;
tobacco smoking.

Fatal reasons include:

age. The older the person is, the more likely it is to develop coronary heart disease;
gender, pathology is often diagnosed in males;
genetic predisposition.

If you are engaged in the prevention of removable causes, adhere to all medical recommendations, you can reduce the risk of ischemia to a minimum.

To preserve life, all causes are eliminated.

Types of prevention of coronary heart disease

Preventive measures are divided into: primary and secondary.

Primary prevention is aimed at avoiding the development of pathology. People who do not have pathology are engaged in it. Primary prevention requires:

observe proper nutrition, adhere to a diet, monitor the diet, distribute the daily diet and diversify it. Eat in moderation and slowly. Pay special attention to the correct combination of products and drink more clean water;
reduce the amount of sugar and cholesterol in the blood;
control body weight;
normalize blood pressure;
observe the daily routine. There should be good rest and feasible physical activity;
give up bad habits, especially smoking.

If the patient is diagnosed with coronary heart disease, then he must follow the rules of secondary prevention, which will help to avoid exacerbation of the pathology and prevent the deterioration of the patient's condition.

It consists of:

a therapeutic effect that normalizes the heart rate;
drug therapy. This therapy allows you to maintain the normal functioning of the blood vessels;
if there is evidence, then the help of surgeons is used;
gradual resumption of physical activity for the patient.

All these preventive measures are aimed at ensuring that when a patient is diagnosed with cardiac ischemia, it does not worsen, this will save the patient's health and life.

Naturally, everything depends on the patient, and it does not matter what kind of prophylaxis will be prescribed, primary or secondary.

The cardiologist gives only the necessary recommendations and advises the patient on all issues. If the patient does not have a desire to adhere to all the rules and prescriptions of specialists, then therapy and prevention will not give effective results.

When to start prevention

In patients diagnosed with coronary heart disease, prevention should begin in childhood, although primary symptoms begin only in middle or older age. Atherosclerosis begins to develop at a young age. Also, habits and bad ones that lead to risk factors for coronary heart disease are laid in children and adolescents.

Data from the World Health Organization found that children start trying to smoke between the ages of 7 and 12, and, as a rule, is addictive. Thus, at the age of 16 - 35% -45% of adolescents smoke, and by the age of 20 - 55%.

Also, statistical studies have determined that 8% of young men smoke at least 4 cigarettes per week, at 14 years old - 32%, at 15 years old - 38%, and at the age of 16 years old - 43%. These figures do not differ much from the results of studies by the world health organization. In the last ten years, the number of girls who smoke has increased rapidly.

Also, from childhood, people develop concepts of proper nutrition, which in the future cause obesity, disorders of the metabolism of fat in the body. From childhood, people develop concepts of proper nutrition, which later cause excess weight, impaired metabolism of fats in the body. Scientists have also proved that if a child is diagnosed with a higher than normal level of cholesterol in the blood, then it persists with age.

High blood pressure indicators can also be observed in adolescents, but it cannot be argued that in the future such a child will become hypertensive, but this should not be ruled out, because such children are at risk.

Epidemiological studies have found that different countries have their own percentage of increased heart pressure among adolescents. Some observations have revealed that the high blood pressure values found in 12-year-old children remained elevated to 19. In this case, this is a real risk of becoming hypertensive.

On the this moment, modern medicine has various programs that combat cardiovascular dysfunction at an early age.

After carrying out such activities, which include maintaining a healthy lifestyle, quitting smoking and drinking alcohol, the risk of the spread of cardiovascular dysfunction factors has been reduced.

The call for a healthy lifestyle should be carried out both in the family and in educational institution... Each child takes an example from their parents, for example, according to statistics, smokers and sedentary parents and children begin to smoke and lead an inactive lifestyle.

The eating habits developed in a child also depend on his parents. Many children take an example from friends of adolescents, so you can promote a healthy lifestyle through them. And as practice shows, for many children a friend has more priority than parents, and they try to be like them. It is considered one of the most effective methods of preventing coronary artery disease.

A situation may develop and vice versa, when a child promotes a healthy lifestyle and proper nutrition to parents. Also, save parents from bad habits.

So, we conclude that the primary prevention of cardiovascular pathologies is based on the fight against risk factors. It would be great to get rid of these risk factors completely, but it is never too late to try to get rid of them.

If we revise all the rules of a healthy lifestyle, then we will notice that there is nothing complicated in this, and there is nothing without which we could not live. For your heart to be healthy and functioning properly, you need to eat rationally, that is, in your diet, salt, fat, cholesterol and calories should be in moderation.

Doctors strongly recommend monitoring your weight and playing sports (you can do not difficult physical exercises, but every day. Smoking and alcoholic beverages negatively affect heart functions, so you should think about whether you need it or you can refuse it. You should also carefully monitor behind your blood pressure.

There is nothing complicated in these rules, and by adhering to them, you can get rid of many cardiovascular pathologies and other diseases.

Prevention with folk remedies

Traditional medicine recipes have beneficial effects and prevention not only on the cardiovascular system, but also on general state the patient as a whole.

But before using any remedy, you need to consult with the treating cardiologist, otherwise their use can only harm. It is not worth considering this method as the main one in treatment, but it is perfect for prevention.

All traditional medicine recipes are used for prevention, but not as the main treatment for cardiovascular diseases.

The most common recipes for folk remedies:

hawthorn broth;
a garlic mixture with honey has a beneficial effect on the general condition of patients diagnosed with coronary heart disease;
have a sedative effect - mint, motherwort and valerian;
decoction of nettle with the addition of honey;
a mixture of garlic, honey and lemon. But this recipe is categorically contraindicated in patients with increased gastric acidity.

Daily massage works well for prevention. chest and aromatherapy. lavender, mandarin and lemon balm oils are well suited for aromatherapy, they are able to relax the heart muscles, which in turn has a good effect on the work of the heart.

Cardiac ischemia is a rather dangerous disease, therefore prevention takes a special place. Compliance with all the rules and recommendations of a cardiologist will improve your health and save your life.

Coronary artery disease, also known as coronary artery disease, is a group of diseases that include atherosclerosis, unstable angina pectoris, myocardial infarction, and sudden cardiac death.

It develops due to insufficient oxygen supply to the cells of the myocardium. Depending on the manifestations and volume of insufficiency, one of the forms of ischemic heart disease is distinguished.

The problem of sudden cardiac death remains the most controversial today, and the most widespread is.

All information on the site is for informational purposes only and DOES NOT ARE a guide to action!
Provide an EXACT DIAGNOSIS you can only a DOCTOR!
We kindly ask you NOT to self-medicate, but make an appointment with a specialist!
Health to you and your loved ones!

Atherosclerosis is a consequence of lipid metabolism disorders, a violation of the ratio of high and low density lipoproteins. In developed countries, this is the first cause of death and disability of the population.

Men and women are more at risk of injury after the onset of menopause.

A number of risk factors are distinguished, which are divided into removable and non-removable:

How the above factors relate to a person determines the risk of developing coronary heart disease and his life expectancy.

The need to quit smoking

Smoking cessation is a prerequisite for the prevention of coronary artery disease. Today, any specialist will confirm, referring to a number of serious studies, that smoking is one of the most active provocateurs of coronary artery disease.

In the International Classification of Diseases, tobacco "habit" is defined as a conduct disorder caused by psychoactive substances.

Tobacco smoking causes a range of noncommunicable chronic diseases that exacerbate each other.

It is important to remember that smoking is not so much a physical addiction as a habit of behavior, a craving for the process itself and the sensation associated with it, i.e. psychological.

There is a biochemical component, but it is often not as strong as the psychological and social one. It has been proven that usually one month is enough to eliminate psychological dependence. But you need to quit immediately and instantly, not gradually.

When a person tries to quit smoking, he is faced with a number of difficulties that must be experienced:

Having given up smoking in any form, a person has a great chance of a full recovery of the body. Experts say that if a person quits smoking, especially before the age of 40, then in 5-10 years his risk of developing coronary heart disease decreases to the average population.

Stressful situations

Stress is one of the strongest factors today that become the causes of disease. Stress ulcers, diabetes mellitus, hypertension and other illnesses are caused by a simple daily reaction to irritating or oppressive circumstances.

This is a protective reaction of the body to a life-threatening factor, but in modern society the concept of danger has shifted, and a person responds with stress to many stimuli. This is a consequence of urbanization and a number of factors of civilization, from which modern man will not go anywhere, but which will have to be paid for.

First of all, you need to learn to control your emotions and reactions to the environment, even if it does not live up to expectations. It is appropriate to mention the types of temperament - choleric people will have the hardest time, but, in the end, the person decides for himself: to be nervous or to explain the situation to himself in a different way.

Stressful situations need to be taken under control. They are always there, but it is important to react to them to learn correctly. Do not let stress take over you, otherwise the chances of getting sick become very high.

In any situation, you need to look for something good, positive. Even if you get sick, start recovering, at the same time, read books in parallel, develop, spend time with benefit.

Chronic fatigue is a condition characterized by a prolonged feeling of tiredness that does not go away with rest. This condition develops for a long time.

Especially susceptible to it are people who perform work with increased responsibility (medical workers, operators of the railway and aviation transport sectors), residents of megalopolises and large cities.

If causal factors will continue to affect, a disease will form - a syndrome chronic fatigue- damage to the regulatory zones of the central nervous system, depletion of nerve mediators, which is manifested by a disorder of mental behavior (depression, apathy, neurosis, aggression, etc.).

Doctors believe that it is not worth combining. Therefore, several times think about taking at least a portion of alcoholic beverages if you have been diagnosed with this.

To protect yourself and your loved ones, with the causes of ischemic heart disease.

In this state, the body is most susceptible to stress, and the harm from it is great, since the body's resistance is reduced. It is necessary to get rid of this pathogenic background.

This can be achieved thanks to the normalization of sleep patterns, observance of the rules of hygiene at work and rest, gaining emotional control, and dosed physical activity.

Load planning

When a person does not plan anything, he often faces the following problems:

unforeseen situations that require a rush to make decisions that require unreasonably large efforts;
at the last moment you have to finish something with emotional stress;
constant tension in trying to keep everything in the head;
being late for meetings, late at work;
criticism from colleagues, friends, relatives.

All this entails regular experiences that turn into chronic stress.

You cannot plan everything, but when a person plans his actions, it is much easier to determine the place for business and rest. He is immune to constant stress and controls his efforts. He clearly understands what and when he will do and does not get nervous.

It's important to be able to make a plan for anything. It can be of different duration (for a year, month, week, etc.), but it should always have priority. Well-defined priorities are the key to confident performance.

Keep your posture

Posture means a lot more than people are used to thinking. Poor posture leads to changes in blood flow in the vertebral arteries and blood vessels of the brain, overstrain of certain muscle groups.

This depletes the flow of oxygen, which provokes a bad mood, inattention, forgetfulness, headaches. After all, it turns out a vicious circle!

In addition to other situations when a person does not monitor his posture, people slouch and due to negative emotions. The worse a person's mood, the less he thinks about posture - he becomes even more hunched over and downcast.

If a person constantly walks with his head down, this also adversely affects ventilation. After a few years, in combination with other factors, this hypoxia is also fraught with serious consequences.

You need to straighten your head, shoulders and keep your posture in any mood. You should understand how serious the consequences can be and control your posture.

Gymnastics

Regular dosed physical activity has many positive effects on the human body:

reduction in excess body weight;
normalization of insulin sensitivity;
normalization of lipid metabolism;
reduction of psychological and physical stress, adaptation to stress;
normalization of vascular tone and blood pressure.

Take three deep breaths.
Rub the ears vigorously (horizontally, then vertically).
Make an expression of grin, several times intensively make chewing movements of large amplitude, without banging your teeth against each other.
Rub the cheeks and wings of the nose.
Massage the back of the head, run your hands several times along the eyebrows outward.
Massage your face with both palms.
Connect the palms together, raise them to the height of the face, with the fingers of one hand grasp the tips of the fingers of the other, then vice versa.
Fold your palms at chest level, spread your fingers, press the palms and fingers of opposite hands towards each other, while springing with your fingers.
Raise your hands at face level, palms towards you, bending fingers alternately, starting with the thumb of the right hand, unbend in the opposite order.
Massage each finger separately.

Other exercise programs should take into account the person's age and the presence of comorbidities.

Don't try to take revenge on your enemies

The desire for revenge creates chronic stress. When they say that the person we hate has power over us, they say it right. He owns our thoughts, we think about him.

Such thoughts do not allow you to sleep and eat peacefully, they age inside and out. While thoughts are busy with revenge, people cannot be happy - there is no time for that. It turns out that while the enemy is doing well, the person is exhausting himself.

You need to take it calmly, you shouldn't take revenge - nothing good usually comes of it. It is necessary to understand that it became possible to see a person in a certain situation, and he showed himself. It's good that in this situation, and not when a lot depended on him.

You need to be able to forgive, and everyone will receive what they deserve. If you cannot forgive your enemies, love yourself at least. Everyone is responsible for his life, and so is the one who spends it on hatred.

Do not expect gratitude when doing good.

Religion also speaks about it. People are so arranged that they very quickly forget all the good, and one offense can block all the positive that a person has done.

Don't expect people to be grateful for all that is good. Those who give themselves completely, for example, to relatives, very often regret it bitterly. As a result, life has been lived, efforts and resources have been spent, but there is no return.

This is what affects health most of all, or rather, first on its mental component, and then on its physical one. Each person lives his own life, and if it is not limited, then full.

Everyone can help himself, and everything depends on himself. "There is nothing worse than good that was not asked for" - an expression that, unfortunately, is often true.

Good is a voluntary act. If so, then the person experiences joy, which should be enjoyed. This is gratitude, and the rest is related attributes.

Having done good to one person, there is no need to expect good from him - bestowal can come from the other side. Realizing this, a person will protect himself from another source of the strongest stresses in terms of duration.

Anxiety about insomnia

A person spends about 20 years of his life in a dream. Everyone needs a different amount of sleep. When a person develops insomnia, they become anxious, suppressing sleep even more.

It is necessary to establish the cause of the sleep disturbance. It may consist in a violation of the regime of work and rest. If insomnia is caused by overwork, you should see your doctor. If, on the contrary, it is caused by an increased rest time, then it is recommended to increase physical activity (morning exercises, skiing, other physical work).

If this is a psychological reason, for example, debts, taxes, you need to pay them back as soon as possible. When the body calms down, sleep will appear. Experts recommend going to bed before you get tired and getting up in the morning, and not, for example, at lunchtime.

How to spend money correctly

The question of material status is not inferior to the previous ones in terms of its role in the formation of chronic psychological exhaustion and a decrease in stress resistance.

For those who are concerned about improving material well-being, it is recommended to start a notebook for keeping records of income and expenses. Track costs Money... This will allow you to form a budget and plan costs for the future, or minimize them, in accordance with needs.

You should be smart about spending on pleasure. Everyone wants to relax, get more out of life, but debts, including loans, do not make anyone happier. You need to learn to treat money with care and responsibility and teach this to your children.

Under the lying stone ... you know. Look for a wide variety of options for earning and part-time work. This is good even if you do not earn very much at first - there will be less time for worries.

In the end, if even with all the efforts made it is not possible to improve the material condition, it is better to take pity on your health and stop worrying and poisoning yourself from the inside. You need to be on the lookout, but there will be an option - just do not miss it.

Diet

Takes a leading place in the prevention and control of ischemic heart disease. It aims to optimize the supply of nutrients that have a positive effect on overall metabolism. Admission is rationally excluded simple carbohydrates, animal fats, table salt. With excess body weight, the calorie intake of the diet decreases.

It matters in what ratio the proteins are supplied (the ratio of amino acids also matters, but when calculating the required ratio, a number of difficulties arise, therefore the indicator is used in research institutions in the development of drugs), fats and carbohydrates. The optimal ratio is 1: 1: 4, respectively.

Experts, regarding the daily diet, give the following recommendations:

It is necessary to limit as much as possible (but it is not recommended to exclude) the consumption of animal fats (lard, fatty meat, butter).
Try not to eat food that has been cooked by frying.
Limit the use of confectionery.
Increase the content of minimally processed cereals in the diet (does not apply to people with gluten intolerance (celiac disease)).
Provide the bulk of the diet to fruits, vegetables and other fresh plant foods.
The presence of omega-3 fatty acids (sea fish, fish oil) is required. It is recommended to eat sea fish or other seafood three times a week.

Separately about table salt. It is recommended by experts from all over the world (at the end of the 20th century) to consume 1-2 g (maximum 4 g) of salt per day. It's hard to find groceries today Food Industry that do not contain salt. The main source is monosodium glutamate.

So, eating a hot dog, pizza, and two plates of salted borsch a day, a person consumes about 15 g of salt. Recently, the World Health Organization (WHO) adopted a rate of up to 5 g of salt per day, recognizing that in modern society it is impossible to consume less. Think about whether it is always worth adding some salt to food?

Secondary prevention of ischemic heart disease

Secondary prevention is a set of measures that are aimed at preventing complications in people with an already existing diagnosis of ischemic heart disease, at improving the prognosis for life and working capacity. It includes medications and non-medications that act on risk factors.

Primary and secondary prevention of coronary artery disease is different by definition, but in this case, in many ways, it is similar.

The main tasks that cardiologists set for patients include:

quitting smoking;
healthy and rational diet;
dosed physical activity;
BP less than 140/90 mm Hg. Art .;
body mass index less than 25 kg / m 2;
total blood cholesterol less than 4.5 mmol / l.

In clinical practice, there are three most popular areas of prevention: the fight against hypertension, hypercholesterolemia, smoking cessation.

In the long term, effective prevention of any disease, incl. and ischemic heart disease, it is necessary to calculate only if the approaches are observed:

population - at the level of the entire population;
high risk - identification of high risk groups of cardiovascular pathology among the population;
secondary prevention.

Psychoprophylaxis should also be carried out, since, in view of the above, these patients are very susceptible to stressful situations, and they should not be nervous. They need to be taught on their own, to mentally overcome the disease.

Prevention of ischemic heart disease in the elderly is associated with the correction of lipid metabolism, since at this age the cause of ischemic heart disease can be predominantly atherosclerosis. Prevention is aimed at preventing thrombosis, stopping senile emotional reactions, psychoprophylaxis.

They try to prescribe sanatorium-and-spa treatment to the elderly in local cardiological sanatoriums, since the adaptive capacities of the elderly are reduced.

Tertiary prevention involves a set of measures aimed at preventing progression. It is carried out in a medical institution under the supervision of a qualified specialist. It is medicated, and often even surgical.