Population aging and cardiology problems
"Hypertension has a bright future"
Ru" said Academician of the Russian Academy of Medical Sciences, Honorary President of the Russian Society of Cardiology, Professor-cardiologist Rafael Oganov.
– You mentioned that nowadays there is a change of leading cardiovascular diseases. Please explain what is changing.– Over the past 30 years, in economically prosperous countries, there has been a decrease in diseases caused by atherosclerosis, and, in particular, coronary heart disease.
And although this will not happen tomorrow, it is expected that in the near future, diseases that are associated with the aging of the population and the development of various degenerative processes will begin to come out in the first place. At the same time, it is expected that the epidemic of atrial fibrillation, degenerative heart defects, heart failure, and strokes will grow, relatively speaking. Therefore, leading cardiologists are already calling for this to be taken into account and somehow prepared.
– Are all the diseases listed by you related to aging?– Basically, yes, with aging, and, of course, with the fact that life expectancy increases.
Even now, for example, aortic valve damage is quite common due to degenerative processes - these are no longer heart defects associated with rheumatism, which were 20-30 years ago, but valve damage due to the fact that its valves undergo degeneration, sclerosis.
– And what is the reason for the retreat of atherosclerosis?– Diseases caused by atherosclerosis are lifestyle diseases.
Recently, people in economically developed countries are beginning to understand what lack of movement, excess calories, alcohol, smoking lead to, and they are beginning to change this lifestyle: they follow a diet, play sports.
– Is the same pattern observed in Russia, or is the problem of atherosclerosis still relevant for us?– In Russia, since 2003, mortality from diseases caused by atherosclerosis has been decreasing.
Most likely, this is also due to a change in lifestyle, but since no special studies have been conducted, one can only guess about it. Of course, improving the quality of the healthcare system plays some role, but mostly it is a way of life. For example, now our legislators have finally realized that it is impossible to fight smoking with education alone, but legislative measures are needed. That is, the situation is gradually improving.
– As a result, which cardiological diseases in Russia have now come to the fore?– We have 50% of all cardiovascular mortality due to coronary heart disease and about 30% due to cerebrovascular diseases.
These two pathologies have been in the first place for many years, but the absolute numbers are slightly decreasing.
– Despite the fact that atherosclerosis is gradually receding, what is the situation with hypertension?– Arterial hypertension has been widespread, and it is, and changes are unlikely to be expected in the coming years.
The population is aging, and hypertension is closely related to age. Risk factors such as overweight, diabetes mellitus, and psychosocial stress are increasing. If no measures are taken, then hypertension has a bright future, it will grow. In elderly people, systolic pressure increases mainly, and it is very difficult to control it. So this problem will not go away in the coming years.
– If we compare such components of cardiological care as diagnostics, therapy and surgery, can we say what exactly we have at a high level, and where are we lagging behind?– I would say that our situation is very motley.
We have centers that are no different from the best foreign centers in terms of equipment and diagnostics, but, unfortunately, there are not enough of them. And in general, there are problems in both, and in the third, especially away from big cities. There is an acute shortage of professional personnel, because it is possible to purchase equipment, but it is more difficult to train a qualified specialist.
– What other diseases affect the functioning of the cardiovascular system? At the Moscow International Forum of Cardiologists, much attention was paid to diabetes mellitus and kidney diseases.– Indeed, these diseases are closely related.
If a patient with diabetes begins to be treated by an endocrinologist, he dies, unfortunately, most often by a cardiologist. Because diabetes mellitus is one of the common risk factors for the development of atherosclerosis, and in women to a greater extent than in men. Diabetes mellitus has been growing recently. The atlas of the International Diabetes Association has been published, and, according to their data, we already have 12 million patients (although this is the opinion of experts, which should be treated critically), and according to the Ministry of Health – 3.5 million patients. Recently, we have also drawn attention to the fact that chronic kidney diseases increase the development of cardiovascular diseases, and these patients may die not from kidney failure, but from heart failure.
– Chronic heart failure, how common is it now?– The following pattern works here: the better we treat acute situations, the more patients with chronic heart failure we will have.
Because we do not let a person die in an acute situation, but we cannot completely cure him. Again, the aging of the population plays a role. Degenerative heart diseases contribute to the development of chronic heart failure.
– Can all patients in need be provided with pacemakers?– Of course, there are problems with this, at least financially, because a good pacemaker costs a lot.
And technically, not every hospital has a specialist who can make the correct diagnosis and determine that the patient needs to use a pacemaker.
– A question about another device – a defibrillator. It is known that in the West, in crowded places, such as airports, defibrillators are freely available, with which you can save a person. We don't have them. Is that a problem?– Of course, it's worth doing, affordable defibrillators certainly save a certain number of lives.
Although there should be a person who knows how to use a defibrillator. In the West, they teach this to policemen, firefighters. But I don't think it changes the whole situation that much.
– What are the breakthroughs and what are the emerging trends in the field of cardiac surgery?– Cardiac surgery, of course, remains the pinnacle of cardiology.
But now traditional surgery is being replaced by endovascular methods, more gentle, they are gradually replacing open-heart surgery. They have already started to change the heart valves without opening the chest.
– And how do you assess the prospects of regenerative cell technologies in cardiology?– So far, this is more hope for the future than reality.
There are still many difficulties that have not been overcome. Even if the injected stem cells turn into cardiomyocytes in the heart, the problem is that the myocardial cells are a whole network that works smoothly. If there are cells that do not fit into this network, they can do more harm than good, they will cause a rhythm disturbance. The effect that is now obtained with the introduction of cells is largely due not to the fact that these cells become myocardial cells, but to the fact that they stimulate the formation of their own cells. Probably, regenerative medicine is the future, but so far it is at the level of hopes and expectations.
– Finally, your recommendations: how to keep a healthy heart?– It's very simple.
Health is based on three pillars – a rational diet, moderate physical activity and smoking cessation.
Portal "Eternal youth" http://vechnayamolodost.ru25.04.2013