Primary and secondary prevention
Primary and secondary prevention has contributed a lot to reducing mortality from KBS, but problems remain. The first problem is the general aging of the population. In this regard, the number of persons with factors that attribute them to the risk group of CVDs will increase, because The prevalence of many factors increases with age. Similarly, the number of people with CVD will increase, which will require strengthening of secondary prevention measures.
This article provides a general approach to the patient, which can be presented in a few simple steps.
a) Step 1. First, assess the overall risk of the first or repeated cardiovascular event (SSSob) for each patient. Using a special algorithm, patients are classified into 4 groups: (1) with obvious CVD, including those with myocardial infarction, MI, PAD, angina pectoris or preliminary vascularization; (2) with no apparent CVD, but with diabetes or with a high risk, as assessed using a cumulative scale; (3) with moderate risk; (4) low risk. Patients with CVD and DM usually allocate immediately. For the remaining stratification, you need to use other prognostic information in the form of a scale developed, for example, by the Framingham Heart Study, ESC, New Zealand Guidelines Group.
b) Step 2. After assigning the patient to the appropriate risk group, 8 objectives of classes 1 and 2 should be used.
c) Step 3. The table below summarizes the approaches to the interventions of all 3 classes. For several RFs (smoking, DLP and AH), the strength and consistency of association with atherosclerotic diseases indicate a causal relationship; The benefits of intervention are well documented for both primary and secondary prophylaxis. Smoking cessation is mandatory for all.
DLP Drug Therapy should be administered to individuals who have 10-year risk of KBS> 10%; its goal should be a significant reduction in LDL cholesterol. Similarly, pharmacological treatment to reduce blood pressure should be prescribed to persons with moderate risk. There is little doubt that diabetes, NFA, obesity, and certain dietary habits increase the risk of CHD and that moderate alcohol consumption reduces the risk, but it was difficult to accurately determine the magnitude of the effect on these RFs associated with the intervention.
Low cost interventions are shown for everyone. Structured programs with a favorable cost-effectiveness indicator are indicated for persons with established illness.
e) Step 4. Periodic assessments of the dynamics of RF and general risk can be useful for assessing the adequacy of the intervention and motivating the patient to implement preventive recommendations. These recommendations need to be adjusted depending on the success of the modification of individual FRs.
Many of these activities can be performed by related medical personnel as part of preventive programs. The benefits of these prophylactic models in specific cases have been demonstrated in high-risk groups after MI or surgical bypass surgery.
e) Special populations. CVDs are the leading cause of death for women in most developed countries of the world. In the US,> 240 thousand women die each year from coronary heart disease (CHD), but a study with primary care physicians, obstetrician-gynecologists and cardiologists showed that less than 1 in 5 doctors knew that more women die from CVD every year. men. The American Heart Association has published a new guideline on CVD prevention for women that contains clinical guidelines adapted to the individual risk level of women.
The elderly also represent a special population group. The previously described interventions are usually applicable for healthy elderly people, but with pharmacological interventions, the initial doses of drugs may be even lower than in young people. It is necessary to take into account comorbidity and drug interactions. However, you should not abandon beneficial interventions based only on the age of the patient. Particular attention should be paid to improving patient education in order to increase adherence to the prevention advice of people with low socioeconomic status.