Month: January 2019

The benefits of physical training.

Termination of FA leads to an increased risk of CHD. The absence of large-scale randomized primary prevention studies that have studied the beneficial effects of FA makes it difficult to assess the benefits of FA in reducing the risk of CHD. However, FA clearly demonstrated a beneficial effect on cardiovascular RF. Exercise increases the level of HDL cholesterol, lowers cholesterol LDL and TG, increases insulin sensitivity and lowers blood pressure in people with elevated and normal blood pressure. Exercise also improves endothelial function and reduces CRP levels.

In the secondary prevention of the cardio-rehabilitation program with components of physical exercises, they showed a favorable effect in reducing the follow-ups. Combined data from many studies have revealed a decrease in OS and cardiovascular mortality by 25%.

Recommendations on physical inactivity. The ANA recently issued revised dietary and lifestyle guidelines starting at 2 years of age. They recommend FA> 30 minutes on most days of the week, even if the FA is divided into short periods. In addition, the ANA proposes to draw attention to the need to increase the FA, guided by the principle “it is better to move every day than to be moved”.

Previous ACC / ANA recommendations for secondary prevention also motivated patients to be physically active. Exercise may include walking, jogging, cycling, swimming, or other aerobic activities for 30–60 minutes on most days of the week, supplemented by increased activity in everyday life, such as climbing the stairs, whenever possible, instead of using an elevator or an escalator Strength training can give an additional favorable effect. Structured exercise programs can reinforce the patient’s long-term commitment to FT.

U.S. recommendations Primary Prevention Surgeon General’s are a great start — every adult should practice 30-minute moderate or intense FA on most days of the week and higher-intensity FA if it is desirable to reduce MT.

From a practical point of view, advice on physical activity (FA) should begin with her buds at the moment, including FA at work and during leisure. If the estimate indicates that FA is less than optimal, then obstacles to an active lifestyle should be examined. Potential obstacles can usually be the lack of time, energy, desire, and also a safe and convenient place to practice. Other barriers include certain medical conditions, such as osteoarthritis or transferred MI. After evaluating the FA, you should follow the advice to increase the cost of calories in everyday life, for example, advice on walking instead of traveling by car. The physician should recommend a steady increase in FA at rest up to> 30 min per day.

Prevalence of obesity. In the United States, over the past 40 years, the proportion of the population with excess MT (BMI> 25 kg / m2) and obesity (BMI> 30 kg / m2) has steadily increased. According to the 1960-1962 NHANES data, 31.6% of men and women had excess MT (BMI of 25.0-29.9 kg / m2), of which 13.4% were obese.

Today, almost 2 out of 3 Americans are overweight (MT) or obese; according to the NHANES 1999-2000, 64.5% of men and women had excess MT, 30.5% of which were obese.

The prevalence of overweight (MT) and obesity among children and adolescents is increasing in parallel with those in adults. At the age of 6-19 years, 15%, and at the age of 2-5 years, 10.4% were overweight (MT) or obesity. This is an alarming trend, because early obesity is a strong predictor of cardiovascular disease (CVD) in adulthood. It is particularly alarming that excess MT can lead to a dramatic increase in the incidence of DM-2 among children. In some areas of the United States,> 30% of new cases of DM-2 were observed among children, with most cases due to obesity.

Obesity risk. Obesity and overweight (MT) are strongly associated with the risk of coronary heart disease (CHD) and cerebral stroke (MI). Since different criteria were used to determine excess MT and obesity, the information and magnitude of this association with coronary heart disease (CHD) do not fully match. The question of whether overweight (MT) is an independent FD KBS, remains a matter of debate, because impact on the risk of coronary heart disease (CHD) may be mediated by arterial hypertension (AH), dyslipidemia (DLP), impaired glucose tolerance (NTG), inflammatory and hemostatic factors.

However, given the strong association with coronary heart disease (CHD), obesity remains an important and easily measurable risk marker.

Data from a number of cohort and metabolic studies provide similar evidence for a link between excess MT, NFA and impaired health. In a recent, long-term study, women studied obesity and NFA as predictors of CHD risk. Although BMI, the ratio of waist to hip volume, NFA independently contributed to the development of CHD, a study that lasted> 20 years showed that obesity increased the risk more than NFA.

Overweight (MT) increases the risk of metabolic disorders such as AH, DLP, IL and NTG. For example, in the Marks and Spenser Cardiovascular Risk Factor Study 14 077 middle-aged women, there were highly reliable, age-adjusted differences between 7 categories of BMI (from <20 to> 30 kg / m2) for GARDEN and DAD, total cholesterol, serum LDL, cholesterol HDL, TG, apo AI, apo B and fasting glucose levels. Excessive MT is associated in adults and children with increased markers of inflammation, such as CRP and fibrinogen, which are associated with an increased risk of CVD. There is a strong relationship between excess MT and an increased risk of CHD, ischemic MI, DMD-2, and other chronic diseases.

Overweight (MT) is an aggravating individual and economic factor. Estimates for 6 large prospective cohorts indicate that in the US, 280–320 thousand deaths per year are associated with overweight (MT), of which 80% occur in individuals with a BMI> 30 kg / m2. According to a national study of 10 thousand adult Americans, obesity is associated with a large number of chronic disorders and a worse quality of life than smoking or alcohol abuse.

Medical expenses for overweight conditions in 1998 were estimated at $ 78 billion (9% of total medical expenses in the United States). This amount is comparable to the cost of treating diseases associated with smoking. A study that examined the effect of increasing MT among men and women aged 35–65 years with initially excessive MT showed that the 3-year increase in health care costs was $ 561 more in individuals with an increase in MT by> 9 kg over this period compared with individuals whose MT remained stable.

The effectiveness of the treatment of metabolic syndrome in coronary heart disease

Risk associated with metabolic syndrome. Metabolic syndrome is a cluster of metabolic disorders, which includes insulin resistance (IR), dyslipidemia (DLP), arterial hypertension (AH), proinflammatory state and overweight (MT), especially abdominal obesity.

The prevalence of the syndrome in the United States: 27% of adults and 10% of adolescents aged 12-19 years meet the criteria for metabolic syndrome (MS). Persons with MS have an increased risk of death from cardiovascular disease (CVD). Not all patients with metabolic syndrome (MS) have the same risk of developing type 2 diabetes mellitus (DM-2) or vascular events; results from several studies suggest that there are other factors, such as inflammation, that can determine high-risk subgroups.

The benefits of treating metabolic syndrome (MS). Two randomized clinical studies have shown that lifestyle changes are of considerable benefit to patients with metabolic syndrome (MS) or impaired glucose tolerance (IGT). In the Finnish Diabetes Prevention Study 522 people. overweight (MT) and impaired glucose tolerance (IGT) did not undergo any intervention or received individual advice regarding weight loss, total fat intake and increase in physical activity (FA).

After 3.2 years of follow-up, the reduction in body weight (MT) was significantly more pronounced in the active intervention group, the incidence of diabetes-2 decreased from 23 to 11%, and the risk decreased by 60% (p <0.001). With such a simple intervention, treatment for 5 years, 5 patients with impaired glucose tolerance (IGT) will prevent 1 case of DM-2.

Further support for this hypothesis was obtained in the course of the Diabetes Prevention Program, in which 3234 patients without diabetes but with impaired glucose metabolism were randomly divided into a group on lifestyle changes aimed at reducing MT and increasing FA, metformin group or placebo. In this study, the implementation of a lifestyle change program resulted in a 58% reduction in diabetes-2 cases compared with the placebo group, while metformin reduced the risk by 31%. It is important that lifestyle changes led to a significantly greater risk reduction than drug therapy.

These two studies have shown that diabetes mellitus-2 can be prevented or delayed, which in turn will reduce atherosclerotic complications in this high-risk group.

However, accurate estimates of reductions in cardiovascular events (SSSob) are not known, therefore cost-effectiveness ratio data are not available.

Interventions related to lifestyle modification can have a large impact on a population. In a prospective study of women, diabetes developed in> 90% of cases of those who did not exercise, had a BMI> 25 kg / m2 and had poor dietary habits, and also smoked.

The effect of exercise should not be underestimated, because in 30% of patients with diabetes, minimal FN was noted during their lifetime. Moreover, although the determination of glycemia 2 hours after FN has the best sensitivity in assessing the risk in patients without diabetes compared to determining fasting glucose, the clinical benefit of this approach remains very modest.

Recommendations. ATP III and JNC-7 guidelines relate to metabolic syndrome (MS). Patients are classified as having metabolic syndrome (MS) in the presence of> 3 of the following symptoms: • waist size> 102 cm in men and> 88 cm in women; • Blood pressure> 135/85 mm Hg. v .; • cholesterol cholesterol level <40 mg / dL for men and <50 mg / dL for women; • TG level> 150 mg / dL; • fasting glucose level> 100 mg / dL.

The main goal of therapy is the underlying insulin resistance (IR). The most safe and effective strategy to reduce insulin resistance (IR) is to reduce body weight (MT) and increase physical activity (FA). Although drugs have been developed that can improve IR, there is no clear evidence that they reduce the risk of CHD in patients with MS. Drug therapy aimed at improving the lipid profile, lowering blood pressure and treating a prothrombotic state reduces cardiac risk in this population.