General and individual risk scales

General and individual risk scales

Due to the fact that many predictors of risk correlate with each other, risk can often be predicted based on information about several risk factors (RF). In most cases, many risk factors (RF) can be identified during initial screening, but it is sufficient to identify several easily measurable risk factors (RF) to calculate the overall risk for coronary heart disease (CHD).

For those who, at the initial screening, the risk is very low or very high, the measurement and evaluation of additional risk factors will give very little useful information, i.e. additional screening will add valuable information only in patients with intermediate risk. Evaluating individual absolute risk will allow you to select cost-effective intervention.

As evidence of the importance of assessing individual risk, NCEP, ATP III, JNC-7, and USPSTF suggested several options for assessing individual risk to determine the intensity of various interventions. The American Diabetes Association also recommends an absolute risk based treatment approach.

Usually, the presence or absence of cardiovascular disease (CVD) is sufficient for the distribution of patients with high or low risk. Patients with established CVD, such as damage to the coronary artery, cerebrovascular or peripheral arteries, constitute the first high-risk group. They always have a higher average risk than those without CVD. Approximately 80% of patients with established CVD will die from this disease, while among those without an established CVD, the death rate will be only 50% of the mortality rates from CVD.

As discussed later in this chapter, people with CVD usually need more “aggressive” interventions. Reducing the risk in these patients refers to secondary prevention, and among those without obvious CVD to the primary.

Patients with diabetes

Patients with diabetes

Patients with diabetes constitute the second high-risk group. The frequency of cardiovascular events (SSSob) and mortality among patients with diabetes is much higher than in the general population, so these patients need “aggressive” preventive interventions. The third group of patients who are at high risk for SCSS and death are patients with CKD, many of whom suffer from diabetes.

For patients without CVD and diabetes, several risk determination strategies based on risk factors (RF) have been developed. Early versions of some manuals recommended a simple calculation of DF. The Framingham Heart Study researchers have developed a handy tool for assessing the risk of a first SSSob, taking into account age, gender, cholesterol, LDL, LDL, GL, DAD, diabetes, and smoking. Points are assigned if and depending on the level of each FR.

After the summation of points, the absolute risk of coronary heart disease (CHD) is assessed over the next 10 years. The National Heart, Lung, and Blood Institute posted an affordable online 10-year risk calculator. Researchers at the Framingham Heart Study also developed scales for determining the risk of secondary prevention of MI and MI. However, due to the fact that patients with CVDs already have a high risk of recurrent CVDs and need “aggressive” prevention, the benefits of this tool remain unclear.

There are several alternatives to the Framingham risk scale. The HeartScore project (Heart Systematic Coronary Risk Evaluation) was created by a European working group based on cohort studies involving> 200 thousand people in 12 European countries.

HeartScore replaced the earlier risk stratification patterns common to the European Society of Cardiology, and shifted the focus from warning KBS to warning CVD. On the basis of age, sex, SAD, CHF, or HCV HDL ratio, HeartScore calculates the 10-year risk of death from CVD, rather than the risk of individual cardiovascular events (SSSob). SD in this scale was not included, because he was not studied in the cohorts used to create the scale. For patients with a 10-year risk of fatal events> 5%, aggressive intervention is recommended.

Another risk assessment tool was created based on the PROCAM study, which for a long time (from 1979 to 1985) monitored for> 5 thousand men aged 35–65 years. In the PROCAM FR algorithm, there were smoking, GARDEN, LDL CH and HDL cholesterol, fasting TG, as well as diabetes, MI in the family history and age. Answers in points to questions regarding these DFs are summarized, as in the Framingham risk scale, and the 10-year absolute risk of fatal or nonfatal IM BCC is determined by the results.

Risk assessment at individual level

Risk assessment at individual level

In contrast to community-based public health interventions, clinicians are responsible for preventive advice for a particular patient. An important step in determining an individual preventive strategy is to assess the risk of developing a clinically significant outcome, because indicators of the cost-effectiveness ratio of any intervention vary depending on the overall risk of the individual or population.

Since the absolute risk in people with an established disease is high, in order to save one life or prevent one cardiovascular event (SSSob) among them, fewer people with high risk should be treated compared with the number of people with lower risk, even if the decrease in relative risk is the same in both groups.

To illustrate this point, suppose that intervention reduces mortality by 25% in primary and secondary prevention, then a high-risk patient with coronary heart disease (CHD) has a chance to die from cardiovascular disease (CVD) over the next 10 years equal to 20%, while in a patient with a low risk, the chance of dying for the same period is 1%.

To save one life among high-risk individuals, only 20 patients need to be treated for 10 years, and 4 of them will die. Thus, reducing the relative risk by 25% will save one life (3 death instead of 4). In the case of a low risk, so that a 25% reduction in relative risk would lead to 3 deaths instead of 4, 400 people will have to be treated, of whom 4 will also die.

Thus, the total cost of one life saved is significantly lower (1/20 of the cost) among those with a high absolute risk. Costly interventions are usually cost-effective only for high-risk individuals, but with a low intervention cost, the cost-effectiveness relationship can be cost-effective even in low-risk populations.

When forecasting a risk, the “ideal” risk factor (DF) is one whose prevalence prevails in a population that can be easily and safely measured and which has a great predictive value.

The measurement should be inexpensive because cost is a major constraint on the use of imaging techniques such as electron beam tomography (CRT) or MRI. In addition, the frequency of false positives should be low to avoid unnecessary and potentially dangerous consequences. Age and gender are examples of non-modifiable risk factors (RF) that meet these criteria.

Blood pressure and smoking are examples of modifiable risk factors (RF) that are easy to identify. The results of diagnostic tests can also serve as predictors of future cardiovascular events (SSSob).

Risk factor assessment at the population level

Risk factor assessment at the population level

To conduct sound public policy, it is necessary to assess the contribution of various risk factors (RF) at the population level. The population risk depends not only on the strength of the factor-disease association and the benefits of the intervention, but also on how widespread this risk factor (RF) is in the population.

For evaluation, indicators such as the frequency of new cases, prevalence, and population attributive risk are used. The frequency of new cases is the emergence of new cases of disease or risk factors (RF) for a certain period of time; prevalence is the proportion of people with a specific disease or risk factor (RF) at a given time.

The population attributive risk shows what amount of risk is caused by a given risk factor (RF), and depends on the proportion of people with this risk factor and on the magnitude of the associated risk.

Population attributive risk also reflects the relationship between exposure to a risk factor (RF) and a disease. Many factors linearly increase risk, so a population attributable risk can be calculated relative to the ideal standard or to an individual with a low risk.

For example, the relationship between hypertension and heart disease or cerebral stroke (MI) is linear, so a decrease in blood pressure at any elevated level reduces the risk. In contrast, the shape of the risk curve for obesity is not linear, the risk increases logarithmically, i.e. Each kilogram gained is associated with a higher risk for those who are already overweight.

Population attributive risk is an important criterion in determining the resources needed for carrying out various preventive interventions and determining priorities in measures to improve public health, such as anti-smoking campaigns. However, this chapter focuses on individual risk assessment for predicting future cardiovascular events (SSSob).

The use of risk factors in clinical practice

The use of risk factors in clinical practice

Regardless of how risk factors (RF) affect the progression of atherosclerosis, they can be divided into 2 broad categories depending on their use in clinical practice:

(1) factors that are useful for risk prediction (risk predictors);
(2) factors that are targets for risk reduction interventions.

Such risk factors (RF), such as smoking and blood pressure, fall into both categories. Even if a particular factor has predictive value, it cannot be argued that modifying it will reduce the risk. If the benefit of an intervention is substantially greater than any of its risks and costs, then the intervention should be used in the appropriate population. So, how do you decide which risk factor (DF) to use as a predictor of risk and what will be the target for risk reduction?

The approaches to using a risk factor (RF) for predicting or reducing risk will be defined below. This article discusses only those risk factors (RF) that affect intermediate or long-term risk. Interventions used to quickly reduce short-term risk, such as aspirin or thrombolysis in acute myocardial infarction (AMI).

Forecasting and risk assessment. Risk prediction can be applied both to the population as a whole and to the individual. Information about the population can be obtained by studying a representative population sample in order to establish the frequency of various risk factors (RF) and plan public health objectives and resources for screening programs.

Individual risk assessment is carried out in order to identify in the population of a separate part of individuals who need a more intensive risk reduction program.

The articles on the site will briefly describe the assessment of the risk factor (RF) and the frequency of events in the general population, and further – a detailed assessment of the individual risk.

Types of evidence on risk factors

Types of evidence on risk factors

Evidence on risk factors (RF) is obtained from various sources. Studies on autopsy have shown that atherosclerosis can begin to develop even at an early age, if there are the same RF CVDs as in adults. Establishing a link between cause and effect is a major step in determining predictors, and the results of several studies are needed to select a preventive intervention. Fundamental studies of human physiology made it possible to penetrate into the mechanisms of atherogenesis and helped to establish the biological probability of a potential intervention in order to change these effects.

Observational studies involving people (cohort, prospective, case-control) are extremely useful in determining the attributive risk of a particular factor. Randomized trials can help confirm a causal relationship and are necessary for choosing interventions to reduce risk.

Each of these strategies has strengths and weaknesses. Descriptive studies (for example, the description of a single observation, a series of observations, cross-sectional, cross-cultural studies, the study of population temporal trends) have considerable value because of the ability to generate hypotheses. However, their design does not adequately control potential factors that may obscure obvious associations. Observational studies (eg, cohort, prospective, case-control) can better control potential inaccuracies.

Observational studies are particularly important in determining the attributable risk of a particular factor, when this factor has a great effect, as in the case of smoking and lung cancer. However, when small or moderate effects are studied in observational studies, the number of uncontrollable distorting factors can be as great as the probable risk itself.

In such cases, randomized studies are needed to confirm causality. When the causal relationship between RF and the disease is confirmed, appropriate intervention should be selected and applied. Even if the causal relationship is beyond doubt, research will help quantify the effect of the intervention. When the question arises about the choice between risk and benefit of intervention, randomized studies are needed to determine its net clinical effect.

This provision is important because the degree of associated risk is not necessarily related to the magnitude of the benefits obtained as a result of the intervention. This lack of correlation may be due to the inability of a specific intervention to achieve the desired effect, or the magnitude of the change may not lead to a corresponding change in risk. An example is the difference between the risk of an increase in blood pressure pa 1 mm Hg. st. and less than expected benefit for CHD while reducing blood pressure by the same amount. Similarly, elevated Gmc is considered to be FR KBS, and folic acid reduces Gmc levels, but randomized studies have shown that lowering Gmc levels with folic acid does not reduce the risk of KBS.

Meta-analysis allows a better assessment of the risk associated with a specific risk factor (RF), or the benefit of an intervention. For example, an assessment of the benefits of aspirin in secondary prophylaxis was obtained as a result of a large meta-analysis of data from 300 clinical studies, which demonstrated that in patients with CVD, aspirin reduces the risk of major SSSob by 25%.

After obtaining acceptable assessments of the benefits and risks for a specific risk factor (RF), a cost-effectiveness analysis can help develop guidance for an intervention. To compare interventions, a single currency is used, calculating QALY or a year of life adjusted for disability (disability-adjusted life-year, DALY). The estimates obtained from this analysis depend on the assumptions made in this analysis. Due to the fact that preventive measures are long-lasting (lasting for decades), the consequences of the initial assumptions regarding these measures may be more important than with short-term interventions. However, the cost-effectiveness indicators of interventions for CVD prevention are important because the prevalence of CHD and the cost of treating it are high.

The cost-effectiveness indicator is calculated as the ratio of the net cost to the increase in life expectancy. Interventions with a cost-effectiveness ratio <$ 40,000 for QALY are comparable to other permanent interventions, such as control of hypertension and hemodialysis. Interventions with a cost-effectiveness indicator of <$ 20 thousand for QALY are welcome, while with an indicator of> $ 40 thousand for QALY are usually perceived by insurers as intervention above an acceptable level. The economic costs of ineffective primary prevention measures for persons with modifiable DFs> 2 in the United States annually amount to $ 13.2 billion.

Cholesterol recommendations and control

Cholesterol recommendations and control

All patients with cardiovascular diseases (CVD) should be screened to determine the level of cholesterol in serum. Some controversy remains regarding screening for primary prevention. The NCEP recommends routine screening for all individuals> 20 years old, ACP (American College of Physicians) – only men 35–65 years old and women 45–65 years old, and USPSTF – screening all men aged> 35 years old and women aged 45 years old. Screening for CVD patients should include a complete fasting lipid profile, including total cholesterol, cholesterol, and HD. For patients without CVDs, the need for screening for HDL cholesterol is questionable: the NCEP recommends such screening, but the ACP does not.

Due to the fact that cholesterol cholesterol levels and the ratio of cholesterol to cholesterol cholesterol are very strong predictors of risk and help in identifying individuals with elevated levels of LDL cholesterol, despite moderate levels of cholesterol, it seems appropriate to determine cholesterol cholesterol simultaneously with cholesterol. .

To reduce the prevalence of HLP in the United States, the NCEP in 1988 released the first report on the treatment of HCS in adults. The latter was published in 2002, in 2004 some components were updated. According to the latest NCEP guidelines, the number of adults in the United States who need to modify lipid levels through lifestyle changes has grown from 52 million to 65 million, and those who need medication from 13 million to 36 million. The goals of the intervention are determined based on the individual risk of coronary heart disease. (KBS).

The updated ATP III guideline recommends different therapeutic goals depending on the patient’s overall risk calculated on the Framingham scale, taking into account other risk markers (elevated levels of TG, CRP and family history). Patients with an existing ASC (or its equivalent – DM or PAD) are at the highest risk of a cardiovascular event (SSSob), therefore their target level of ANS cholesterol is the lowest – <100 mg / dL or even lower – <70 mg / dl for those who have recently had ACS or have KBS and diabetes or high or poorly controlled RF.

In 2006, the ACC / ANA updated their secondary prevention guidelines on lipid control, repeating the recommendations made by the NCEP and strengthening some of them. As with the NCEP guideline, a target LDL-C level of <70 mg / dL was added as optional. However, ACC / ANA expanded the choice of target LDL cholesterol levels <70 mg / dl for all patients with CHD, and not just those who have a very high risk; However, this position is not supported by all researchers. In addition, patients with a TG level of 200-499 mg / dL should have a non-HDL cholesterol content <130 mg / dL, and further decrease to <100 mg / dL is considered appropriate.

According to the NCEP primary prevention guidelines, patients with a moderately high risk of CHD (RF> 2, total 10-year risk 10-20%) should receive appropriate therapy to achieve LDL <130 mg / dL (optimally <100 mg / dL) . These indicators are also a goal for patients with moderate risk (RF> 2, 10-year risk <10%). For patients with a lower risk, the target LDL level should be <160 mg / dL. In addition to this, according to the recommendations of the NCEP on lifestyle changes, the diet should include 25-35% of calories due to fat, while the proportion of saturated fatty acids should be <7% and cholesterol <200 mg / day.

It is difficult for patients to understand the calculation of calories in percentages, so it is recommended to convert them to grams of fat, protein and other components of the diet. Professional nutrition counseling can also be helpful. If using dietary therapy fails to reach the target level of LDL cholesterol, it is necessary to begin drug therapy. In all cases, it should be an addition to diet therapy and increase of FA.

The guidelines of the European Society Cardiology also include gradations of target levels. Although they are identical for all patients (cholesterol <190 mg / dl, or 5 mmol / l; LDL cholesterol <115 mg / dl, or 3 mmol / l), the duration and intensity of drug therapy are different. In primary prevention, if the 10-year absolute risk of CHD or a risk calculated for the age of 60 years> 5%, modification of the lifestyle and analysis of lipid levels after 3 months are recommended. If after this time, cholesterol or LDL cholesterol is still above the target level, then you can begin drug therapy.

For asymptomatic high-risk patients who have cholesterol and LDL cholesterol are close to target levels (5 and 3 mmol / l, respectively), target levels should be <4.5 mmol / l (175 mg / dl) for cholesterol and <2, 5 mmol / l (100 mg / dl) for LDL cholesterol. The same target levels are set for persons with KBS and / or SD.

In secondary prophylaxis in patients with high LDL cholesterol and low HDL cholesterol or high TG, aggressive treatment is necessary, perhaps even combined. For individuals with established disease, low levels of HDL cholesterol and normal LDL cholesterol, pharmacological intervention may be considered based on the results of the VA-HIT study.

Criteria for a risk factor for coronary heart disease (CHD)

Criteria for a risk factor for coronary heart disease (CHD)

Primary and secondary prevention of coronary heart disease (CHD) is indisputable for public health. Given the prevalence of this disease, preventing even a small number of cardiovascular events (SSSob) will save thousands of lives, avoid countless suffering, and save billions of dollars from the money spent on health care.

In addition, measures that can prevent coronary heart disease (CHD) can reduce the risk of other manifestations of atherosclerosis – stroke, peripheral arterial disease (PAD), and also affect hypertension, diabetes, cognitive function, cancer, depression and other chronic conditions . Due to the fact that cardiovascular diseases (CVD) have become “the number one killer” in the world, the use of large-scale preventive strategies should become the main objective of health care in developed and developing countries.

The constant accumulation of knowledge about the pathogenesis of atherosclerosis and the understanding of the relationship between lifestyle, biochemical and genetic factors and heart disease have contributed to a significant decrease in age-corrected cardiovascular mortality. The first step to prevention is the recognition of these factors as predictors of a likely atherosclerotic event. Based on risk factors (RF), scales were developed for assessing the individual risk of cardiovascular events (SSSob).

However, the disease prevention process should continue after assessing the likelihood of future events and consists in identifying an intervention that will reduce the risk. Once the studies have correlated the benefits of interventions with their risk and cost, appropriate guidelines can be developed for health care organizers.

Guidelines have been developed for the prevention of individual risk factors (RF), which ensured successful screening and modification of several major risk factors (RF): smoking, dyslipidemia (DLP), and arterial hypertension (AH). However, the implementation and integration of these guidelines remains a difficult task. The large volume and complexity of the presentation of materials in these manuals make it difficult to use them. The lack of time for doctors to act according to the recommendations is an additional barrier: only cardiovascular preventive measures recommended by the USPSTF (U.S. Preventive Services Task Force) will take the clinician at least 1.5 hours a day. The lack of appropriate remuneration also limits the use of certain preventive interventions.

The articles on the site used a new approach to the determination of risk factors (RF) in order to simplify the prevention of cardiovascular diseases (CVD). First, various types of DF and methods of using information about them in clinical practice will be discussed. It then proposes a simple approach to using RF as predictors of risk. Then follows a description of a specific sequence of preventive interventions, which are divided into three categories.

After that, this article will describe potentially modifiable risk factors (RF) and interventions, provide information on their prevalence, associated risk, benefits and costs of treatment, as well as recommendations for each RF and multifactor intervention strategies.

When cardiovascular diseases (CVD) became the dominant chronic diseases in economically developed countries, this phenomenon was regarded as a natural consequence of the aging population. In most cases, CVDs are mainly diseases of anthropogenic origin, i.e. largely dependent on a person’s lifestyle. Over the past 50 years, great progress has been made in identifying many CVDs due to lifestyle and biochemical and genetic factors, as well as in disseminating this information among the population.

How the Cardiovascular System Works

In what condition are our veins, arteries and capillaries, in this state we are also. Each organ and system has its own resource. Once healthy vessels become clogged, they are deposited salts, cholesterol plaques appear, as the result of which is, not only damaged the wall of the vessels themselves, but also to the taphole blood. The load on the heart increases, and it gradually wears out.

The consequences are the most sad – atherosclerosis, tri ombas leading to heart attacks and strokes, hypertension, arrhythmia, etc. But do not despair and despair: the heart, blood vessels and blood can be cleansed, restored to them a lost safety margin, prolong their normal work for another long years. How? Regular cleaning procedures.

The book contains the best methods for cleaning the heart and blood vessels, diluting blood and capillarotherapy, including nowhere else previously printed , but already deserved the highest marks of specialists: treatment with medical leeches and bees, curative starvation, a healing system of ancient yogis and much more.

We do not think about the condition and even the presence of internal organs as long as they work properly. The most important in the complex “computer” of the body is the cardiovascular system (the circulatory system),which feeds oxygen to our tissues and organs.

Pumping the blood should a healthy heart. Uvs , today we often hear the expression “weak heart” when it comes to young people. As a rule, it is they who, in view of their professional activities, live in a state of constant psycho- emotional stress. And if we add here people’s inclination to unrestrained entertainment “non-stop” – it becomes clear how much the cardiovascular system suffers from the frequent release of adrenaline and norepinephrine. It would seem that the bad thing is that the “unaccounted” adrenal is produced in the human organism . On the contrary, we feel more cheerful. But from excessive overexcitation and work in the normal regime, the arterial pressure rises , the stocks of potassium and magnesium ions deplete, arrythmia arises, etc.

Hence the wear of the heart and the contamination of the vessels. It goes without saying that neither a cigarette smoked, a glass of wine , nor a cup of strong coffee, nor “its well” when it comes to morning exercises and an evening walk, are also beneficial to the cardiovascular system . As well as the addiction to the TV, a long “sofa bed” and excessively satisfying food.

What usually is the prehistory of such catastrophes of our organism as arterial hypertension, atherosclerosis, myocardial infarction and cerebral infarction? Tested stress, after which we did not allow the body to fully recover.And here we mean not only a qualitative rest, but also a sufficient restoration of the level of potassium and magnesium ions in the blood . The relentless observation that the proper balance of these substances is maintained in the body is one of the cornerstones of humane treatment of the cardiovascular system. And here, by the way, it ‘s not just to eat foods that contain a lot of magnesium and potassium. It is important not to abuse foods,supersaturated fats, proteins, calcium and phosphorus (of course, we are not talking about abandoning these substances in principle, and this is not possible). The listed ingredients strongly suppress potassium and magnesium. To cheerfully imbibe such a bias in the diet , you should eat 450 grams of spinach or 200 g of sea kale daily, or constantly take medicines containing potassium and magnesium.

Surely you know the expression “heart failure “, in other words, lack of blood circulation. But does everyone know that it is not only innate, but and acquired due to careless attitude to his cardiovascular system?

The duty of the heart is to pump every hour up to 210 liters of blood. And neglected vessels lose their ability in a normal regime to provide our organs and tissues with the substances they need . It is the purification of blood and blood vessels that is devoted to this book.

Human life is impossible without a permanent circulation of blood in the body. Blood supplies oxygen and nutrients to cells and removes slag , carbon dioxide and cell waste products. The function of the blood movement is performed by the cardiovascular system, which consists of the heart and the cryogenic and lymphatic vessels. A person has a closed circulatory system, that is, blood is only in the vasculature , and its movement is due to the work of the heart.

We will understand the structure and functions of parts of the circulatory system.

A heart

In the textbook of anatomy you could see that the heart ka would be suspended on a bundle of large vessels in the center of the chest, approximately at the level of the location of the third rib.

FOR YOUR INFORMATION

The volume of the heart usually corresponds to the volume of his master’s fist.

The average parameters of the heart of an adult human are 12-15 cm in length and 9-11 cm in width.

What does the heart consist of? This hollow muscular organ contains four chambers. The heart wall consists of a myocardium (a special muscle tissue) performing a contractile function, and fibers that form the cardiovascular system of the heart. Outside, this organ is covered with a dense membrane – the pericardium. The heart can be divided into two halves – the right and the left. Each of them consists of the atrium and the ventricle. The righthalf pumps venous blood through the lungs, and the left half – arterial (a kis rich in blood) blood throughout the body. The chambers and the output of the heart are separated by valves, which ensure blood flow only in one direction, preventing it from returning. With a contraction of the heart at first, the atria become dyed, while the blood enters the ventricles, and then, when reduced, goes to the small and large circles of the circulation

FOR YOUR INFORMATION

When we are in a calm state, the heart commits about 60-70 beats per minute. The days of “quiet” life are identical to those thousands of heart beats (that is, 13-25 thousand yachts liters pumped to rye), and a month to three million.

Consider the work of the right heart. Venous blood from the whole body returns in the right atrium along two large veins. Then the blood enters the right ventricle, and from there – into the lungs (a small circle of blood circulation), where carbon dioxide is removed and the blood is enriched with oxygen. Then, through the lungs, the blood returns to the heart, along the four veins it flows into the right atrium, then into the ventricle and is pushed into the aorta, where the movement of blood throughout the body begins .

In other words, the heart is the engine that provides the movement of blood through the body . This is just one of the muscles, which really resembles the engine by the presence of two valve pumps (right and left). Another difference between the heart muscle and the skeletal muscle is its belted system of blood vessels (or vessels), because the heart requires twice as much blood flow. By the way, the names of coronary vessels consume a tenth of all blood moving to the arterial bed from the left ventricle. Atria and ventricles are communicated by means of openings, which are opened and closed by valves. Exactly the same valves cut off the ventricles from arterial beds .

Can the heart not work, that is, be at rest? Can. The period of systole (contraction) of the atria and ventricles alternates with a diastole, a relaxation of the heart muscle. During diastole, the blood is sent from the veins to the atrium, then, when the atria contract, it enters the ventricles, which are still relaxed. Thus , the time of systole and diastole of the ventricles and atria is different.

The continuous rhythm of the work of the heart keeps the blessings of an end to the sinus node. Of course, the heart muscle itself functions automatically , that is, it is reduced due to self-occurrence of bioelectric impulses in it. It is the sinus node located in the right atrium that is the place where these impulses originate. Following them, the heart muscle begins to contract. If the heart is healthy, the average frequency of its contractions is 60 beats per minute. Accordingly , the functions of the sinus node are disrupted, the amount of blood it receives (in combination with oxygen and nutrients ) should be reduced. It turns out that the pr and poor nutrition of the function of the sinus node and the heart system, through which nerve impulses are transmitted to the atria and ventricles, are violated. As a consequence – paroxysmal tachycardia, various atrioventricular blockades and other types of arrhythmia.

FOR YOUR INFORMATION

It’s hard to believe, but in the working capacity of the human heart lies a huge potential but is designed to work without failures for 90-100 years! If you also support it, then this period increases by 40 years .

Now you know how the heart works – the most important muscle in the body.

Vessels

In addition to the heart, the circulatory system includes cranial vessels – veins and arteries , which are connected by a capillary network.

Vessels differ in structure. In the walls of the artery there are more muscle fibers and elastic tissue to maintain normal arterial pressure in the body. The special feature of veins is that they have valves that prevent reverse current blood. A common quality for all blood vessels is the inner layer (intima), imparting the inner wall of all vessels smoothness for better blood flow.

Thanks to the “crimson rivers” in our body, there are tons of continuous movement of blood in the vessels, and there is a full (or in the case of abolevaniya vessels – not quite) the power of each of our cells, because it is through the blood, through its movement and carried etsya coordinated work of all organism, all organs and tissues in unison.

But the exchange of substances and gases between cells and blood occurs through the smallest vessels called capillaries. They filigree all the human body (this explains the fact that we have, for example, the blood from thefinger, even if we do not hurt at all with a needle). It is impossible to see capillary sap without a microscope, they are thinner than a human hair, and their walls consist of only a few cells.

FOR YOUR INFORMATION

The total length of all capillary vessels of one person, be they extended in a continuous line, would be about 80 thousand kilometers!

In other words, capillary vessels are the ” life-long” of our body, through which blood, oxygen, nutrients and mineral salts are delivered to the cells by blood flow , while the decay products are washed out.

In the diet of the body through the blood stream, a strict balance must be observed . To all cells, without exception, the blood must supply the right amount of vital substances. And to completely remove the decay products.And wherever it is important that there is not a single “weak link” in the body , after getting into the affected organ, the blood will get sick of this disease further. Faced with obstacles in the form of damage to the arteries, veins and capillaries, blood “stalled” in the vessels, and they are afflicted, provoking diseases of other organs, especially the heart. Consequently, purification of the cardiovascular system begins with the purification of blood and blood vessels, first of all – the capillaries.

How does the human heart and capillary vessels interact ? The power of the heart, no matter what “fiery motor” it is, in fact, is not enough to give blood flowing through the arteries, a push of the right force, capable of delivering blood to the capillaries. However, the blood enters the capillary , moreover, then it moves back, getting into the veins.

Schematically, the blood flow can be depicted as follows: from the heart, blood is directed to the arteries (imagine them in the form of stretching and expanding tubes). Arteries trans port it to the capillaries. Having been there, the blood enters the veins (imagine them in the form of suction tubes) and through them – again into the heart. It turns out that the cardiac output is designed to “push” the blood from the arteries to the capillaries.Why are the capillaries sick? Let’s start with the fact that the capillaries in our body are the sector most susceptible to the harmful effects of products of decay. All that is included in the concept of “unhealthy way of life”, in practice, would very quickly lead to a decrease in the penetration of blood vessels to their full blockage. And, if one of our organs is sick, first of all it is a sign that the capillaries are ill with us . And the fact that the blood cannot be conveyed to a certain cell of the body means that soon the cells that have remained without adequate nutrition will die off, overloading the orgasm with the decay products that will accumulate inside us in dangerous quantities.

However, not only capillaries can get sick. Not infrequently, the history of the heart disease of the cardiovascular system is damaged by the internal shell of the arteries.

Imagine that small atheromatous plaques appear on the walls of arterial vessels . Over time, there will be more, and they will increase in size.

It will take some time, and the inner shell of the artery will resemble a dry, cracked earth. As a result, the blood will cease to flow into some “harbor” of our body. In other words, one or more internal organs will begin to testthe blood supply deficit. And the more noticeable these obstacles will be “pushed” into our bloodstream , the more significant will be the pressure rises. But this is only the beginning. Over time, thrombi will begin to form in the arteries, which, expanding, can completely cover the vessel and lead to a heart attack. After all, what thicket does everything in the body, when doctors detect a heart attack? The thrombus hangs on the inner wall of the artery on the stalk like a parasitic fungus. It is clear that, carrying such a grain on its own , the artery works with great difficulty. At some point, the overstrain of the artery reaches a critical point, the thrombus breaks away from the vessel and, like a lethal pool , carried away by the bloodstream, rushes along the channel of the vessel. And when finally the clot is in a narrow space and SAG tre Vaeth it can occur death.

It is interesting that in men, blood vessels are clogged much more quickly, in addition, at a younger age. Women are lucky here – right up to the beginning of the climax, they develop a hormone that inhibits the clogging of blood vessels. Ks tati, women here in some way took care of men and in microdoses transmit this hormone to me in the process of intimate contact. Consequently, even regular marital life is beneficial for the purification of the cardiovascular system.

So, we summarize what was said. In what condition are the vessels (veins, arteries and capillaries), in this state we are also. But all the body and system has its own resource. Vessels become clogged, salts are deposited in them, cholesterol plaques grow, the walls and blood cells are damaged. The load is increasing and the heart – pumping blood to the organs and tissues through bad, “clogged” blood vessels is becoming increasingly difficult.There is such a thing as general peripheral resistance from convictions. Probably everyone understands that when the liquid moves through smaller diameter tubes , more force is required from the “pump” side. With persistent increased stress, the heart wears out, and the heart muscle degenerates.

The consequences of clogging of vessels are the most sad – atherosclerosis, blood clots, in going to heart attacks and strokes, hypertension, arrhythmias and other diseases of the heart and vessels, as well as worsening of the work of all internal organs and the central nervous system.

FOR YOUR INFORMATION

In middle age, etc. otsessy thinking, memory and ability to learn new knowledge deteriorate. Frequently this is only due to the lack of nutrition and oxygen, which the brain receives less in connection with the “clogged” vessels.

But do not give up and despair – the heart, blood vessels and blood can be cleaned, return them a lost safety margin and prolong normal work for many years to come.

Blood

What is blood? It is a vital thick viscous liquid of bright red color.

It is constantly in motion, circulating through the closed system of our blood-

vessels.

Why is it red, not blue, like princes and princesses from fairy tales? The reason for her color – a substance that is called hemoglobin. It is they who are filled with erythrocyte cells. In other words, red blood cells are red blood cells, and leukocytes are white.

The average blood volume in an adult is about 65 to 80 ml per 1 kg of body weight, in a child – from 8 to 10 ml per 1 kg of body weight. 55% of the blood consists of liquid plasmas , 4% of the “thick” cell mass.

Blood is a “vehicle”, on which absolutely all substances within our body move . That is why, on the second day, it is so important to start its general cleaning with the purification of blood and blood vessels. Unceasingly circulating, the blood supplies the tissues of our internal organs with oxygen and nutrients.

And it also helps to move to the “outlet” to all waste of our life. Therefore, reading the book further, you will understand why both traditional medical practitioners and traditional healers demand that we first of all clean our large intestine properly , from which blood “draws” toxins, slags, etc. into our bodies.

Think about it – by entering into any sick internal organ, the blood absorbs its “sores” and carries them further through the body. Meanwhile, only a healthy immune system of blood can protect us from viruses that are especially rampant in late spring and early autumn, all sorts of bacteria, food allergens and toxins , not to mention that only healthy blood can prevent the appearance and growth of an organ nism of malignant cells. In short, if the blood is unhealthy – there can be no question of the normal functioning of the whole organism. After all, having it is good , healthy immunity means that our body can easily have a pob To go to illness without the help of copper kametoznyh means, abuse of which, by the way, also destroys the immunity of blood. Even from the artistic Russian literature, we know that our ancestors attached great importance to the procedure of bloodletting, rightly assuming that it is extremely important for the purification of the circulatory system. If suddenly a deaf, prolonged headache starts , a heaviness in the liver, an ache in the lower back and joints, the doctor obliged the patient to leeches, and they soon restored the broken blood circulation.

Why the blood vessels become dirty

You already know that in order to prevent diseases of the cardiovascular system, you need to monitor the balance in the body of potassium and magnesium, which are actively competed with animal fats, rich in cholesterol, most of which in meat products.

Cholesterol is the slag from which we will have to purify the heart, blood vessels and blood.

Harm and benefit of cholesterol

To cholesterol the attitude is twofold. On one side , an excess of this substance often leads to atherosclerosis, and an increase in cholesterol levels is noted for obesity, diabetes, gout, hypertension and certain liver diseases.

On the other hand, cholesterol is an indispensable substance in the body: it participates in the synthesis of bile acids (during digestion ) and is the basis for the formation of corticosteroids, sex hormones and vitamin D, which regulates calcium metabolism. It is also a part of cell membranes , that is, it forms a “skeleton” for every cell in the body. Useful cholesterol is, in fact, the “handy” building element of the cells of our body.

FOR YOUR INFORMATION

Normally, the human body contains up to 0.2% (140-180 g) of cholesterol from the total body weight.

In human plasma, cholesterol is found in the lipoprotein complexes (lipo proteids). Low-density lipoproteins ( LDL) are isolated – in plasma up to 70-80%, and high-density lipoproteins (HDL) – up to 20-24 %. An increase in the level of LDL is a risk factor for the development of atherosclerosis and the formation of gallstones. HDL, on the contrary, have an anti-atherogenic effect.

Today, people who realize that health is really our main wealth, ensuring the inflow of any other wealth, try not only to eat right, but also to control the level of cholesterol in the blood. For this, it is sufficient to conduct a special blood test every six months. The grounds for referring to a doctor will appear, if suddenly it turns out that the level of “harmful” cholesterol in your body exceeded 4 mmol / l. And, if the indicators are not very depressing, doctors pre write to you for prevention of a special anti-sclerotic diet. Otherwise you will have to undergo medical treatment ment treatment. Or apply any of the techniques described in this book.

One of the causes of the violation of cholesterol metabolism is the excessive intake of cholesterol (LDL) with food. Alimentary, or nutritious, hypercholesterolemia occurs when consuming a large amount of food rich in protein and (eggs, caviar, liver, animal fats). Such a diet, more characteristic of residents of countries with a high level of development, and leads to atherosclerosis.

Cholesterol is produced in the body, and itself, especially with the help of alkogol and nicotine , which provokes the constriction of blood vessels (when, for example, we “smoked”, having spent the night at the computer, and feel as if our head compresses the head ). Thus, it is impossible to completely “not let” cholesterol into the blood vessels. What then remains to be done ? That’s right, clean them.

What is atherosclerosis

In this article I will use the concept of ” atherogenous plaques.” In the special medical literature, for example in the medical literature, the term “atherosclerotic plaques” is commonly found . This name comes from atherosclerosis – a disease that is rightly considered a “plague” of a modern person, most of all a secured consumer who does not deny himself delicious food and inactive forms of recreation, such as computer games. Atherosclerosis is submissive at all ages: if 5-6 years ago thought about the risk of getting atherosclerosis only by people and middle and old age, now more and more often pathological changes of blood vessels about they become teenagers, and it is from well-to-do families, in which there are all or almost all. “How to be?” – Ask shaken parents. First of all – to think over your diet and diet of your children. After all, the presence of atheromatous plaques in our vessels is not an irreversible process, and with some effort, we can expand the enlightenment in the diseased vessels, and then completely eliminate this infection.

When we talk about a completely healthy body, it is understood that absolutely healthy pure blood freely moves through wide, unoccupied arteries.

If the vessels are affected by atherosclerosis, this means that an overabundance of cholesterol in the body has led to a certain ( tending to constantly increase) amount of lipid deposits on the inner surface of the vessels leading to the development of atherosclerotic plaques. And their appearance is the surest signal of the fact that in the body the exchange of fats was severely violated.

Atherosclerosis is a chronic asteroid disease. It begins with the disruption of lipid metabolism and the deposition of cholesterol and low-density lipoproteins in the shell lining our vessels from the inside. Initially pho rmiruyutsya atheromatous plaque, then they are the proliferation of connective tissue (sclera Lake) and later joined etsya calcification of the vascular wall. These processes lead to deformation of the vascular wall and a sharp narrowing of the lumen of the vessel until the vessel is fully occluded. Consequently, the blood flow in the relevant organs worsens and their functions are violated.

Symptoms ischemia of different organs can manifest themselves even at a moderate restriction SRI vessels. Most often are affected:

♦ coronary arteries, which leads to the development of ischemic heart disease, up to angina pectoris and myocardial infarction;

♦ cerebral arteries, which causes cerebral ischemia until the stroke;

♦ vessels of the extremities, which leads to intermittent claudication, up to the development of gangrene;

♦ If a similar pattern develops in the renal arteries, then a sharp decrease in renal function is observed , and if in the arteries of the abdominal cavity, then the development of an intestinal infarction is possible .

It is clear that these are extreme options, but nevertheless …

In the late stages of atherosclerosis development there are violations from the coagulating blood system – against the background of already existing plaques and deformation of the vascular wall , microcracks can occur, on which platelet aggregation occurs with the formation of microthrombi. The state of the blood changes to the side of hypercoagulability – an increase in the level of clotting factors contained in the blood, and further increases the capacity for thrombogenesis.

Let’s compare our cardiovascular system with a water tap.

The new, just bought faucet supplies much more water than the tap, which lasted ten years. It is clear that on the walls of the old crane accumulated salt and rust on. With the cardiovascular system, the same thing happens over time . The blood begins to be pumped in a smaller amount, which means that absolutely all our organs also receive a reduced amount of nutrients. But there are also decay products , which are derived from our cells also during the blood circulation . Hence, with a decrease in the effectiveness of blood transfusion, they “get stuck” in us, provoking the emergence of various diseases and pathologies.

 Preventing Disease

Movement is life!

We work with you a lot – and suffer from stress . We “relax”, we urge artificial vivacity – and “finish off” our health with alcohol, cigarettes and coffee.

We earn well – and die from overeating and abuse of passive rest . It is hard to believe, but mortality from cardiovascular diseases has increased along with the spread of mobile phones. After all, the presence of a mobile phone at our fingertips has stolen from us even those few meters of “walking” that we have done to approach a stationary telephone set!

Modern medicine has progressed considerably in the study of the causes of heart disease , also because it changed its view on the role of skeletal muscles in the functioning of the circulatory cycle. For centuries it has been thought that the task of skeletal muscles is to help a person move, engage in physical labor and sports. It was meant that they are only “users” with respect to the circulatory system , after all, by making certain physical efforts, we force our muscles to consume 6 0-80 times more blood than in the state of “sofa-bed”, respectively, and increase the load on the heart . It turns out that to save the heart, you need to lie as much as possible and e move? By no means. Long-term rest state levels the micropump functions of skeletal muscles – in other words, they stop helping the heart pump blood and it is forced to work alone. Consequently , the heart becomes much more tired and wears out . Now you understand why the word “physical culture” is present in the list of treatment procedures prescribed by a cardiologist?

Alas, many people will argue – when to go in for sports, if the occupation and the working schedule itself (often unregulated) leave no opportunity for this?

First – a day at the desk, in the car or in the same pose at the conveyor , and then – household chores. After all , a single mother will not go to the gym, instead of preparing a dinner for the child and checking his lessons. So you can not lose a single possibility of “passing physical exercise”: for example, make yourself stand in public transport, even if there are places a (in the bus rolling, the whole body is forced to balance, so the skeletal muscles work). Take for the rule not to use the elevator, even if you live on the 13th floor. At first it will seem absurd to you, but decide for yourself that first you reach the elevator to the 10th floor, a few weeks later – until the 9th, after a few delays – until the 8th. After a while, hiking to your 13th floor will be something like an obligatory evening walk for you (believe me, with the experience of training this will stop taking you a lot of time).

But the most important thing is that the effect on the condition of the cardiovascular system of the system and the whole organism will be the same as if you bought a subscription to an expensive gym and went to work 3 times a week!

FOR YOUR INFORMATION

If you are already tempted by the idea of “cheap and angry” to go in for sports (that is, vital self-healing), take note of one trick. Still on approach to the house, start to breathe deeply. Once on the doorstep, you will have time to feed the blood with oxygen. This will help you in the fight against shortness of breath – at first it will not advance immediately, but in the course of time will cease to advance at all.

Remember that the most important thing – until mature years, keep the vessels elastic. And their elasticity directly depends on the flexibility of the body. After all, the vessels can not remain elastic for a long time , if the human body is in the same position for days on the computer, without detachment in order to bend a few times, or, until the office staff sees them , sit on the twine.

How to eat

Sad truth

We are well aware that on the Black Continent – in Africa – a disease such as AIDS is very common . But people with a sick heart, on the contrary, can not be found there.

Statistics show that the more developed and provided with a country, the more people with a sick heart in it , the more often cardiovascular diseases become the cause of high mortality . After all, a wealthy person regularly buys himself, for example, foods high in protein and cyanocobalamin ( smoked meat and fish products) and pasteurized dairy products. Among the countries where people die, including due to good nutrition, are the USA, Canada, Australia, Russia and Finland.

FOR YOUR INFORMATION

In 2000, according to statistics, with the measurement in Russia of cardiovascular disease, which arose against the background of atherosclerotic vascular lesions, was 801 cases per 100 000 population. In Japan, the same indicator in 2000 – 187 cases (the difference is almost 5 times!). This is due not so much to the development of medicine as to the way of life and nutrition. For

Japan is characterized by a bias in the “fish” diet , and seafood and fish just contain HDL, which have an anti-atherogenic effect.

You have already become acquainted with the main causes of accumulation in the body of cholesterol.

This is a “sofa” lifestyle and the lack of regular and balanced physical activity, a predilection for heavy meat fatty foods ( arenaceous, smoked, dried meat products, especially the gentleman’s kit “fish with beer “), regular use of alcohol. In addition to the fact that x- oleasterin deposits begin to grow inside of us , so also the body weight increases. Agree, only very few people are calm about the fact that they begin to grow stout. For most people, especially for women, this is a huge nuisance, if not a tragedy. However, we all begin to beat in great harmony when the weight really becomes critical. For the time being, it exceeds the body mass index suitable for us by only 4-5 kg ​​- this does not frighten us, they say, everything is normal , this age. Meanwhile, back in the middle of the last century, scientists proved that an “unplanned ” weight gain of 4 kg is the first step of the body on the way to atherosclerosis.

By the way, it is in the USA that the most depressing indicators for the contamination of organisms with cholesterol plaques are in people aged 65 and over. The reason is that for many decades the population of our country was eating “mass”, cheap and harmful products, and the shortage of food in the 90s of the 20th century convinced the many that potatoes with bacon and pickles are the most notable useful and satisfying daily food.

However, it will be naive to believe that atherosclerosis from this day is more often than not the “fun of the elderly”. A huge number of young people today strongly “save” themselves cholesterol plaques, because it abuses so- called “youth” products . First of all, this is the range of McDonald’s and all kinds of popular network bistros. Not less popular and all kinds of shop fast food, and it ‘s not just about hot dogs that we eat on the run, but also about office products – soups, pasta and instant mashed potatoes, which replace their lunch daily with 98% of “office ladies” .

It takes two months to absorb all these “Big Macs” daily , so that “colonies” of lipids are formed on the inner shell of our arteries. It is clear that just so a person does not feel it. However, scientists, trying not to miss the opportunity to formalize young victims of mass catastrophes and natural disasters , come to depressing discoveries. For example, among the young people who died in the terrorist attack in New York on September 11, 2001, there was a huge number of girls aged 26-30 and men aged 18-15 who had an intensive cholesterol deposition on the walls of the vessels . At 35% of these people, according to doctors, had a chance to be disabled in 45-50 years. Fast food is one of the main sources of cholesterol .

Modern life, especially in big cities, requires us to be quick. And increasingly “fast” seems to us pleasant and tasty. You can get rid of hunger by eating crisps. Free yourself from the evening prepared for buckwheat porridge, you can order the head pizza from semi-finished products. Traditional for many beer use after work is usually combined with a snack – the same fast food, as few people would think that before the beginning of a beer party it would be better to visit the most ordinary dining room or cafe, in which there is a real mashed potatoes, and not ” from the sachet. ”

There is an exit

The scientists’ assurance that atherosclerosis can be completely eradicated from our body , provided that the diet and sports are observed, is not mif. It is another matter that the diet of food , and the way of life, for people “stuffed” with lime-lipids, will have to be changed very seriously. And some changes in nutrition, without physical loads, too, do not cope. But after all, and the result is guaranteed – if we take care of ourselves for real, we can hear from the doctor in a year or a year and a half from the doctor that atherosclerotic plaques have dissolved inside us and disappeared without a trace. So everyone is free to decide for himself whether the passion for “urban food” is worth a significant shortening I have a life, the last years of which , moreover, have to spend a little sympathetic obese disabled.

We are used to believe that atherosclerosis, which is the result of an over-saturation of the body with cholesterol, is primarily an American problem. Do not consider jokes about the fact that Americans, by the grace of fast food, are the most fat and the least mobile nation. What is true here is that it was precisely the Mérican scientists who first raised the alarm, realizing that the population of the huge strata was a victim of food abundance. It was the “fat Americans”, who seriously took this national problem seriously , managed to achieve worthy results in the region and reduce the indicators of heart failure, heart attacks and strokes.

When the “anti-cholesterol boom” rolled across America, the US Congress adopted

A nationwide program to combat atherosclerosis , leading campaigns began to develop products without fats, sugar, salt and cholestina, and in American films, the smoking hero began to become a “loser” – the results after a while really impressed. During the last two decades of the last century, American physicians were able to halve the number of patients and 30% the number of heart attacks. And if at first the respectable mother Europe watched the anti-cholesterol activity of American industrialists and doctors with a mocking smile, then today it’s time to sound the alarm to the Europeans themselves. On example, the Czechs with their national predilection for beer and pashtetics or Poles – lovers of eating smoked meat.

Not so long ago, the European Union adopted a program for the European correction of lipid metabolism in European countries.

In the USA , despite the fact that “gourmet” products have not yet become a mass consumer , the situation with atherosclerosis is in fact nothing better than in Europe.

Today approximately 60% of the working-age population of the USA needs to observe a special atherosclerotic diet. The problem of atherosclerosis is seriously taken up by native scientists. They argue for a more responsible attitude of people to preventive measures. For example, in every family where atherosclerosis is detected in a person under the age of 55, a thorough examination of all people, including children from 2 years of age, is necessary , since they are all at risk.

Where in the world are most of the long-livers? Correctly , in Japan and Korea. It is there that the largest number of old people who have crossed a staggering line and are at the same time tolerably feeling themselves. Why? Because the food of the Japanese and Koreans is dominated by substances called phosphorolipids. The fact is that daily in their diet ration is dominated by soy and seafood, to which they contain phosphorolipids. By the way, another interesting observation – in the United States among the emigrant women, the highest mortality rates as a result of atherosclerosis is precisely among Japanese and Koreans, since their blood circulation system is particularly rapid Oily and heavy American food.

The main advantage of phosphorolipids is a powerful antioxidant ability.

They very “skillfully” connect and remove from the body x of the cholesterol and significantly inhibit the development potential of atherosclerosis. In addition, an increase in the human body phosphorolipids halved the risk of developing malignant tumors of internal organs.

In addition to soy and marine products, the inhibition of the growth of atherosclerotic plaques is influenced by the regular intake of certain vitamin supplements. The most effective of them is nicotinic acid, which doctors advise taking daily 3-4 g per day courses 1-2 times a year. As a rule, the course of taking nicotinic acid is calculated for several months. She also has positive side effects – vasodilation and acceleration of oxidation-reduction reactions , important, including for the prevention of atherosclerosis. Another anti-sclerotic drug, working on prevention, is ascorbic acid. The minimum dose of a daily intake that can improve lipid exchange, – 3 g. The adult is given a daily dose of 10 g. Being a strong antioxidant , ascorbic acid is continuously converted into dehydroascorbic acid, which contributes to the qualitative relief of free radical reactions, “difficult” for our body. By the way, most fruits ( especially citrus fruits) have a high content of natural vitamin C, which is easily absorbed by our body.

Finally, some physicians advocate for the regular reception of ion-exchange resins, which bind cholesterol and bile acids to more effective food products. I recommend you cholestyramine – the most effective for today’s anti-sclerotic copper kametoznoe agent.