Risk of IBS 1 that. Basic Risk Factors IBS

Causal myocardial ischemia may be a blockage of a vessel atherosclerotic Blyaska. Education process thromba or spasm vessels. Gradually increasing the magnitude of the vessel usually leads to chronic insufficiency blood supply myocardia. which manifests as stable threw stress. The formation of a thrombus or spasm of the vessel leads to acute insufficiency of the blood supply to myocardium, that is, myocardial infarction .

In 95-97% of cases cause of development ischemic heart disease becomes atherosclerosis. The process of blocking the lumen of the vessel atherosclerotic plaques, if it develops into coronary arteries. Causes insufficiency of the heart of the heart, that is, ischemia. However, the sake of fairness should be noted that atherosclerosis is not the only cause of IHD. Heart power failure can be caused, for example, by increasing the mass (hypertrophy) of the heart when hypertension. people have physically hard work or athletes. Some other reasons for the development of the CHA are noted. Sometimes it is observed when anomalous development coronary arteries, with inflammatory diseases of vessels. with infectious processes, etc.

However, the percentage of cases of developments of the CHA for reasons that are not associated with atherosclerotic processes is rather insignificant. In any case, myocardium ischemia is associated with a decrease in the diameter of the vessel, regardless of which caused this reasons.

Great importance In the development of IBS have the so-called risk factors IBS. Which contribute to the emergence of IBS and create a threat to its further development. Conventionally can be divided into two large groups: changeable and unchangeable risk factors IBS .

The varying risk factors, the IBS include:

• arterial hypertension (i.e high blood pressure),
• smoking,
• excess body weight ,
• carbohydrate disorders (in particular diabetes ),
• sedentary lifestyle ( hydodina),
• irrational food
• increased cholesterol blood content, etc.

The most dangerous from the point of view of the possible development of IBS are arterial hypertension, diabetes, smoking and obesity .

Condumatible risk factors, IHD, as it is clear from the name, are those from which already, as they say, are not going anywhere. These are factors like

• age (older than 50-60 years);
• male gender;
• humidated heredity, that is, the cases of the disease of the CHA near the nearest relatives.

In some sources, it is possible to find another classification of the risk factors of the ICD, according to which they are divided into socio-cultural (exogenous) and internal (endogenous) risk factors. The socio-cultural risk factors of the CHD are called those of them that are due to a human living environment. Among these risk factors, IBS are the most common:

• incorrect meals (excessive consumption of high-calorie food, saturated with fats and cholesterol);
• hypodynamia;
• neuropsychiatric overvoltage;
• smoking,
• alcoholism;
• the risk of the occurrence of IHD in women will increase with long use hormonal contraceptives .

Internal risk factors are called those that are caused by the patient's body. Among them

• hyperholesterolemia. That is, increased blood content in cholesterol;
• arterial hypertension ;
• obesity;
• metabolic disease;
• cholelithiasis ;
• some features of personality and behavior;
• heredity;
• age and sexual factors.

Most of these risk factors are really dangerous. On literate data, the risk of the occurrence of IBS increased level Cholesterol is increased by 2.2-5.5 times, hypertensive disease - 1.5-6 times. A very strongly affects the possibility of the development of IBS smoking, according to some data, it increases the risk of developing IBS in 1.5-6.5 times. High risk factors are also hypodynamia, excess body weight, carbohydrate impairment, primarily diabetes mellitus. Increases the risk of developing HBS. Continuous use of soft water, poor mineral salts (calcium, magnesium, chromium, lithium, zinc, vanadium), as this also provokes metabolic disorders in the body. A noticeable impact on the risk of developing IBS is provided by such, at first glance, factors are not related to blood supply, as frequent stressful situations, mental overvoltage, mental overwork.

However, most often "guilty" are not stress by themselves, but their influence on the features of the person's personality. In medicine, two behavioral types of people are distinguished, they are called by type A and type B. Type A include people with an easy-reaching nervous system, most often choler temperament. A distinctive feature of this type is the desire for a competition with everyone and victory by all means. Such a person is inclined to overestimated ambitions, hastily, constantly dissatisfied with the achieved, dwells in eternal voltage. Cardiologists It is claimed that this particular type of personality is capable of adapting to the stressful situation, and people of this type of IBS develops much more often (at a young age - 6.5 times) than in humans of the so-called b, balanced, phlegmatic, friendly.

We remind you that no article or website will be able to put the correct diagnosis. Need a doctor's advice!

Coronary artery disease

Currently, cardiovascular diseases are the main cause of mortality and disability throughout the world. The leading role in the mortality structure from cardiovascular diseases belongs to ischemic heart disease.

Ischemic disease Hearts (IBS) - chronic illnesswhich develops with insufficient oxygen intake to myocardium. The main cause (more than 90% of cases) of insufficient oxygen flow is the formation of atherosclerotic plaques in the lumen of the coronary arteries, the arteries of the bloodstream heart muscle (myocardium).

Prevalence.

According to the World Health Organization (WHO) mortality from cardiovascular diseases is 31% and is the most frequent cause fatal outcomes around the world. On the territory of the Russian Federation, this figure is 57.1%, of which more than half of all cases fall into the share of IHD (28.9%), which in absolute figures is 385.6 people per 100 thousand people per year. For comparison, mortality from the same reason on the territory of the European Union is 95.9 people per 100 thousand population per year, which is 4 times less, compared with our country.

The frequency of the CHA increases sharply with age: Women from 0.1-1% aged 45-54 years to 10-15% aged 65-74 years, and men from 2-5% aged 45-54 years to 10 -20% aged 65-74 years.

The cause of development and risk factors.

The main cause of the development of ischemic heart disease is atherosclerotic damage to the coronary arteries. Due to certain risk factors, cholesterol on the walls of the vessels is postponed for a long time. Then the plaque is gradually formed from cholesterol sediments. Atherosclerotic plaque, gradually increasing in size, disrupts blood flow to heart. When the plaque reaches significant sizes, which causes an imbalance in the delivery and consumption of blood myocardium, then the ischemic heart disease begins to manifest various forms. The main form of manifestation is angina.

The risk factors of the ICC can be divided into modifiable and unmodifiable.

Unmodifable risk factors are the factors that we cannot affect. These include

• Floor . Male floor is a risk factor for cardiovascular diseases. However, entering into a climacteric period, women are deprived of a protective hormonal background. And the risk of developing adverse cardiovascular events becomes comparable to male floors.
• Age. After 65 years, the risk of cardiovascular diseases increases sharply, but not equally for everyone. If the patient has a minimum number of additional factors, the risk of developing adverse events remains minimal.
• Heredity. It should also be considered a family predisposition with heart-vascular diseases. Influencing the risk is the presence of cardiovascular diseases in the female line up to 65 years, by male up to 55 years.
• Other unmodifable risk factors. Other unmodifiable factors include ethnicity (for example, in blackheads, a higher risk of stroke and chronic renal failure), Geographic Affiliation (for example, high stroke frequency and IBS in Russia, Eastern Europe and the Baltic countries; Low risk of CHD in China).

Modifiable risk factors - factors for which can be affected by a change in lifestyle or appointment medicinal preparations. Modifiable can be divided into behavioral and physiological and metabolic.

Behavioral risk factors:

• Smoking. According to the World Health Organization, 23% of IHD deaths are due to smoking, reducing the life expectancy of smokers at the age of 35-69, on average for 20 years. Sudden death among those who dig a pack of cigarettes during the day, is observed 5 times more often than among non-smoking.
• Food habits and motor activity.
• Stress.

Physiological and metabolic features:

• Dyslipidemia. Under this term is understood as an increase in total cholesterol, triglycerides and a balance between cholesterol fractions. The level of total cholesterol in patients should be at no higher than 5 mmol / l. The level of low density lipoproteins (LDL) in patients did not undermine myocardial infarction should not be higher than 3 mmol / l, and in individuals who have suffered a myocardial infarction this indicator must comply with the value< 1,8 ммоль/л. Также негативный вклад в развитие неблагоприятных сердечно-сосудистых событий вносят липопротеиды высокой плотности (ЛПВП) и триглецириды. ЛПВП должны быть выше 1,42 ммоль/л, а верхняя рекомендуемая граница для триглицеридов – 1,7 ммоль/л.
• Arterial hypertension. To reduce the risk of cardiovascular complications, it is important to achieve the target level arterial pressure less than 140/90 mm Hg. In patients with a high and very high risk of cardiovascular complications, it is necessary to reduce blood pressure up to 140/90 mm Hg. and less, within 4 weeks. In the future, provided good tolerability, the decrease in blood pressure is recommended to 130/80 mm Hg. and less.
• Obesity and nature of fat distribution in the body. Obesity is an exchange-analimentary chronic disease, which is manifested by the excessive development of adipose tissue and progresses with natural flow. It is possible to estimate the excess body weight by the formula defining body mass index (BMI):

BMI \u003d body weight (kg) / height 2 (m 2). If BMI 25 or more is an indication for weight loss.

Diabetes. Given the high risk of developing undesirable cardiovascular events at the SD, as well as the fact that the first myocardial infarction or brain stroke in patients with SD ends fatally, hypoglycemic therapy is an important component of the primary prevention of undesirable cardiovascular events in patients with type II patients.

To calculate the degree of risk, a Score scale has been developed. This scale allows you to calculate the 10-year risk of cardiovascular disease.

Risk factors ischemic heart disease

To successfully deal with the disease, the causes and mechanisms of its development should be studied. However, most diseases are based on a whole complex of various causal factors. So, with many infectious diseases, whose pathogen is accurately known, very often its introduction into the body does not yet predetermine the disease. The disease will develop in humans only when along with a virulent microbe on the body there are factors such as supercooling, fatigue, lack of vitamins, weakening of immune barriers. The history of tuberculosis confirms this.

Was there a tuberculosis in the Middle Ages? Of course. However, he was widely spread in the XIX century, when the sad glory of mankind was entrusted to him, especially cruelly mowed the urban population. What was the caused of this epidemic? The rapid growth of the industry, the concentration and crowding of the population in the cities, bad housing conditions, dustiness of premises, child labor in production without elementary labor protection and almost without any medical care - All this created the conditions for the unprecedented propagation of tuberculosis. However, due to the improvement of living conditions, especially among children, the incidence of tuberculosis has sharply decreased. Consequently, the disease is caused by not alone pathogens of tuberculosis, which are now found from most people.

Fig. 11. The mechanism of development of atherosclerosis

As for noncommunicable diseases, in particular the CHD, it is even more difficult. Scientists cannot associate the development of atherosclerosis or CDS with one reason. There are many of these reasons. American researchers P. Gopkins and R. William in 1981 published a review in which all the factors that contribute to the development of IBA were attempted. There were no such factors anymore, 246! Of course, this number includes the main factors that are most substantially affecting the human body, and minor. The effect of these factors is combined. One person has one combination of factors to the fore, the other is different. As a result of a long exposure to the body of these factors called "risk factors", in plasma of blood, the content of cholesterol lipoprotechnic particles is gradually increasing or the condition of the arterial wall changes. This relieves the penetration of lipoprotechnoid particles into the wall of the arteries, conditions are created for their long delay, even if the blood level is not too high.

As can be seen from fig. 11, all that contributes to the increase in the content of atherogenic lipoproteins in the blood and a decrease in the level of anti-theaterogenic particles, contributes to the development of atherosclerosis. However, in general, the question of being or not to be atherosclerosis is determined by the interconnection of lipoproteins with the arterial wall. Therefore, the increased permeability of the arterial wall for atherogenic lipoproteins is also of great importance for the development of atherosclerosis. Below we will look at individual risk factors that cause the development of the CHD.

Hypercholesterolemia, or elevated cholesterol content in the blood. People with high cholesterol in the blood accumulate main carriers (carriers) cholesterol - beta-lipoproteins. In this regard, it would be more correct to talk about the increased content of blood not so much cholesterol, how many beta-lipoproteins. Since it is practically easier to determine the cholesterol content in the blood, it is decided to judge the level of lipoprotein in the blood indirectly, on the content of cholesterol. In newborns different countries, nationalities and races of cholesterol in the blood is relatively low: on average in cord blood - only 70 mg / dl, that is, 70 mg of cholesterol in 100 ml of plasma. With age, cholesterol levels in the blood increases, and unevenly. So, at a one-year-old child, the cholesterol content is doubled. Later, its level slowly rises and by 18-20 years reaches 160-170 mg / dl. After twenty years at the cholesterol level in the blood, the singularities and lifestyle of people begin to affect the blood. In the highly developed countries of Europe, North America and in Australia, as a rule, the cholesterol content in the blood increases, in men - up to 50-55 years to 60-65 years - in women, respectively, men - up to 210-220 mg / dl , Women - up to 220-230 mg / dl. In residents of African countries, Southeast Asia, South America, over 20 years old, cholesterol levels in the blood or does not change, or increases slightly.

As already noted, after consumption of food, rich in cholesterol, cholesterol content in the blood increases. If a person is long in such a diet, then it develops so-called food hypercholesterolemia. Sometimes hypercholesterolemia arises as a result of some diseases (for example, as a result of lowering the function of the thyroid gland) or hereditary disorders, when the body synthesizes cholesterol in excess or slowly "recycles" it.

Whatever the origin of hypercholesterolemia, it is extremely undesirable for the body. Statistical data suggests that people have different groups between cholesterol and the EBS rate there is direct dependence. Low cholesterol in blood (below 200 mg / dl) determine the inhabitants of countries where IBS is rare, and high level Cholesterol (above 250 mg / dl) - in residents of districts, where this disease is common. That is why the elevated cholesterol content in the blood is considered one of the main factors contributing to the development of IBS.

Hypertriglyceridemia. This term refers to the increased level of triglycerides in the blood. Often, the increase in triglyceride content is accompanied by the rise of cholesterol level, but there are more cases of "clean" hyperitriglyceridemia. In such people in the blood, the main carriers (carriers) of triglycerides are accomplished - Lipoproteds, as well as the beta-lipoproteides are rich in cholesterol, which have, albeit atherogenic properties. The results of clinical observations confirm that people with a high level of triglycerides in blood often develop atherosclerosis and IBS.

The level of triglycerides in the blood is susceptible to significant individual fluctuations. Based on the results of clinical observations and population studies, it is possible to conclude that the content of triglycerides in the blood is over 140 mg / to undesirable, and over 190 mg / dl - already risky in terms of the development of atherosclerosis.

The hyperitriglyceridemia is due to a violation of the exchange of triglycerides in the body, which can be provoked or exacerbated by incorrect, irrational powers, alcohol use, and, moreover, in women - using contraceptive (contraceptive) hormonal drugs and other reasons.

The high level of triglycerides in the blood is observed in diabetes patients, gout suffering from nephrotic syndrome, with a reduced function of the thyroid gland and other diseases.

Hypoalofalipoprotehememia (reduced content of alpha-lipoprotein in the blood). In part of patients with atherosclerosis and IBS, cholesterol or triglyceride levels, or rather beta and interrupted lipoproteins, remains the same in the blood plasma, but the content of alpha-lipoproteins is reduced. Since alpha-lipoproteins, in contrast to beta and premie-lipoproteins, protect the vascular wall from the lesion atherosclerosis, the decrease in the level of alpha lipoproteins in the blood can be considered as an atherosclerosis risk factor. It is likely that the myocardial infarction in women in the report coloric period is rare because they have the level of alpha-lipoproteins in the blood higher than in men.

Therefore, in the study of lipid metabolism, it is advisable to determine not only the level of total cholesterol and triglycerides in the blood, but also the ratio of cholesterol atherogenic lipoproteins to cholesterol anti-theaterogenic lipoproteins:

beta-xs + prize-xs

where xs is cholesterol of the corresponding lipoprotechnical classes. The higher this attitude, the greater the likelihood of atherosclerosis and its complications. In patients with severe atherosclerosis, complicated by IHD, such an attitude reaches 6 units and more. On the contrary, the ratio of less than 3 units is characteristic of people who do not suffer from IHD, and for long-livers. Often they have a high content of alpha-lipoprotein cholesterol in the blood (more than 80 mg / dl).

To determine the so-called cholesterol coefficient of atherogenicity, only two indicators are used - the data of the total xs and alpha-xs:

Hs common - alpha xs

K \u003d -----------

Judging by this coefficient, the threat of the development of atherosclerosis increases in people with a low content of alpha-lipoproteins in the blood and a balance between the levels of beta and interruption-lipoproteins, on the one hand, and the level of alpha-lipoproteins on the other.

Hereditary factors. It has long been noticed that the signs of IBS, including myocardial infarction, are often detected from close relatives. There are cases when the myocardial infarction was the cause of the death of the relatives of three generations: from grandfather to grandchildren. The hereditary line is primarily transmitted by violations of a lipoprotechnoid exchange of one or another type, which manifests the level of blood lipoproteins in the blood (hyperlipothemia). At the same time, the content of cholesterol or triglycerides, or both of these components of lipoproteins, increase in the blood, or both of these components of lipoproteins at the same time. At the heart of such violations, in most cases there is a genetic (hereditary) enzymatic defect, as, for example, with the first type of hyperlipoprotehemia.

This disease is most often found in young children. In the blood of a child with hyperlipoprotehememia of the first type, there is no special enzyme - lipoprotein lipase, which splits the largest lipoprotection particles of blood - chilomikrons. As a result, the chilomicrons are long in the blood of a suspended state. Blood plasma becomes white like milk. Following the thick of the skin of the child, fat particles are gradually postponed, forming yellowish tubercles - xanthomas. The child is disturbed by the liver and spleen functions, bouts of abdominal pain occur. If the child will be assigned in a timely manner in a timely manner, it will largely be fenced from the unpleasant consequences of the first type hyperlipopoprotemia.

Other people may inherit a violation of the exchange of different type, in which they have a very high level of cholesterol and carrying lipoprotechnoid particles from an early age. Such a violation is genetically due to a shortage of specific receptors specific for beta-lipoproteins on the outer surface of cell membranes of some organs and tissues. As a result, not all beta-lipoproteins are associated with such receptors and penetrate the cells into the subsequent splitting and disposal of the formed products. Therefore, the content of beta lipoproteins and cholesterol is growing in the blood.

Other options for hereditary defects are also known, due to the rapid splitting of cholesterol in the body and leading to hypercholesterolemia.

Whatever the cause of hereditary hypercholesterolemia, especially homozygous (transmitted from both parents), this is an extremely disturbing phenomenon. The level of cholesterol in the blood with homozygous hyper-cholesterolemia is sometimes rising to 700-800 mg / dl (normally not higher than 220 mg / dl). As a result, xanthomas appear in the skin of the eyelids, hands and feet, in the field of muscular tendons attachment, for example, along the Achilles of the tendon, and relatively often - lipoid arms along the periphery of the cornea of \u200b\u200bboth eyes. Atherosclerosis and IHS in people with such violations are developing early (often up to 20 years), and in the future, if you do not undertake the necessary medical measures, myocardial infarction arises or other complications.

The great importance of the hereditary features of the body in the development of atherosclerosis is shown in the special literature, which describes cases early Development Myocardial infarction in twins with genetically determined violations of lipid metabolism.

Is it possible to determine the danger of early development of atherosclerosis in children if hypercholesterolemia determined from their parents? Yes, you can.

According to the results of the study of cholesterol in the blood, taken from a newborn baby (for analysis, cord blood is taken) or in children of the first year of life, in most cases it is possible to predict what the likelihood of atherosclerosis is in the future. Fortunately, hereditary homozygous hypercholesterolemia is rare. Heterozygous (transmitted from one of the parents) hypercholesterolemia is detected much more often. But it proceeds not so hard as homozygous.

Undoubtedly, due to hereditary features, some people are more vulnerable to atherosclerosis than others. And yet it is difficult to imagine that the heredity of generations so quickly changed so that only this is to explain the widespread distribution of IHD. Obviously, the epidemic wave of the IBS is other reception.

Food. Features of nutrition, the usual diet is given a considerable significance in the development of atherosclerosis primarily to emphasize the harm of excessive, unbalanced nutrition, which contributes not only to obesity, but also the level of lipid levels in the blood is particularly easily increasing the content of triglycerides in the blood, if there are many saturated fats in the received food. With long-term consumption of products rich in cholesterol, - egg yolks, caviar, liver and brains Animal-level cholesterol in the blood gradually increases. The Swedish scientist X. Malmosis in 1965 confirmed this fact in experiments on volunteers who eaten on the day of 6 eggs. Animal fat contains cholesterol that is easily absorbed in thin intestine. In addition, in the conditions of an excess of animal fats and lack of plant cholesterol in the body, it is easily connected with saturated fatty acids (contained in animal fats), forming cholesterol esters, which are slower than leaving further changes and oxidation. If cholesterol is associated with unsaturated fatty acids (contained in vegetable fats), it is easier to transform into the body.

There are many experimental and clinical observations that testify that after replacing in the food of saturated animal fat, unsaturated vegetation, cholesterol levels are reduced and the development of an atherosclerotic process is delayed. On this basis, nutritionists of the whole world emphasize that in the daily diet of a person, part of animal fats should be replaced with vegetable in order to prevent and treat atherosclerosis. It is to replace, and not just add vegetable fats to animals.

Meat, butter, other animals Fats and milk are the main sources of saturated fats in human food. In meat of pets, as a rule, more saturated fats than in the meat of wild animals. This contributes to the relatively small pets of pets, widespread use for their nutrition of feed and other food additives. Improving the living standards of the population will undoubtedly contribute to increasing consumption of meat and animal fats.

Thus, it becomes an urgent problem of restrictions in the food of the human animal fats without reducing protein in it. In Australia, for example, where the consumption of animal products is high, and the IBS is widespread, the original method was proposed for enriching meat and milk unsaturated fatty acids necessary for the human body. Its essence is as follows. In natural conditions unsaturated fatscontained in plant feeds, in the stomach of ruminant animals under the action of bacteria turn into saturated. To increase the share of unsaturated fatty acids in milk, meat and fat of cows and sheep, Dr. T. Cattle recommends introducing into the diet of these animals, small portions of unsaturated vegetable fats, such as sunflower oil, in caseic capsules, which protect fats from bacteria in the stomach of animals. The capsules arrived together with food in the intestine in the intestine here, and the unsaturated fats contained in them are absorbed. So you can increase the number of unsaturated fatty acids in meat 3-5 times and in milk - ten times. As far as this proposal is promising - the future will show. A sharper is the question of how to provide a person with the most rational nutrition of vegetable fats, reducing the consumption of animal fats.

Speaking about the role of nutrition in the development of atherosclerosis, it is necessary to mention another circumstance. Modern man Increasingly began to use high-purified and canned food and less often - products rich in vegetable fiber. The latter possesses the property to bind cholesterol (100 g of fiber can connect 100 mg of cholesterol) and accelerate the promotion of content in the intestine.

Thus, food consuming rich in fiber will contribute to a slowdown in the absorption of cholesterol in the intestines and the accelerated removal with feces. In addition, in the opinion of some scientists, if we exclude the so-called coarse food and move to the "delicate" diet, the overeating will come, which enhanced the level of cholesterol and triglycerides in the blood. Finally, food products and microelements, the lack of which in the body determine the development of atherosclerosis in the body during purification by some methods.

With excessive meat consumption, the risk of atherosclerosis is also increasing. A. I. Ignatovsky, who in 1908, noted the development of atherosclerosis in rabbits after the feeding of meat, suggested that this is leading the cholesterol contained in meat. However, the results of simple calculations indicate that cholesterol in meat is not so much so that its level in the blood rose as high as after the addition of pure cholesterol. The reason for such an atherogenic meat, unfortunately, is not clear to us now. Although it is convincingly proven that as a result of the consumption of animal proteins, in particular meat proteins, hypercholesterolemia and atherosclerosis develop in large numbers. Some researchers associate it with the features of the amino acid composition of animal proteins: with a high lizin attitude to arginine and a relatively low content of glycine.

In the diet of residents of highly developed countries, the share of meat and meat products is large. According to the Ministry of Agriculture, Fisheries and Food of the UK, each Englishman by the 70 years "eats" an average of 3 cows, 17 piglets, 25 sheep, 420 chickens and a bundle of sausages with a length of 6.4 km. Figures, as you can see, impressive.

At the same time, numerous facts are known that in vegetarians, the level of lipids in the blood is lower than those who consume mixed (vegetable and meat) food. This does not mean that a person should have only vegetable food. But serves as a warning that he needs to avoid excessive consumption of meat products. It is significant that after the consumption of milk, even in large quantities, cholesterol in the blood does not increase, because in the fresh milk contains a factor inhibiting cholesterol synthesis in the body.

English scientist J. Yutkin believes that raising the level of lipids in the blood in residents of highly developed countries is connected with the consumption of sugar in large quantities. According to his calculations, in the past two centuries, people began to include 25 times more sugar in their daily diet. In the Soviet Union only for 1960-1980. Sugar consumption per capita for the year has increased from 28 to 44.4 kg! There is a close connection between the exchange of fats and carbohydrates to which sugar and the body exists in the body. In excess of carbohydrates, conditions are created for the delay and accumulation of fats. The action of carbohydrates in people with a high level of interrupted lipoproteins and triglycerides in the blood is noticeable: after receiving carbohydrates, especially sugar, the content of these components them in the blood increases even more.

Dr. J. Yukkin conducted a simple experiment. It selected 20 people who suffer from angina, 25 people with interspersed chromota (arterial patients with atherosclerosis lower extremities) And 25 healthy people, only 70 people aged 45 to 66 years. He decided to take into account the amount of sugar, including the sugar contained in confectionery, ice cream and other products that consumed these people on average. It turned out that people suffering from angina, they consumed 132 g of sugar, patients with atherosclerosis of the lower extremities - 141 g of sugar per day, and healthy - 77 g of sugar. As can be seen, atherosclerosis patients consumed sugar much more than healthy. Dr. J. Yukkin published his book about Sahara under the sensational name "Pure white, but deadly".

In fact, it is impossible to ignore the fact that sugar for a person is new food Product. In Europe, sugar appeared only in the XVI century, and widespread only in the XIX century, when the sugar began to produce from sugar beet. The consumption curve of sugar per capita began to rise and steadily continues to crawl up. Above the data on the growth of sugar consumption in the Soviet Union. According to statistics, the consumption of sugar in the United States per capita in the early 70s reached 44 kg per year, and in 1974 it was already 50 kg. At the same time, in recent years, sugar consumption is increasing not so much in its pure form, as in the form of confectionery products - sugar syrups, canned berries and fruits, ice cream, etc.

Purified sugar (refined) does not contain a chromium microelerant (it is lost in the process of sugar purification), which is essential for the exchange of sugar itself in the body. Therefore, when using purified sugar in large quantities, it is derived from tissues and its insufficiency may occur in the body that promotes the development of diabetes and atherosclerosis. On the recommendation of the doctors, in some countries, along with refine, they began to reaffece the crude "yellow" sugar rich in chrome again. But this is not a way out. Excessive sugar intake in any form does not pass without a trace for the body.

Diabetes. Sugar diabetes is called a disease that is manifested by the increased content of glucose (one of the simplest sugars) in the blood. With a significant rise in the level of glucose in the blood, it begins to stand out by the kidneys with urine, caring water. This is manifested by an abundant urination, so the disease received another name - diabetes. In patients there are thirst, elevated, "insatiable" appetite. The organs and tissues of patients with diabetes are ceased to absorb glucose in the necessary quantities, experiencing a deficiency in the main source of energy. Partially this deficit is made at the expense of fats and proteins, but if the disease is progressing, patients can fall into a comatose state and die.

After the experiments of D. Mering and O. Minkowski, with the removal of the pancreas in dogs (in 1889) and brilliant Ji works. V. Sobolev (in 1901) became clear the role of "islet" pancreatic fabric in the absorption of glucose organism. In the main, extinguishing, the pancreas fabric in animals and humans were engaged in about 1 million "islets", consisting of specific cells that produce and secreted into the blood of a special hormone called insulin (from the word "insuls" - an island).

In 1922, Canadian scholars F. Banting and K. Best for the first time in the world received from the "Islet" fabric of the boards of the gland insulin and successfully applied it to treat sugar diabetes. Since then, patients with diabetes have an opportunity to effectively be treated and returned to normal life.

By calculations medical statisticals, on the globe there is almost 100 million people with obvious clinical signs diabetes; In this case, every 10-15 years the number of diseased diabetes doubles. In addition, there are many patients with so-called potential and hidden forms of diabetes. First of all, it includes people with burded heredity, who have parents or other close relatives sick diabetes, as well as people suffering from obesity. To identify hidden diabetes, a man who has this disease is assumed to be carried out, the load with sugar and determine the blood sugar level fluctuations, and if necessary, the possibilities are also investigated and insulin content in the blood. Thanks early diagnosis Such forms of diabetes and appointment in the subsequent diet can prevent the progression of the disease and avoid its heavy complications. The basic principle of such a preventive diet is the principle of the gentry of the "island" pancreatic apparatus by limiting or exclusion from systematic consumption of sweets or products rich easily and fast suction carbohydrates.

So, the exchange of carbohydrates, their utilization in tissues is largely regulated by hormones, first of all, the hormone "islet" pancreatic fabric is insulin. This hormone also has the ability to influence the exchange of fats, creating conditions for their delay in tissues. As a result of increased insulin products in the body, as a rule, fats and laying substances are delayed in tissue depot, as well as in the vascular wall. This contributes to the formation of atherosclerotic plaques in vessels. Meanwhile, the state of the body, in which insulin production increases, arise relatively often: obesity, overeating, consumption of a large amount of sweets, flour products, sweet fruit. If human overeating is in a habit and is long supported, then conditions are created in the body for the development of diabetes, obesity, atherosclerosis.

With age, the incidence of diabetes is growing. In some countries, more than a third of the elderly suffers from this disease. Most often, with the "senior diabetes", the content of insulin in the blood is not reduced, but increases. However, the biological activity of this insulin is insufficient, because many elderly increases the formation of so-called insulin antagonists of both hormonal and non-coronal origin. At the same time, insulin activity in the blood is generally braked. In such conditions, the "island" (insular) of the pancreas apparatus is forced to work with a large overvoltage; The absorption of glucose tissues may find out. This leads to an increase in blood glucose content, and the absolute level of insulin turns out to be higher than normal. Such forms of diabetes were called insulin and independent.

It has been established that insulin exists in the blood free and in the associated forms. Free insulin contributes to the utilization of glucose muscle tissue, liver, other organs. Related insulin has its specific effect only on fatty tissue. Insulin antagonists slow down the activity of its free shape, the associated insulin easily affects fatty tissue, contributing to the enhanced formation of fat in it.

Light forms of diabetes can remain compensated for a long time due to the reserve capacity of the body. In this case, the "islands" of the pancreas produce insulin in increased quantity. Its concentration in the blood increases, allowing the body to overcome the difficulties that arose on the way of absorption of glucose tissues. At the same time, with an increased concentration of insulin in the blood, the transformation of glucose into fats is enhanced, that is, the synthesis of triglycerides increases, conditions are created for their longer delay in fatty depots and in the vascular wall itself. That is why light shapes of diabetes in the progression of atherosclerosis sometimes play no less, and maybe even big rolethan diabetes middle severity or heavy. Patients with a light form of diabetes only by strict constant compliance with the diet can avoid increasing insulin secretion and thereby protect themselves from the dangerous internal factor of the development of atherosclerosis and from the possibility of moving the hidden diabetes to explicitly.

The results of the population examination of residents of Leningrad showed that almost 21% of men 40-59 years old on an empty stomach level of blood glucose above the upper limit of the norm, that is, more than 110 mg / dl. This suggests that most such people have diabetes mellitus, since the increased content of blood sugar in an empty stomach is one of the reliable signs of this disease.

As for severe forms of diabetes mellitus, with an absolute decrease in insulin levels in the blood, they are often accompanied by an increase in cholesterol formation in the liver, as well as enhanced mobilization of free fatty acids from fatty depot. At the same time, the development of atherosclerosis is increasing, how much the risk of blood formation is increasing. And if the patient in the coronary arteries had not previously formed not very large atherosclerotic plaques, they can become a focus of formation of thrombus. This sharply increases the danger of blockage of the enlightenment of the coronary arteries and provokes the development of myocardial infarction.

The close relationship between atherosclerosis and diabetes, apparently, has others to be further research. So, clinicians know many such cases when diabetes is developing against the background of this violations of lipid metabolism. In suffering from IHD, especially when it is combined with an increased level of blood lipids, the risk of diabetes is halucing. It is assumed that the high level of atherogenic lipoproteins somehow contributes to the binding of insulin and thereby loss of its activity. This requires an increasing consumption of insulin and leads to its reinforced production in the pancreas with all the ensuing consequences: diabetes and atherosclerosis are progressing, conditions are created for the development of myocardial infarction and other complications.

Lack of physical activity. If you analyze how the life of people in the economically developed countries of the XX century differs from the lives of people of the XVIII-XIX centuries, it turns out that from the position of the physiologist, the difference is primarily as follows. Due to civilization, the costs of muscular energy sharply decreased and the calorie content of food increased significantly, in particular, the consumption of animal fats and high-purified carbohydrates increased.

Even in the middle of the last century, 96% of all the energy on Earth was produced by the muscular power of man and pets and only 4% - technical means. Today, these relationships have acquired directly opposite meaning.

As a result of all this, a person began to move a little, it was not possible to work very physically that he did not fail to affect the state of his cardiovascular system. Evolutionary the cardiovascular system A person, like many other animal organisms, has adapted to constant physical exertion. A good example of today is available athletes - runners for large distances, skiers and representatives of other sports. Their cardiovascular system successfully copes with difficult exercise.

What happens if the untrained person is characterized by a sedentary lifestyle, will quickly pass only 200-300 m? He will have a heartbeat, the heart rate will increase to 120-125 per minute, the time of diastole (heart relaxation) will be significantly reduced. Next, due to the income of the neuro-vascular apparatus of the heart muscle, underdeveloped collaterals (additional vessels), blood supply to the heart, which should increase several times, will not reach the required level. As a result, oxygen starvation of the heart muscle will come, the general muscular fatigue and person will not be able to continue movement.

Nothing like this will happen to the heart of the trained person: it will get oxygen to the fullest. Moreover, at the same load on the heart, the heart rate will increase the frequency. Thus, the physical possibilities of an athlete is significantly higher than that of the untrained person.

The famous cardiologist V. Raab called the modern civilized man "Actual Supil": Works of life are connected mainly with tension nervous system, while the muscular apparatus, the heart muscle is weakened from inaction; Cardiac power reduces. A condition is developing, which is called the deregiousness of the heart. Therefore, the heart of a person leading a sedentary lifestyle is more susceptible to IHD. It can be safely argued that the person who goes to work on the car, inside the institution moves on the elevator, and returning home (again by car), sends to the clock from the TV, sooner or later IBS expects.

At the same time, the results of studying the lifestyle of long-livers (according to the 1970 census in the Soviet Union lived almost 300 thousand people over 90 years old) showed that physical work is an indispensable condition for their longevity. Many long-livers, overlooking the centenary, continue to work.

Physical activity should be considered as one of effective tools Prevention of atherosclerosis and IHS. According to the observations of doctors, who is strongly engaged in physical exercises, are 3 times less susceptible to the risk of heart disease. In this regard, exercise and sports games are widely recommended, especially swimming, tennis, football, ski ridges, running, walking, cycling. In a word, significantly large loads than during the exercises of the morning gymnastics.

It is very characteristic that animals who are accustomed to constantly move (minks, sands, etc.) or to make great physical work (for example, a horse), - high blood content in the blood of anti-theaterogenic alpha lipoproteins, whereas in animals, little moving (for example, In pigs), atherogenic beta and interrupted lipoproteis predominate in the blood. Horses, unlike pigs, are not at all exposed to atherosclerosis.

The American doctor P. Wood recently said that men regularly engaged in running long distance (an average of 25 km per week), the proportion of anti-theaterogenic lipoproteins is also reduced in the blood and the proportion of atherogenic is reduced.

Obesity. The reason for the obesity of practically healthy people is excessive food intake, the calirage of which exceeds the energy costs of the body. Often obese suffer from people relating to the reception of food as a source of pleasure or as one of the ways of compensation for personal adversity. Other obesity develops with age, seemingly normal nutrition.

To better understand the reasons for age obesity, consider in general, as in our body an appetite is regulated.

In the special education of the brain - hypothalamus (subburo) - there is a center regulating food intake. When the glucose content is reduced in the blood (during the fasting), the activity of this center increases, the appetite is excited and the person wants to eat. As soon as the blood glucose content (in the process of food intake) reaches a certain level, the food center is oppressed. If this system of regulation of glucose content in the blood works correctly, in most cases the mass of human body remains stable. However, it is not always possible to rely on appetite. According to the Leningrad scientist V. M. Dilman, a person with a age decreases the sensitivity of the food center to the action of glucose, that is, the feeling of satiety comes after consumption of food in large quantities. If a person does not follow his habits, then from a certain period of life he begins a gradual increase in body weight.

The food center can "mislead" and relatively young people. For example, obesity from them often develops when moving from active physical activity to a low-wear lifestyle, when the excitability of the food center and appetite remains the same, and the energy produces are significantly reduced. The decline in the body's energy cell is also characteristic of the elderly and old people. Immirement food consumption is undoubtedly promoting obesity.

Sometimes the habit of overeating is acquired as a child, if the family is customary to consume sweets, baked products made of white flour, fried food in excessive amounts. In fact, today in many families every day eat as it was eating only on holidays.

Often obesity contributes to the abuse of beer and other alcoholic beverages, since, on the one hand, there are many calories in these beverages, and on the other hand, alcoholic beverages increase their appetite and entrust the overeating. 0.5 liters of beer, 200 g of sweet wine, 100 g of vodka or 80 g cognac, liqueur or Roma contain about 300 kcal (kilocalorium). Recall that the daily need of an adult man, not engaged in physical labor, approximately 2500 kcal. Therefore, the body of alcohol lovers only due to alcoholic beverages Gets 20-30% of the calories required. Often, after drinking alcohol, there is so much food that the good half of it turns into fat.

Obesity is manifested by an increase in the volume of adipose tissue for which additional blood supply is required and, therefore, an additional load on the heart is created. In addition, fat deposits in the field of the front abdominal wall Raise the diaphragm, limit the movements of the chest, shifting the heart and interfering with its work.

As noted above, with an excess of carbohydrates incoming from food (starch and sugars), insulin production, which contributes to the conversion of carbohydrates into fats is enhanced. As a result, along with fat deposition, the concentration of fatty acids in the blood increases, the level of triglycerides and atherogenic lipoproteins increases. Blood fatty acids reduce insulin activity, and its additional quantities are needed for the growing body weight. As a result, the insular apparatus functions with excessive voltage. Gradually, its capabilities are depleted, insulin products fall, hidden diabetes mellitus becomes apparent. So there are new dangers in the course of the disease and its new complications.

In obesity suffering, a high level of lipids in the blood is often determined. In other words, a fat person is more predisposed to atherosclerosis, and consequently, to IBS than a person with a normal body weight. It is not surprising that fat people have a myocardial infarction appear 4 times more often.

Obesity, diabetes, a high level of lipids in the blood, atherosclerosis - all of this sometimes units "one chain reaction", which basically has a constitutional predisposition to exchange violations, combined with an incorrect lifestyle, primarily with overeating. That is why the fight against obesity by rational balancing of nutrition and physical Loads Practice great importance. Exercise should be considered as a method for preserving constant body weight, in other words, as a method for preventing obesity. The limitation of food intake is the most effective measure against the already developed obesity.

Factors affecting the bark of the brain and the centers of neuro-humoral regulation. A certain relationship between an increase in the number of cardiovascular diseases (primarily hypertension and IBS) and such factors as urbanization, accelerating the pace of life, an increase in professional and household psycho-emotional tensions is no doubt. All of these factors significantly affect the central nervous system of a person.

Works S. P. Botkin, I. M. Sechenova, I. P. Pavlova, G. F. Lang, et al. It was established that the state of the psycho-emotional sphere is directly related to the development of many diseases. Numerous evidence that psycho-emotional overvoltage leads to an increase in excitability in brain formations such as large hemispheres, hypothalamus, reticular formationWhere to vessels, various organs and tissues, a reinforced pulse flow rushes. As a result, pathological reactions occur: vascular spasms, the tone of the vascular wall increases, the flow of metabolic processes is disturbed.

Ischemic heart disease (IBS) is a common cardiovascular disease, which consists in the difference between the blood supply to the muscular shell of the heart and its needs in oxygen. Blood enters myocardium by coronary (corner) arteries.

If there are atherosclerotic changes in the corrugated arteries, the influx of blood deteriorates and occurs, leading to a temporary or resistant dysfunction of the muscular heaving of the heart.

Cardiovascular pathology occupies the championship in the mortality structure worldwide - about 17 million people die over the year, of which 7 million - from IBS. According to WHO, there is a tendency to increase mortality from this disease. To improve the quality of life of people and reduce the incidence, it is necessary to determine the risk factors. Many factors are common in the development of IBS and other diseases of the circulatory system.

What do you understand under risk factors?

Under risk factors imply those events or circumstances that increase the likelihood or progression of a certain pathology. Risk factors for IHD shall be divided into:

• modifiable;
• unmodifiable.

The first group of risk factors IBS (which cannot be influenced):

• sexuality;
• age;
• hereditary leaning.

The second group of IBS risk factors (which can be changed):

• smoking;
• arterial hypertension;
• metabolic disorders;
• hypodynamia;
• psychosocial factors, etc.

• cholesterol indicators;
• arterial pressure;
• the fact of smoking;
• age;

By default, the very high risk group includes people with:

• already diagnosed with cardiovascular pathology;
• diabetes;
• reduced kidney function, which lasts 3 months ( chronic illness kidney);
• large number of individual risk factors.

Risk Factors Cardiovascular Diseases

Risk Factors for IHD

Male gender

Crown arteries, which causes hearts in 99%, is determined three times less often in female people than those of men in the time interval of 41-60 years. This is due to the influence of estrogen on endothelium, smooth muscles Vessels and a smaller percentage of other Risk factors from women among women (including smoking).

However, there is evidence that after 70 years, atherosclerotic lesions of the coronary arteries are found equally often among both sexes, as well as IBS.

Age

Over time, the probability of developing IHD increases, although it is now observed to rejuvenate this pathology. This risk group of IBS includes patients over 65 years old and patients over 55 years.

Bigness of Family Anamnesis on Cardiovascular Diseases

If the patient has relatives who diagnosed atherosclerosis to 55 years old from male representatives and up to 65 - in female, then the likelihood of its occurrence in the patient increases, therefore, this is an additional risk factor.

Violation of fat exchange

The pathology of the metabolism of fats laboratory is expressed in dyslipidemia and in hyperlipidemia. During the dislipidemia, the relationship between transporting lipids with molecules / lipids is disturbed, and with hyperlipidemia, the level of these blood molecules becomes higher.

Fats are in blood in transport form - as part of lipoproteins. Lipoproteins are divided into classes on the basis of the difference in the composition and density of the molecule:

• high density lipoproteins
• low density lipoproteins,
• middle density lipoproteins
• lipoproteins are very low density.

In the emergence of atherosclerosis take part:

• low density lipoproteins (LDL), which are transported by cholesterol (hs), triglycerides and phospholipids from the liver into peripheral tissues;
• high density lipoproteins (HDL), which carry these molecules from the periphery into the liver.

The highest atherogenesis (the ability to cause atherosclerosis) possess LDL, because they include cholesterol to the wall of the vessels, where it is postponed under certain conditions.

HDP - "Protective" Lipoprotein, which prevents local cholesterol accumulation. With the development of atherosclerosis, the change in the ratio of HDL and LDL in favor of the latter is associated.

If the HS HPP value is below 1.0 mmol / l, the body's leaning increases to the laying of cholesterol in the vessels.

The optimal is considered the indicator of the HC LDL below 2.6 mmol / l, but its growth to 4.1 mmol / l and above is associated with the starting atherosclerotic changes, especially at a low level of HDL.

Causes of developing IBS

Hyperholesterolemia

Hyperdischolesterolemia is an increase in the level of total cholesterol and LDL cholesterol.

W. healthy man The level of total cholesterol is less than 5 mmol / l.

Border value - 5.0-6.1 mmol / l.

The level of 6.1 mmol / l and above is accompanied by an increase in the risk of developing atherosclerosis and IBS 2.2-5.5 times.

Arterial hypertension (AG) is an elevated level of systolic and / or diastolic pressure of more than 140/90 mm Hg. Art. constantly. The probability of the appearance of IBS with hypers increases by 1.5-6 times. While hypertension, the left ventricular hypertrophy is observed, in which the atherosclerosis of the coronary arteries and the IBS develops 2-3 times more often.

Violation of carbohydrate metabolism and diabetes

Sugar diabetes (SD) - endocrine pathology, in which all types of metabolism are involved and there is a violation of the absorption of glucose due to absolute or relative insulin deficiency. In patients with diabetes, dyslipidemines are observed with an increase in the level of triglycerides and LDL and a decrease in HDL.

This factor exacerbates the course of existing atherosclerosis - acute is the cause of death in 38-50% of patients with SD. In 23-40% of patients there is a solemn form of heart attack due to diabetic neuropathic lesions.

Smoking

The risk of developing IHD during smoking increases by 1.2-2 times.

On the body, this risk factor affects nicotine and carbon oxide:

• they reduce the level of HDL and increase blood coagulation;
• carbon oxide affects myocardium directly and reduces heart reduction strength, changes the structure of hemoglobin and thereby worsens the delivery of oxygen into myocardium;
• nicotine stimulates adrenal glands, which leads to emission of adrenaline and norepinephrine, which causes hypertension.

If the vessels are often spasched, damage is developing in their walls, which suggest further development of atherosclerotic changes.

Low physical activity

Hydodine is conjugate with an increase in the risk of IBS by 1.5-2.4 times.

With the risk factor:

• slows down metabolism;
• reduced heart rate;
• the blood supply to myocardium worsens.

Also hypodynamine leads to obesity, arterial hypertension and insulin resistance, which is an additional risk factor of IBA.

Patients who lead a sedentary way of life die from myocardial infarction 3 times more often active.

Obesity

The presence and stage of obesity determines the body mass index (BMI) - the relationship between weight (kg) and the growth in the square (m²). Normal CMT - 18.5-24.99 kg / m², but the risk of IHD increases under the body weight index 23 kg / m² in men and 22 kg / m² in women.

With abdominal type of obesity, when fat is laid in greater extent on the stomach, the risk of IBS is even with not very high values BMI. A sharp increase in weight in youth (after 18 years by 5 kg or more) is also a risk factor. This risk factor CHA is very common and is quite easily modified. With ischemic heart disease is one of the fundamental factors affecting the entire body.

Sexual activity

Cholesterol is the predecessor of the genital hormones. With age sexual function Both floors tend to fade. Estrogen and androgens cease to be synthesized in initial quantities, cholesterol is no longer on their construction, which is manifested by an increased level in blood with the further development of atherosclerosis. Also, the low activity of sexual life is the same hypodynamine leading to obesity and dlypidemia, which is a risk factor of IBS.

We should not forget that people with diagnosed IBS have sexual activity, on the contrary, is associated with an increase in the risk of heart attack.

Psychosocial factors

There is evidence according to which people with cholecan, hyperactive behavior and the surrounding reaction are illicit from myocardial infarction 2-4 times.

The stress medium causes the hyperstimulation of the cortical and brain layer of adrenal glands, which allocate adrenaline, norepinephrine, cortisol. These hormones contribute to an increase in blood pressure, an increase in heart rate and an increase in the need of myocardium in oxygen against the background of spasped coronary vessels.

The meaning of this factor is confirmed by a greater frequency of IBS among people who are engaged in intellectual labor and living in the city.

Useful video

About the main risk factors of coronary heart disease. Find out of the following video:

Conclusion

1. Most of the risk factors listed above are IBS allowed themselves to modify and thereby make prevention of this disease, and its main complications.
2. Healthy lifestyle, timely diagnosis and adequate treatment of chronic diseases plays a decisive role in the emergence, development and negative effects of coronary heart disease.

Ischemic heart disease is a cardiovascular pathology, which is based on the difference in the blood flow of the muscular shell of the heart and the actual need for oxygen.

Coronary artery disease

Primary preventive measures in ischemic heart disease suggest a whole range of measures that will eliminate factors leading to the appearance of IBS. All risk factors are divided into groups:

• the risk factors of the development of IBS, the removal or modification of which will definitely reduce the risk of further complication of the disease;
• factors, removal or modification of which with high probability will reduce the risk of exacerbation of ischemia;
• factors, removal or modification of which with a smaller probability will reduce the risk of aggravation of ischemic heart disease (IBS);
• factors that confirm the inability to change or eliminate the problem.

Information is based on research data of evidence-based medicine, which have been identified at the end of a number of clinical studies.

Changeable and unchangeable factors

There is a conditional separation of factors:

1. Changeable risk factors.

1.1 Increased blood pressure.

1.2 Tobacocking.

Important! The possibility of the emergence of coronary pathology of the heart in people who smoke are doubled.

1.3 Failure of carbohydrate metabolism, for example: the appearance of diabetes mellitus.

1.4 hypodymna, which implies the weakening of the muscles at a low-speed lifestyle, seated operation.

1.5 Incorrect meals, which involves the absence of the day and use harmful food, overeating or dinner after seven o'clock in the evening from "heavy" products.

1.6 High blood cholesterol content.

1.7 Abuse of alcoholic beverages.

1. Unchanging factors.

2.1 Age Frames. Most often, the increase in blood cholesterol and blood pressure indicators occurs after fifty years.

2.2 Clinical researches The Institute of Medicine has shown that the risk of getting coronary heart disease is higher in men who smoke, eat a lot of harmful food with a high content of HDL cholesterol and another.

2.3 Inheritance, when the blood is cheering. This is another factor in the development of ischemia, which can lead to the emergence of this cardiac pathology. Sometimes there are cases when a fatal outcome in several generations: from the great-grandfather to the grandson. By inheritance, a lipoprotechnoid exchange failure is transmitted. In this case, the cholesterol content increases in the blood (mg / for (1.1 mmol / l). Most often the main cause of the phenomenon is the enzymatic defect.

Dyslipidemia

Various research work Epidemiological character showed that the level of total cholesterol in the blood XC (mg / dL (1.1 mmol / l)), LDL low density lipoproteins (mg / for (1.1 mmol / l)) are positively associated with the risk factors of ischemia. When it comes to the same indicator, but already high density of HDL (mg / for (1.1 mmol / l)), the connection becomes negative. In the first case, "positive cholesterol", and in the second - "cholesterol is negative." An abnormally high level of lipids as an objective risk factor is uniquely not set. Although their connection with a low level of HDL cholesterol (a decrease in value (mg / for (1.1 mmol / l))) is a factor contributing to the manifestation of IBS.

To determine the etiology of the development of ischemia and other cardiovascular pathologies, especially if we are talking about atherosclerosis, choose the right course of treatment, it is recommended to perform the following laboratory research: study of the concentration of total cholesterol in the blood Xc (mg / for (1.1 mmol / l)); High density cholesterol level of HS LPDP (mg / dl (1.1 mmol / l)); The study of the volume of triglycerides (mg / for (1.1 mmol / l)).

Dyslipidemia

Important! The accuracy of a possible prediction, which confirms the risk of IHD, is significantly increased, if we measure the content in the plasma of the high density cholesterol of HDL.

Stratification of risk IBS

As epidemiological studies are harvesting, it has become clear that the risk of ischemia, other cardiovascular pathologies depends on the increase or decreased blood pressure. In the first case, the risk increases, and in the second decreases. But to unambiguously say what pressure is the norm - unreal. Since even a minor increase in value within the normal range can lead to an increase in the risk of ischemic heart disease (IBS).

In patients with diagnosis of arterial hypertension, the forecast depends on the blood pressure (its reduction or increase) and on other concomitant moments, for example: availability of associated clinical paintings No less indicator of an increased degree of arterial pressure with IHD. Therefore, the stratification of patients in the degree of risk of developing cardiovascular diseases is relevant.

Stratification of risk

Stratification is based at the level of damage to certain organs and other cardiovascular pathologies. In this case, the quality of the assessment of individual prediction is increasing for each particular person. Thus, it is possible to find out the category of patients, which is the most susceptible to high cholesterol in the blood of the XC and HS HDL; High blood pressure, those who can get sick of coronary heart disease IBS. This is how the main group of people in need of social and medical qualified and continuous support is determined.

Manifestation of IBS in children

When the disease is manifested in early ageThe plasma does not have a special enzyme - lipoprotein lipase. It provides cleavage of the largest particles of blood - chilomikrons. In this case, blood becomes white like milk. A. skin Pokrov Fat clusters begin to form - yellow tubercles. The child has problems with the normal operation of the liver and spleen, often accompanied by painful sensations In the area of \u200b\u200bthe abdomen.

Manifestation of Ischemia B. childhood by inheritance

To help a small patient, it is necessary when manifesting the first signs of hyperlipoprotehemia to turn to your doctor to appoint a special diet.

Yet:

Blood test for HDL level, appointment testimony, decoding

Ischemic heart disease is one of the most common therapeutic problems, and according to the statistics of the World Health Organization, the ischemic heart disease received almost epidemic distribution in modern society. The basis for this was the increasing frequency of diseases of the ischemic disease of the heart of people in various age groups, high percentage of disability, as well as what it is one of the leading causes of mortality.

Coronary artery disease (IBS) - chronic disease due to the insufficiency of blood supply to the heart muscle or, in other words, its ischemia . In the overwhelming majority (97-98%) cases, the CHD is a consequence of atherosclerosis of the heart arteries, that is, the narrowings of their lumen due to atherosclerotic plaques formed during atherosclerosis on the inner walls of the arteries.

The study of coronary heart disease has almost a two-year history. To date, a huge actual material is accumulated, indicating its polymorphism. This made it possible to distinguish between several forms of ischemic heart disease and several options for its flow. Ischemic heart disease is the most important problem of modern health. For a number of reasons, it is one of the main causes of death among the population of industrialized countries. It affects workable men (more than women) unexpectedly, in the midst of the most active activity.

Causes and Risk Factors Development of Ischemic Heart Disease

The causal myocardial ischemia may be blockage of the vessel atherosclerotic plaque, the process of formation of a thrombus or spasm of vessels. The gradually increasing blockage of the vessel usually leads to chronic insufficiency of the blood supply to myocardium, which manifests itself as a stable angina stress. The formation of a thrombus or spasm of the vessel leads to acute insufficiency of the blood supply to myocardium, that is, to myocardial infarction.

In 95-97% of cases, atherosclerosis becomes the cause of coronary heart disease. The process of blocking the surveillance of the vessel atherosclerotic plaques, if it develops in coronary arteries, causes insufficiency of the heart of the heart, that is, ischemia. However, it is worth noting that atherosclerosis is not the only cause of IHD. Heart power failure can be caused, for example, by increasing the mass (hypertrophy) of the heart with hypertension, people in physically hard work or athletes. Sometimes it is observed by the pronal development of coronary arteries, with inflammatory diseases of the vessels, with infectious processes, etc.

Of great importance in the development of IBS have so-called risk factors which contribute to the emergence of IBS and create a threat to its further development. Conditionally, they can be divided into two large groups: changeable and unchangeable risk factors IBS.

The varying risk factors of the IBS belongs :

Arterial hypertension (i.e. increased pressure),

Smoking,

Excess body weight

Impaired carbohydrate metabolism (in particular diabetes),

Lifeline lifestyle (hypodynamia),

Irrational food

Increased content in blood cholesterol;

Neuropsychiatric overvoltage;

Alcoholism;

The risk of the occurrence of IHD in women will increase with long-term use of hormonal contraceptives.

Condumatable risk factors are IBS :

Age (older than 50-60 years);

Male gender;

Huppied heredity, that is, cases of the disease of the CHA near the nearest relatives;

Obesity;

Metabolic disease;

Cholelithiasis.

Most of these risk factors are really dangerous. According to literary data, the risk of CDS at an elevated level of cholesterol is increased by 2.2-5.5 times, with a hypertension of 1.5-6 times. A very strongly affects the possibility of the development of IBS smoking, according to some data, it increases the risk of developing IBS in 1.5-6.5 times. High risk factors are also hypodynamia, excess body weight, carbohydrate impairment, primarily diabetes mellitus. A noticeable impact on the risk of developing IBS has such factors as frequent stressful situations, mental overvoltage.

Classification of IBS

The CRS classification is still not to the end of a solid problem in cardiology. The fact is that ischemic disease is distinguished by a huge variety of clinical manifestations, which depend on the mechanisms of its occurrence. Representations of cardiologists about the mechanisms of development of the IBS are changing rapidly as scientific knowledge of the nature of this disease is expanding.

At the moment, the classical is the CHA classification adopted by WHO (World Health Organization) in 1979. According to this classification the main forms of IBS are:

1.Sudden heart death (Primary heart stop, coronary death) is the most severe, lightning clinical clinical version of the CHA. It is the IBS that causes 85-90% of all cases of sudden death. Only those cases of sudden cessation of cardiac activity include sudden cardiac death, when death comes with witnesses within an hour after the appearance of the first threatening symptoms. At the same time, before the death of patients, the condition of the patients was estimated as stable and non-concern.

Sudden heart death can be provoked by excessive physical or neuropsychiatric tension, but may arise alone, for example, in a dream. Immediately before the onset of sudden cardiac death, approximately half of the patients, a pain attack is noted, which is often accompanied by the fear of close death. Most often, sudden heart death occurs in community-friendly conditions, which determines the most frequent lethal outcome of this form of the IBS.

2.Angina (Breast toad) is the most common form of CHA. Angina is the attacks of suddenly emerging and usually quickly disappearing pains in chest. The duration of the attack of angina ranges from a few seconds to 10-15 minutes. The pain most often occurs during physical stress, for example, when walking. This is the so-called angina angina. Less often, it arises with mental work, after emotional overloads, when cooled, after abundant food, etc. Depending on the stage of the disease, the stainlessness of the stress is divided by first angina angina, stable angina (with an indication of the functional class from I to IV), progressive angina. For further development CHS angina stress is complemented by a rest angina, at which pain attacks Take place not only at strain, but also at rest, sometimes at night.

3.Myocardial infarction - the formidable disease in which the progress of the angina chase can go. This form of IHD is due to the acute insufficiency of the blood supply to myocardium, which is why there is a focus of necrosis, that is, the leaning of the fabric. The main reason for the development of myocardial infarction is a complete or almost complete blockage of the arteries of a thrombus or a swollen atherosclerotic plaque. With a complete blockage of the artery, the thrombus occurs the so-called large-scale (transmural) myocardial infarction. If the blockage of the artery is partial, then several smaller deaths are developing in myocardium, then they talk about the small-fought myocardial infarction.

Another form of manifestation of IBS is called post-infarction cardiosclerosis. Post-infarction cardiosclerosis occurs as a direct consequence of myocardial infarction. Post-infarction cardiosclerosis - This is the defeat of the heart muscle, and often the heart valves, due to the development of scar tissue in the form of areas of various magnitude and prevalence that replace myocardium. A post-infarction cardiosclerosis is developing because the dead sections of the heart muscle are not restored, but are replaced by a scar cloth. Manifestations of cardiosclerosis are often becoming such conditions as heart failure and various arrhythmias.

Symptoms and signs of ischemic heart disease

The first signs of IHD, as a rule, become painful sensations - that is, the signs are purely subjective. The reason to appeal to the doctor should be any unpleasant feeling in the field of the heart, especially if it is unfamiliar to the patient. Suspicion of the IHD should occur in the patient and if the pain in the bladded region occurs during physical or emotional loads and go alone, have an attack.

The development of IBS lasts for decades, during the progression of the disease, its shapes may vary and, accordingly, clinical manifestations and symptoms. Therefore, we will consider the most common symptoms of IBS. However, it should be noted that about one third of patients with IHDs may not even experience any symptoms of the disease, and not even know about its existence. The rest can be disturbed by such symptoms of IBS like pain in the chest, in the left hand, in the lower jaw, in the back, shortness of breath, nausea, excessive sweating, heartbeat or heart rate disorders.

As for the symptoms of such an IBS form as a sudden heartfelt death: a few days before the attack, a person appears the brediction of the unpleasant feeling behind the sternum, psycho-emotional disorders are often observed, fear of close death. Symptoms of sudden cardiac death: loss of consciousness, stopping respiratory, no pulse on large arteries (sleepy and femur); lack of heart tones; Expansion of pupils; The appearance of a pale gray shade of the skin. During an attack, which often occurs at night in a dream, after 120 seconds after its start, the cells of the brain begin to die. After 4-6 minutes, irreversible changes in the central nervous system are occurring. After about 8-20 minutes, the heart stops and death occurs.

Before talking about the ischemic heart disease, it is necessary to tell how the heart muscle gets oxygen and nutrients, so necessary for its normal operation. The fact is that the heart, being a muscular pump, does not get anything from that blood, which pumped, which is "transit" through this pump. But the heart is the same body as everyone else, even more so, in constant mechanical work, and, of course, should have a constant inflow of oxygen and nutrients. This happens as follows: from the base of the aorta (the largest vessel of our body, which comes out of the left ventricle of the heart) two coronary arteries are departed - right and left. They return to the heart, they are branched there, enter the myocardium and form a system of small arteries, which supplies the heart to everyone. It follows from all this that the heart has its own blood supply system.

Well, now, about ischemic heart disease. Coronary artery disease - this is pathological conditioncharacterized by an absolute or relative impairment of the blood supply to myocardium due to the lesion of the coronary arteries of the heart, as a rule, atherosclerosis, in other words, the appearance of hemodynamically significant atherosclerotic plaques in the coronary arteries and, as a result, a local decrease in the enlightenment of the arteries. Ischemic heart disease is due to the disorder of the coronary blood circulation, the lesion of myocardium arising from the violation of the equilibrium between the coronary blood flow and the metabolic needs of the heart muscle. In other words, there is a deficiency of oxygen and nutrients in the area of \u200b\u200bmyocardium, for which the affected vessel is responsible.

As it develops and increasing each plaque, the increase in the number of plaques increases and the degree of stenling of coronary arteries increases, largely determining the severity of clinical manifestations and the course of ischemic heart disease. The narrowing of the glorification of the artery up to 50% often proceeds asymptomatic. Typically, clear clinical manifestations of the disease occur with the narrowing of the lumen to 70% or more. What is proximal (closer to the beginning of the artery) there is a stenosis, the greater the mass of myocardium is undergoing ischemia in accordance with the circulatory zone. The most severe manifestations of myocardial ischemia are observed during the stenosis of the main trunk or the mouth of the left coronary artery.

There are several clinical forms of coronary heart disease, each of which has independent importance due to the characteristics.

Classification of IBS:

1. Available coronary death (primary heart stop).
1.1 Sudden Coronary Death with Successful Resuscitation
1.2 Sudden coronary death (death)
2.Thenocardia
2.1 Stable angina stress (with an indication of the functional class).
2.2 coronary syndrome x
2.3 Vazospadic angina
2.4 Unstable angina
2.4.1 Progressive angina
2.4.2 For the first time, angina
2.4.3 Early postinfarcloth angina
3.Infark myocardial
4.Turn infarction cardiosclerosis
5.Bebolic form of IBS
6. Heart rhythm
7. Forced failure

Risk factors for the occurrence of IBS.

There are factors or circumstances of our life, in which the risk of atherosclerosis, and, accordingly, the risk of ischemic heart disease increases significantly. These factors are divided into modifiable (changeable) and unmodifiable (unchangeable).

Unmodifable risk factors.
1. Heredity. It is considered burdened by IHD in the presence of close relatives (parents, grandfathers, grandparents, brothers, sisters) cases of the occurrence of CDS on the male line up to 55 years, in the female up to 65 years.
2. Age. In various populations, direct relationship between the age of a person and the frequency of the occurrence of IHD is revealed - the greater the age, the higher the incidence of IBS.
3. Floor. Men are much more often sick of IBS. In women up to 50-55 years old (the age of the onset of menopause) cases of identifying IBS are extremely rare. The exceptions are women with early menopause and various hormonal disorders in aggravating circumstances: arterial hypertension, hyperlipidemia, diabetes mellitus. After the occurrence of menopause, the frequency of the occurrence of IBS in women begins to grow steadily and after 70-75 years old Men's and women's curves are the incidence of IBS the same.

Modifiable risk factors.
1. Incorrect meals Nutrition rich in saturated fats of animal origin, with an elevated content of cook salt and low food tissue.
2. Hypertension. The value of high blood pressure as a risk factor is proven by multishable studies around the world.
3. Hyperholesterolemia. Increased in the blood of total cholesterol (OSH), low-density lipoprotein cholesterol (HC LDL). High density lipoproteid cholesterol (HS HDL) is considered as an anti-sliced \u200b\u200bfactor - the greater the level of HS LPDL, the risk of IBS is less.
4. Low physical activity or lack of regular physical exertion. In people leading a sedentary lifestyle, the frequency of the occurrence of IBS is 1.5-2.4 more than physically active.
5. Obesity. Especially unfavorable by abdominal type, when fat is postponed in the abdomen.
6. Tobacco Direct communication of smoking with the development and progression of atherosclerosis is well known and does not need comments.
7. Diabetes. The relative risk of death Even in persons with a violation of tolerance to glucose increases by 30%, and in patients with SD 2 type by 80%.
8. Alcohol abuse. Up to 30 g of pure alcohol per day for men and 20 g - for women, on the contrary, is the factor of anti-risk.
9. In recent years, attention is paid to the study of such risk factors, as chronic psycho-emotional stress, homocysteinemia (increase in blood levels of homocysteine), violation of the coagulation system, increased heart rate.