What factors contribute to the emergence of the main non-infectious. What are noncommunicable diseases? Features of the course and treatment of non-communicable diseases

04.12.2019

In the second half of the twentieth century, the main danger to public health and a problem for public health began to be presented by non-communicable diseases, primarily diseases of cardio-vascular system, which are currently the leading cause of morbidity, disability and mortality in the adult population. There was a "rejuvenation" of these diseases. They began to spread among the population of developing countries.

In most economically developed countries, diseases of the cardiovascular system rank first among the causes of morbidity, disability and mortality, although their prevalence varies considerably in different regions. In Europe, approximately 3 million people die from cardiovascular diseases every year, in the USA - 1 million, this is half of all deaths, 2.5 times more than from all malignant neoplasms taken together, and ¼ of deaths from cardiovascular diseases are people under the age of 65. The annual economic loss from death from cardiovascular disease in the United States is $ 56.9 billion.

In Russia, these diseases are the main cause of mortality and morbidity among the population. If in 1939 in the general structure of the causes of mortality they accounted for only 11%, then in 1980 - over 50%.

Diseases of the cardiovascular system are numerous. Some of them are mainly heart diseases, others - mainly arteries (atherosclerosis) or veins, and still others affect the cardiovascular system as a whole ( hypertonic disease). Diseases of the cardiovascular system can be caused by congenital malformation, trauma, inflammation, and others. Congenital defects in the structure of the heart and large vessels, often referred to as congenital malformations hearts, are recognized by doctors in children even in infancy, mainly on the noise heard above the heart.

There are also diseases of the cardiovascular system, which are based on the inflammatory process. Occasionally, this inflammation is bacterial. This means that bacteria grow on the inner lining of the heart valves or on the outer lining of the heart that cause purulent inflammation these parts of the heart.

I chose this topic because my future profession is related to medicine. I would like to learn more about human diseases in general and about the causes of this or that disease.

I took this topic, as it is relevant today. Every third person has some kind of heart disease. Many scientists have devoted themselves to the study of heart disease.

The cardiovascular system consists of the heart and blood vessels with a liquid tissue filling them - blood. The blood vessels are divided into arteries, arterioles, capillaries, and veins. Arteries carry blood from the heart to the tissues; they branch out in a tree-like manner into ever smaller vessels and turn into arterioles, which disintegrate into a system of the thinnest vessels-capillaries. Small veins begin from the capillaries, they merge with each other and become stronger. Cardiovascular systems provide blood circulation necessary for its transport functions - delivery to tissues nutrients and oxygen and removal of metabolic products and carbon dioxide. At the center of the circulatory system is the heart; from it originate large and small circles of blood circulation.

The systemic circulation begins with a large arterial vessel, the aorta. It branches into a large number of medium-sized arteries, and these into thousands of small arteries. The latter, in turn, disintegrate into many capillaries. The capillary wall has a high permeability, due to which there is an exchange of substances between blood and tissues: nutrients, substances and oxygen pass through the capillary wall into the tissue fluid, and then into the cells, in turn, the cells give carbon dioxide and other metabolic products into the tissue fluid into the capillaries.

Arteries are elastic tubes of various sizes. Their wall consists of three shells - outer, middle and inner. The outer shell is formed by connective tissue, the middle one - muscle - consists of smooth muscle cells and elastic fibers. A smooth inner membrane lines the vessel from the inside and is covered from the side of its lumen with flat cells (endothelium). Thanks to the endothelium, the blood flow is unhindered and its liquid state is maintained. Blockage or narrowing of the arteries can lead to severe circulatory problems.

Veins have the same structure with arteries, but their walls are much thinner than arterial ones, they can subside. In this regard, veins of two types are distinguished - muscle and muscle. Through veins of the muscleless type (veins meninges, eyes, spleen, etc.), the blood moves under the influence of gravity, along the veins of the muscle type (shoulder, femoral, etc.) - overcoming the force of gravity. The inner lining of the veins forms folds in the form of pockets - valves that are arranged in pairs at regular intervals and prevent the reverse flow of blood.

The heart is a hollow muscular organ located in the chest cavity, behind the sternum. Most of the heart (about 2/3) is in the left half of the chest, the smaller part (about 1/3) in the right. In an adult man, the average heart weight is 332 g, in a woman - 254 g. The heart pumps about 4-5 liters of blood in 1 minute.

The wall of the heart consists of three layers. The inner layer - the endocardium - lines the heart cavity from the inside, and its outgrowths form the heart valves. The endocardium is composed of flattened smooth endothelial cells. The middle layer - the myocardium - is formed by a special cardiac striated muscle tissue. The outer layer - the epicardium - covers the outer surface of the heart and the areas of the aorta, pulmonary trunk and vena cava nearest to it.

The atrioventricular openings are closed by valves with a cuspid structure. The valve between the left atrium and the ventricle is bicuspid, or mitral, between the right - tricuspid. The edges of the valve cusps are connected with the papillary muscles by tendon threads. There are semilunar valves near the openings of the pulmonary trunk and the aorta. Each of them has the form of three pockets that open in the direction of blood flow in these vessels. When the pressure in the ventricles of the heart decreases, they fill with blood, their edges close, closing the lumens of the aorta and pulmonary trunk and preventing the return of blood to the heart. Sometimes the heart valves damaged in certain diseases (rheumatism, atherosclerosis) cannot close tightly, the work of the heart is disturbed, and heart defects occur.

I. Diseases of the cardiovascular system.

Atherosclerosis.

The basis of many lesions of the cardiovascular system is atherosclerosis. This term comes from Greek wordsathere - wheat gruel andsclerosis - solid and reflects the essence of the process: the deposition of fatty masses in the wall of the arteries, which subsequently acquire the appearance of a slurry, and the development of connective tissue, followed by thickening and deformation of the arterial wall. Ultimately, this leads to a narrowing of the lumen of the arteries and a decrease in their elasticity, which makes it difficult for blood to flow through them.

Atherosclerosis is a chronic disease of large and medium-sized arteries, characterized by the deposition and accumulation of plasma atherogenic apoprotein-B-containing lipoproteins in the intin, followed by reactive proliferation of connective tissue and the formation of fibrous plaques. Atherosclerosis usually primarily affects large arteries: the aorta, coronary arteries, arteries feeding the brain (internal carotid arteries). With atherosclerosis, the lumen of the artery narrows, the density of the arterial wall increases, and its extensibility decreases; in some cases, aneurysmal stretching of the artery walls is observed.

It has been established that many external and internal, in particular hereditary, factors are the cause of the development of atherosclerosis or adversely affect its course. One of the causes of atherosclerosis is considered to be the disproportion in the content of various classes of lipoproteins in the blood plasma, some of which contribute to the transfer of cholesterol into the vascular wall, i.e. are atherogenic, others interfere with this process. The occurrence of such disorders and the development of atherosclerosis is facilitated by prolonged consumption of food containing an excess of animal fats, rich in cholesterol. The factor of excessive consumption of fats is especially easily realized when the liver does not produce enough enzymes that destroy cholesterol. On the contrary, atherosclerosis does not develop in persons with high activity of these enzymes, even with prolonged consumption of food containing a large amount of animal fats.

A description of more than 200 factors contributing to the onset of atherosclerosis or adversely affecting its course, however, the most important are arterial hypertension, obesity, insufficient physical activity and smoking, which are classified as large risk factors for the development of atherosclerosis. According to data from mass surveys of the population, atherosclerosis is much more common among patients with arterial hypertension than in people with normal blood pressure.

The earliest manifestations of atherosclerosis are lipid spots, or lipid stripes; are often found already in childhood. These are flat spots of yellowish color, of various sizes, located under the inner lining of the aorta, most often in its chest... The yellowish color of the spots is given by the cholesterol contained in them. Over time, some lipid spots dissolve, while others, on the contrary, grow, occupying an ever larger area. Gradually, the flat spot turns into a cholesterol plaque protruding into the lumen of the artery. In the future, the plaque is compacted by invading connective tissue, often calcium salts are deposited in it. The growing plaque narrows the lumen of the artery, and sometimes completely clogs it. The vessels supplying at its base are injured by the plaque and can rupture with the formation of hemorrhage, which raises the plaque, aggravating the narrowing of the artery lumen until it is completely closed. Insufficient blood supply to the plaque itself often leads to the fact that its contents are partially necrotic, forming a mushy detritus. Due to insufficient blood supply, the surface of the fibrous plaque sometimes appears, while the endothelium covering the plaque sloughs off. Blood platelets that do not adhere to the intact vascular wall settle in the area devoid of endothelium, giving rise to the development of a thrombus.

Widespread and significantly pronounced atherosclerosis and atheromatosis of the aorta can be the cause of the development of its aneurysm, which is manifested by symptoms of compression of the organs adjacent to the aorta. The most dangerous complications of aortic aneurysm are its dissection and rupture.

The basis for the prevention of atherosclerosis is a rational lifestyle: a mode of work and rest, which reduces the likelihood of mental overstrain; exclusion of hypodynamia, health-improving physical education; quitting smoking and drinking alcohol. Is of great importance proper nutrition: ensuring the stability of normal body weight, excluding excess amounts of animal fats from food and replacing them with vegetable fats, sufficient content of vitamins in food, especially vitamin C, limited consumption of sweets. Timely detection is important in the prevention of atherosclerosis. arterial hypertension, as well as diabetes mellitus, which predisposes to the development of vascular lesions, and their systematic, carefully controlled treatment.

Myocardial infarction.

Myocardial infarction - acute illness heart, due to the development of one or more foci of necrosis in the heart muscle and manifested by a violation of cardiac activity. It is observed most often in men aged 40-60 years. It usually occurs as a result of damage to the coronary arteries of the heart in atherosclerosis, when their lumen narrows. Often this is joined by a blockage of blood vessels in the area of \u200b\u200bits lesion, as a result of which blood completely or partially ceases to flow to the corresponding area of \u200b\u200bthe heart muscle, and foci of necrosis (necrosis) are formed in it. In 20% of all cases of myocardial infarction is fatal, and in 60-70% - in the first 2 hours.

In most cases, myocardial infarction is preceded by a sharp physical or mental stress. More often it develops with exacerbation ischemic disease heart, During this period, called pre-infarction, angina attacks become more frequent, the action of nitroglycerin becomes less effective. It can last from a few days to several weeks.

The main manifestation of myocardial infarction is a prolonged attack of intense pain in the chest, burning, pressing, less often tearing, burning character, which does not disappear after repeated administration of nitroglycerin. The attack lasts more than half an hour (sometimes several hours), accompanied by severe weakness, a feeling of fear of death, as well as shortness of breath and other signs of heart failure.

In most cases, myocardial infarction is accompanied by characteristic changes in the electrocardiogram, which can be delayed, sometimes appearing several hours or even days after intense pain subsides.

When there is acute pain behind the sternum, which does not disappear after taking nitroglycerin, it is necessary to urgently call an ambulance. On the basis of a thorough examination of the patient, including electrocardiography, the disease can be recognized. Before the arrival of the doctor, the patient is provided with maximum physical and mental rest: he should be laid down, if possible, calm down. If suffocation or lack of air appears, the patient must be given a semi-sitting position in bed. Although nitroglycerin does not completely eliminate pain in myocardial infarction, its repeated use is advisable and necessary. Distractions also bring noticeable relief: mustard plasters on the heart and sternum, heating pads for the legs, and warming the hands.

From a preventive point of view, it is important that any sudden acute cardiovascular weakness, especially an attack of cardiac asthma in old and old age, should first of all cause a medical worker to think about the development of painful myocardial infarction.

Rarely, gastrological or abdominal myocardial infarction occurs. It manifests itself as sudden pain in abdominal cavity, vomiting, bloating, and sometimes intestinal paresis. This variant of myocardial infarction is the most difficult to diagnose. Localization of abdominal pain can lead to misdiagnosis of an acute abdomen. There are known cases of erroneous gastric lavage in such patients.

With the "cerebral" variant of myocardial infarction, described by the Soviet clinician NK Bogolepov, signs of cerebral vascular catastrophe prevail in the clinical picture. Reflex spasm of cerebral vessels, short-term cardiac arrhythmias seem to be the cornerstone of such cerebral phenomena in infarction.

Sometimes myocardial infarction is clinically manifested only by heart rhythm disturbances.

During myocardial infarction, the following periods are distinguished:

- preinfarction;

- acute (7-10 days);

- subacute (up to 3 weeks);

- restorative (4-7 weeks)

- the period of subsequent rehabilitation (2.5-4 months);

- post-infarction.

Many complications occur with myocardial infarction. Among early complications heart attacks are most important various forms shock (collapse), often there are also heart failure, severe heart rhythm disturbances, external and internal ruptures of the heart muscle.

A patient in the acute period of the disease needs constant supervision of staff. The first attack is often followed by repeated, more severe ones. The course of the disease can be complicated by acute heart failure, heart rhythm disturbances, etc.

A system of rendering assistance to patients with myocardial infarction has been developed. It provides for the departure of an ambulance medical team to the patient, treatment measures at the site of the attack, and if necessary \u003d their continuation in the ambulance. Many large hospitals have established intensive care units (wards) for patients acute heart attack myocardium with round-the-clock electrocardiographic monitoring of the state of cardiac activity and the ability to immediately provide assistance in threatening conditions.

Care and regimen for myocardial infarction.

The food is fractional and varied, but in the first days of the illness it is better to eat less, preferring less high-calorie food; fruit and vegetable purees are preferred. Foods that cause bloating, such as peas, milk, kvass, are excluded from the diet, since the resulting rise in the diaphragm makes it difficult for the heart to work. Fatty meats, smoked meats, salty foods, any kind of alcoholic beverages are prohibited.

From the first days of treatment, in the absence of complications, the doctor prescribes an individually selected complex of physiotherapy exercises. It is necessary to ensure that the air in the room where the patient is located is constantly fresh.

Rehabilitation therapy, aimed at preparing a patient with myocardial infarction for an active lifestyle, begins from the first days of treatment. It is carried out under the guidance and supervision of a physician.

The daily routine should be strictly regulated. It is better to insert and go to bed every day at the same time. Sleep duration is at least 7 hours. Meals should be four times a day, varied, rich in vitamins and limited in calories (no more than 2500 kcal per day). Quitting smoking and alcohol abuse is a necessary condition in the prevention of myocardial infarction. These "lifeguard" activities are often harmful. The nature of the healing treatment must be agreed with the doctor.

Arrhythmias of the heart.

Arrhythmias of the heart are various abnormalities in the formation or conduction of excitation impulses in the heart, most often manifested by disturbances in the rhythm or rate of its contractions. Some arrhythmias of the heart are detected only with the help of electrocardiography, and in cases of irregularities in the rhythm or rate of heart contractions, they are often felt by the patient himself and are detected when listening to the heart and when probing the pulse in the arteries.

Normal, or sinus, heart rhythm is formed by excitation impulses that occur with a certain frequency in special cells in the right atrium and propagate along the conducting system to the atria and ventricles of the heart. The occurrence of cardiac arrhythmias may be due to the formation of excitation impulses outside the sinus node, their pathological circulation or slowing down of conduction along the cardiac conduction system due to congenital anomalies of its development, or in connection with disorders nervous regulation activity or heart disease.

Cardiac arrhythmias are diverse in their manifestations and are not the same in clinical significance. The main arrhythmias of the heart include extrasystole, paroxysmal tachycardia, bradycardia with heart block, as well as atrial fibrillation. The latter in most cases is associated with heart disease, often observed in some rheumatic heart diseases.

Atrial fibrillation is manifested by complete irregularity of heart contractions, most often in combination with their frequency. It can be constant and paroxysmal in nature, and the paroxysms of arrhythmia sometimes precede its constant form for several years.

In elderly and senile people, cardiac arrhythmias usually occur against the background of cardiosclerosis, but ischemic myocardial dystrophy is often involved in their origin. Organic changes in the myocardium most of all contribute to the occurrence of cardiac arrhythmias when they are localized in the sinus node and in the conducting system. Congenital anomalies of these formations can also be the cause of cardiac arrhythmias.

In the pathogenesis of cardiac arrhythmia, a major role belongs to shifts in the ratio of the content of potassium, sodium, calcium and magnesium ions inside myocardial cells and in the extracellular environment.

Coronary artery disease.

Ischemic heart disease is an acute and chronic heart disease caused by a decrease or cessation of blood delivery to the myocardium due to an atherosclerotic process in the coronary arteries. The term was proposed in 1957. a team of WHO specialists. In the overwhelming majority of cases, this is caused by a sharp narrowing of one or more branches of the coronary arteries supplying the heart, due to their atherosclerosis. Restriction of blood supply to the myocardium reduces the delivery of oxygen and nutrients to it, as well as the removal of waste metabolic products, toxins.

Depending on the combination of several factors, the manifestations of coronary heart disease can be different. Its first manifestation may be sudden death or myocardial infarction, angina pectoris, heart failure, heart rhythm disturbances. Often, this disease affects people who are still young (aged 30-40 years), leading an active lifestyle, leading to huge moral and economic losses. The annual mortality rate from coronary heart disease ranges from 5.4 to 11.3% and depends on the number of affected arteries and the severity of coronary atherosclerosis.

The prevalence of coronary heart disease spread to the size of an epidemic in the second half of the 20th century, although some of its manifestations were known for a long time.

Ischemic heart disease can occur in both acute and chronic forms. The widespread prevalence of this disease among people of the most working age has turned coronary heart disease into an important social and medical problem. The increased incidence of ischemic disease is associated, first of all, with a decrease in physical activity of people, hereditary predisposition, overweight and other risk factors. The prevalence of coronary artery disease is higher among people who are characterized by a constant striving for success in all areas of activity, prolonged work overload. This complex of features is sometimes called the "coronary personality profile."

The course of the disease is long. It is characterized by exacerbations, alternating with periods of relative well-being, when the disease may not subjectively manifest itself. Initial signs coronary artery disease - attacks of angina pectoris that occur during exercise. In the future, seizures that occur at rest can join them. Paroxysmal pain, localized in the upper or middle part of the sternum or retrosternal region, along the left edge of the sternum, in the atrial region. By its nature, the pain is pressing, tearing or nagging, less often stabbing.

In the diagnosis of coronary heart disease, electrocardiographic research methods are widely used. ECG is usually recorded in 12-lead at rest, once or repeatedly.

Coronary heart disease therapy aims to restore the lost balance between blood flow to the heart muscle. Diet plays an essential role in the prevention of coronary heart disease. Its basic principles are: limiting the total amount and calorie content of food, allowing you to maintain a normal body weight, significantly limiting animal fats and easily digestible carbohydrates, excluding alcoholic beverages; fortification of food with vegetable oils and vitamins C and group B. With moderate physical activity, it is recommended to eat four times a day, at regular intervals, with a daily caloric intake of 2500 kcal. The diet should include foods high in complete protein, raw vegetables, fruits and berries.

Hypertonic disease.

Essential hypertension is a disease of the cardiovascular system characterized by constant or periodic blood pressure. Unlike other forms of arterial hypertension, this increase is not a consequence of another disease.

Hypertension is a disease of the 20th century. In the 70s in the USA there were 60 million people with high blood pressure, and only ¼ of the adult population had “ideal” blood pressure. The prevalence of "topical hypertension" among men in Russia (Moscow, Leningrad) is higher than in the United States, but the percentage of those on drug treatment is 2-3 times lower.

The cause of hypertension has not been fully disclosed. But the underlying mechanisms leading to consistently high blood pressure are known. Leading among them is the nervous mechanism. Its initial link is emotions, emotional experiences, accompanied by various reactions in healthy people, including an increase in blood pressure.

Another mechanism - humoral - regulates blood pressure through active substances released into the blood. In contrast to neural mechanisms, humoral influences cause more long-term and stable shifts in the level of blood pressure.

To prevent further development hypertension, it is necessary to reduce nervous tension, discharge the accumulating "charge" of emotions. Such discharge most naturally occurs in conditions of increased physical activity.

The steady progression of hypertension can be stopped and even reversed by timely treatment. The constant restriction or exclusion of salty foods from food is the most important of the real and available measures to counter arterial hypertension. Medicine has many means that enhance the excretion of sodium chloride in the urine by the kidneys. Therefore, a patient with hypertension is often prescribed diuretics.

It is reliably known that an overweight person suffering from hypertension sometimes only needs to get rid of excess body weight so that blood pressure normalizes without medication. Indeed, with the disappearance of adipose tissue, the branched network of the smallest vessels that have developed in this tissue as it grows is eliminated as unnecessary. In other words, body fat forces the heart muscle to work under conditions of increased pressure in the blood vessel system.

So, each person can independently prevent the development of hypertension without resorting to medications. This is proven by observations large groups patients who strictly followed the recommendations regarding physical activity, low-calorie nutrition and restriction of table salt in food. A one-year follow-up period showed that the majority of people had normalized blood pressure, decreased body weight, and no longer needed to take antihypertensive drugs.

Hypertension is not one of the incurable. Arsenal modern medicine sufficient to maintain blood pressure at the required level and thereby prevent the progression of the disease.

Prevention measures for hypertension coincide with the recommendations for patients. They are especially necessary for people with a hereditary predisposition to this disease.

II. Risk factors for diseases of the cardiovascular system.

Smoking.

South America is considered the homeland of tobacco. Tobacco contains the alkaloid nicotine. Nicotine increases blood pressure, constricts small blood vessels, and quickens breathing. Inhalation of smoke containing tobacco combustion products reduces the oxygen content in arterial blood.

In the second half of the 20th century, cigarette smoking became a common habit. Observations over 6 years of mortality in men aged 45-49 years showed that the overall mortality rate for regular smokers was 2.7 times higher than for non-smokers. According to American scientists, cigarette smoking contributes to 325 thousand premature deaths annually in the United States.

In one of the studies, it was shown that the average number of cases of cardiovascular diseases per year per 1000 people aged 45-54 years in non-smokers is 8.1, when smoking up to 20 cigarettes a day - 11.2, and when smoking more than 20 cigarettes - 16.2, i.e. twice as many as non-smokers.

Nicotine and carbon monoxide (carbon monoxide) seem to be the main damaging factors. Cigarette smoke contains up to 26% carbon monoxide, which, when released into the blood, binds to hemoglobin (the main oxygen carrier), thereby disrupting the ability to transport oxygen to tissues.

The harm of smoking is so significant that in recent years measures against smoking have been introduced: the sale of tobacco products to children, smoking in public places and transport, etc. is prohibited.

Psychological factors.

This factor has always been and still is of great importance in the development of cardiovascular diseases. In recent years, the features of human behavior have been thoroughly studied. Was highlighted the type of behavior of people (type A *)

"Type A" behavior is an emotionally motor complex observed in people engaged in endless attempts to do more and more in less and less time. These people often have elements of "freely manifested" hostility, easily arising at the slightest provocation. Individuals with type A * behaviors have certain symptoms. These people often do several things at the same time (reading while shaving, eating, etc.), during a conversation they also think about other things, not paying all attention to the interlocutor. They walk and eat quickly. It is very difficult to convince such people to change their lifestyle for several reasons:

They usually take pride in their behavior and believe that the success they have achieved in work and society is related to this type of behavior.

Individuals with Type A * behavior are usually pragmatists and find it difficult to understand how their behavior can lead to heart disease.

In most cases, these are energetic, hard-working people who bring great benefits to society. And the challenge is to convince them to adopt habits that will counteract the adverse health effects of their behavior.

Overweight.

In most economically developed countries, overweight has become common and poses a serious health problem. The reason for this, in most cases, is seen in the discrepancy between the intake of a large number of calories from food and low energy consumption due to a sedentary lifestyle. The prevalence of overweight, being minimal in 20-29-year-olds (7.8%), steadily increases with age to 11%, in 30-39-year-olds, up to 20.8% - in 40-49-year-olds and up to 25.7% - among 50-59-year-olds.

The relationship between overweight and the risk of developing the cardiovascular system is rather complex, since it was an independent risk factor.

Overweight is attracting a lot of attention due to the fact that it lends itself to correction without the use of any drugs... Determination of normal body weight, because there are no uniform criteria for these purposes.

Reducing excess body weight and maintaining it at a normal level is quite difficult. Controlling your body weight, you need to monitor the amount and composition of food and your physical activity. Nutrition should be balanced, but the food should be low in calories.

Increased blood cholesterol levels.

Cholesterol circulates in the blood as part of fat-protein particles - lipoproteins. A certain level of cholesterol in the blood is maintained by the cholesterol supplied from food, and its synthesis in the body. The border of the normal level of cholesterol in the blood, allocated in practice, is conditional. The blood cholesterol content of up to 6.72 mmol / l (260 mg%) is considered normal. Lower blood cholesterol levels, 5.17 mmol / L (200 mg%) and below, are less dangerous.

Elevated blood cholesterol levels are common. The level of cholesterol in the blood of 6.72 mmol / l (260 mg%) and higher in men 40-59 years old occurs in 25.9% of cases.

Conclusion

The rapid change in the twentieth century in the way of life associated with industrialization, urbanization and mechanization, largely contributed to the fact that diseases of the cardiovascular system have become a mass phenomenon among the population of economically developed countries.

Modern principles of prevention of cardiovascular diseases are based on the fight against risk factors. Large preventive programs carried out in our country and abroad have shown that it is possible, and a decrease in mortality from cardiovascular diseases has been observed in recent years in some countries, the best proof of this. It should be emphasized that some of these risk factors are common to a number of diseases.

Basic lifestyle habits are established in childhood and adolescence, so teaching children becomes especially relevant healthy way life in order to prevent the development of habits in them that are risk factors for cardiovascular diseases (smoking, overeating, and others).

List of used literature.

1. A. N. Smirnov, A. M. Vranovskaya-Tsvetkova "Internal Diseases", - Moscow, 1992.

2. R. A. Gordienko, A. A. Krylov "Guide to intensive care", - Leningrad, 1986.

3. R. P. Oganov "To protect the heart ..." - Moscow, 1984.

4. A. A. Chirkin, A. N. Okorokov, I. I. Goncharik "Diagnostic reference book of therapist", - Minsk, 1993.

5. V. I. Pokrovsky "Home medical encyclopedia", - Moscow, 1993.

6. A. V. Sumarokov, V. S. Moiseev, A. A. Mikhailov "Recognition of heart diseases", - Tashkent, 1976.

7. NN Anosov, Ya. A. Bendet "Physical activity and heart", - Kiev, 1984.

8. V. S. Gasilin, B. A. Sidorenko "Ischemic heart disease", - Moscow, 1987.

9. V. I. Pokrovsky "Small Medical Encyclopedia 1", - Moscow, 1991.

10. EE Gogin "Diagnostics and treatment of internal diseases", - Moscow, 1991.

11. M. Ya. Ruda "Myocardial infarction", - Moscow, 1981.

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general information

Noncommunicable diseases (NCDs), also known as chronic diseases, tend to be long-term and result from a combination of genetic, physiological, environmental and behavioral factors.

The main types of NCDs include cardiovascular diseases (such as heart attacks and strokes), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes.

The burden of NCDs is disproportionately high in low- and middle-income countries, which account for more than three quarters of NCD deaths worldwide (32 million).

Who is at risk for these diseases?

NCDs are common in all age groups, in all regions and in all countries. These diseases are often associated with older age groups, but evidence suggests that of all deaths associated with NCDs, 17 million are in the 30-69 age group. Moreover, more than 85% of these “premature” deaths occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to risk factors for NCDs, such as unhealthy diets, physical inactivity, exposure to tobacco smoke or alcohol abuse.

Factors such as rapid and disorganized urbanization, the globalization of unhealthy lifestyles and an aging population contribute to the development of these diseases. The effects of unhealthy diets and inadequate physical activity can manifest in individuals as high blood pressure, high blood glucose, increased level blood lipids and obesity.

Risk factors

Modifiable behavioral risk factors

Modifiable behaviors such as tobacco use, physical inactivity, unhealthy diets and harmful use of alcohol increase the risk of NCDs.

More than 7.2 million people die each year from the effects of tobacco use (including the effects of exposure to second-hand smoke), and this figure is projected to rise markedly in the coming years. (1)
4.1 million people die each year from the effects of excessive salt / sodium intake. (1)
Of the 3.3 million deaths a year from alcohol use, more than half are attributable to NCDs, including cancer. (2)
1.6 million deaths per year can be attributed to insufficient physical activity. (1)

Metabolic risk factors

Metabolic risk factors contribute to four major metabolic changes that increase the risk of NCDs:

high blood pressure
overweight / obesity
hyperglycemia (high blood glucose)
hyperlipidemia (high blood lipids)

The first metabolic risk factor for death from NCDs worldwide is high blood pressure (which is associated with 19% of all deaths worldwide) (1), followed by overweight, obesity and high blood glucose.

What are the socio-economic impacts of NCDs?

NCDs threaten progress towards the 2030 Development Agenda, which has a target of reducing premature deaths from NCDs by one third by 2030.

There is a strong link between poverty and NCDs. The skyrocketing incidence of NCDs is projected to impede poverty reduction initiatives in low-income countries, in particular by increasing household health costs. Vulnerable and unprotected populations are more likely to get sick and die at a younger age than those in more affluent social groups, mainly due to their exposure to higher risks of exposure to unhealthy products such as tobacco, or a tendency to unhealthy diets and also due to limited access to health services.

In resource-poor settings, health-care costs associated with NCDs are rapidly depleting household resources. Each year, the exorbitant costs of NCDs, including the costs of often lengthy and expensive treatment and the consequences of the loss of the breadwinner, plunge people into poverty and hinder development.

Prevention and control of NCDs

Targeted action to reduce exposure to risk factors for these diseases is an important way to tackle NCDs. There are low-cost solutions that governments and other stakeholders can use to reduce the impact of modifiable risk factors. Monitoring progress and trends in NCDs is essential in formulating policies and setting priorities.

Reducing the negative impact of NCDs on individuals and society as a whole requires an integrated approach that should involve all sectors, including health, finance, transport, education, agriculture, planning and others, working in collaboration with each other to reduce risks. related to NCDs, and promoting interventions to prevent and control these diseases.

Investing in better management of NCDs is essential. NCD management involves identifying, screening and treating these diseases and providing access to palliative care for all who need it. Highly effective core NCD interventions can be delivered through primary health care to strengthen early detection and timely treatment. The evidence shows that, if implemented in a timely manner, such interventions are an excellent economic investment as they can reduce the need for more expensive treatments.

Countries with inadequate health coverage are unlikely to be able to achieve universal coverage of essential NCD treatment and prevention interventions. Such interventions are critical to achieving the global target of a 25% relative reduction in the risk of premature death from NCDs by 2025 and the SDG target of reducing premature deaths from NCDs by one third by 2030.

WHO response

WHO's role in overall leadership and coordination

In the 2030 agenda for sustainable development, NCDs are recognized as one of the main obstacles to sustainable development. As part of the Agenda, Heads of State and Government committed to taking decisive action at the national level to reduce by one third premature deaths from NCDs through prevention and treatment by 2030 (SDG target 3.4). This target was established following the 2011 and 2014 UN General Assembly High-level Meetings on NCDs, which reaffirmed WHO's overall leadership and coordination role in monitoring and promoting global action on NCDs. The UN General Assembly will host the third High-level Meeting in 2018 to review progress and build consensus on the way forward for 2018-2030.

To support countries in their work at national level, WHO has prepared the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020, which includes nine global targets that will have the greatest impact on global NCD deaths. These goals relate to the prevention and management of NCDs.

Reference literature

(1) GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016; 388 (10053): 1659-1724

Socially significant non-communicable diseases include diabetes, hypertension (with complications), tumors and mental illness.

Of these, diabetes mellitus is the most common. Currently, it affects about 6% of the world's population, and in Russia 8.5 million inhabitants. Often, diabetes mellitus proceeds with the development of complications, which are the causes of disability and death at a young age. In addition to medical problems, the high incidence of diabetes is accompanied by the emergence of a variety of social problems that have to be addressed by the patient himself, his family, medical staff, and the state.

Diabetes – this is a disease caused by an absolute or relative deficiency of the hormone insulin in the human body, which regulates, among other factors, carbohydrate metabolism and glucose metabolism in particular.It ensures the flow of glucose into the cells from the blood when it rises there after a meal, physical activity, neuropsychic stress.

Thus, the level of glucose in the blood is relatively stable (from 3.3 to 5.5 millimoles per liter) at different times of the day and in different physiological states of a person. After eating a meal rich in carbohydrates and fats, the glucose level naturally rises, but after two hours in healthy people it returns to normal. In diabetic patients, a lack of insulin is accompanied by an increase in fasting blood sugar and after each meal. In this case, the level of glucose in the blood is normalized not after two hours, but after a longer time.

An increase in blood glucose levels - hyperglycemia - is one of the hallmarks of diabetes. In addition, patients have increased urine output (polyuria) and thirst, which requires increased intake liquids (polydipsia). Almost always in such patients, glucose is found in the urine (glucosuria). Diabetes mellitus is not a single disease. Depending on the causes of its occurrence and development mechanisms, there are several clinical forms, among which the most common insulin-dependent diabetes (type I diabetes) and non-insulin dependent diabetes (type II diabetes).

Insulin-dependent diabetes has an acute onset, affects young people and children (which indicates its genetic basis), leads to weight loss, often proceeds with complications, and insulin administration is required to correct it.

Non-insulin dependent diabetes is more common in people over 40. Often, it is detected by chance during preventive examinations (i.e., it may be asymptomatic). He, like type I diabetes, has a hereditary predisposition, provoked by overeating or excessive alcohol consumption. Patients are usually overweight.

To compensate for metabolic and other disorders, sometimes it is enough to follow a diet with restriction of carbohydrates, fats and take sugar-reducing drugs. The causes of diabetes are genetic factors, viral infections (mumps, rubella, measles, hepatitis), the immune systemas well as excess nutrition.

Diagnosis of overt diabetes is straightforward. Patients present with complaints characteristic of this disease of dry mouth, increased appetite and excessive thirst, increased urinary output, weight loss, drowsiness, increased fatigue, and a tendency to infection.

Complications from the cardiovascular system in diabetes are one of the main causes of death in this disease. They can be manifested by damage to small vessels (arterioles and capillaries), the retina of the eye and the kidneys. Diabetic retinopathy leads to severe visual impairment and blindness, and diabetic nephropathy often ends in development renal failure and death. Small vessels are often affected lower limbs, which is accompanied by the development of gangrene due to insufficient blood flow.

In large arterial vessels, atherosclerosis develops with the formation of plaques on the inner surface of the vessel and a decrease in its lumen. With a similar lesion of the vessels of the heart, myocardial infarction develops. In diabetic patients, it is atypical, difficult to diagnose and ends in death in half of the patients.

Most diabetic patients have manifestations of disorders of the nervous system in the form of sensitivity (deep and superficial), decreased reflexes, and movement disorders. The most formidable complication is the development coma... Coma in diabetes occurs as with very high level glucose in the blood (hyperglycemic coma), and when the sugar level falls below 2.2 millimoles (hypoglycemic coma).

Hyperglycemic coma develops with the refusal to use insulin and sugar-reducing drugs, gross violations of the diet, the use of large amounts of alcohol. Signs of an oncoming coma are severe headache, abdominal pain, aversion to food, the appearance of the smell of acetone from the mouth.

Hypoglycemic coma develops with an overdose of insulin, starvation, neuropsychic overexcitation. Coma begins suddenly, acutely. Subjectively, patients feel severe hunger. The skin on the face turns pale, large drops of cold sweat appear on the forehead. After this, convulsions and loss of consciousness develop. To prevent hypoglycemic coma, people often carry sugar, chocolate, or sweet fruit juice with them.

Diabetes mellitus requires patients to adhere to a certain lifestyle, which includes effective self-control and regular medical examinations, an understanding of the medical and social essence of this pathology, and the implementation of positive psychological attitudes concerning all aspects of human life.

Hypertonic disease – this is a persistent increase in blood pressure above normal (more than 140/90 mm Hg). It is the most common form of pathology, which is characterized by an increase in blood pressure. In addition to it, secondary arterial hypertension is distinguished - renal, endocrine, etc.

Essential hypertension and secondary arterial hypertension have different causes, development mechanisms and treatment principles. In modern Russia, an increase in blood pressure is found in 50 million people.

The reasons for the increase in blood pressure are not known in most cases. Blood pressure rises in most people with increasing age, as the mechanisms of its regulation are disrupted. This is one of the natural manifestations of aging in the body.

The development of arterial hypertension in young people is much more dangerous because of the possibility of the development of pathology that threatens the lives of patients. Stroke, acute and chronic heart failure, myocardial infarction much more often complicate hypertension in patients who do not refuse bad habits (smoking, drinking a lot of alcohol, eating fatty foods) and lead a sedentary lifestyle.

With the right treatment, there are no symptoms of the disease other than high blood pressure. Only with its significant increase appear persistent headache, nausea, vomiting, blurred vision, flashing "flies" before the eyes, shortness of breath, palpitations, anxiety.

Essential hypertension requires a certain lifestyle from patients: attending regular medical examinations, careful selection of a diet, giving up bad habits, and regular physical activity.

Oncological diseases – these are diseases in which disorders of the body are caused by tumors consisting of atypical cells that form tumors in any tissue that differ from normal cells of this tissue in a number of ways.

Tumor cells are capable of an infinite number of divisions. In this case, the process of division itself is disrupted: cells have different shapes and sizes. Their function and metabolism differs sharply from the corresponding healthy cells.

Tumor cells are able to utilize proteins, fats, carbohydrates, vitamins, trace elements, antioxidants and other substances necessary for growth and reproduction from the blood faster than normal cells. This is accompanied by their rapid growth. Cells malignant tumors have the ability to metastasize, i.e. their transfer by blood or lymph from the main tumor to other organs and tissues with the subsequent development of secondary tumors.

Tumors, especially malignant ones, quickly cause adverse changes in the body in many physiological systems (immune, blood, nervous). The causes of death of cancer patients are most often internal bleeding or rapidly progressing infectious diseases.

Malignant cells develop from normal cells as a result complex processwhich is called transformation. At its first stage (initiation), changes appear in the genetic material of the cell, making it malignant. This happens under the influence of carcinogens. At the next stage, in cells susceptible to carcinogenic changes, the consolidation of malignant properties occurs through promotion.

Risk factors for occurrence oncological diseases can act from the environment or from the hereditary apparatus of man. The presence of a pathology from this group of diseases in relatives is the most important risk factor. Breast cancer in a mother increases the likelihood of a similar tumor in her daughters by 1.5-3 times compared with healthy families... An increased risk of oncological diseases has been noted in people with chromosomal diseases. In patients with Down syndrome who have trisomy 21, the likelihood of developing leukemia is 12–20 times higher than in people with a normal chromosome set.

Among the environmental factors that increase the likelihood of such diseases, one can note smoking, prolonged exposure to ultraviolet radiation, ionizing radiation acting in accidents at nuclear facilities and when using nuclear weapons.

Nutritional characteristics are also a risk factor for oncological pathology, which most often occurs in the gastrointestinal tract. Eating junk and salty foods, as well as excessive consumption of strong alcoholic beverages, lead to stomach cancer. The role of viruses in the onset of cancer is not unambiguous, despite the available evidence. Of great importance in the formation of oncological diseases of chemical carcinogens.

Lung cancer is the most common cancer in both men and women. The main cause of the disease is smoking (in men - 90%; in women - 70%). The likelihood of risk increases with the number of cigarettes smoked.

Malignant tumors of the lung can occur on contact with asbestos, arsenic, nickel and most often develop in the bronchi. With this course of the disease, the leading symptom is a persistent cough. It is accompanied by sputum mixed with blood, wheezing in the lungs, pain in the chest, shortness of breath. Then respiratory and heart failure develop. The tumor can grow into the lumen of large blood vessels, which leads to massive bleeding and death of patients.

Breast cancer can develop in any tissue that forms it. Risk factors for the disease are age, the presence of breast cancer in family members, the presence of a breast cancer gene, previous breast disease, early onset of menstruation and late onset of menopause, no pregnancy or first pregnancy after 30 years, obesity after menopause.

With age, the likelihood of illness increases. About 60% of malignant tumors occur in women over 60 years of age. The greatest risk of the disease occurs in women over 75 years of age. A woman is 2–3 times more likely to develop breast cancer if her first-degree relative has or is suffering from this disease. The role of other risk factors in the onset of this disease is much less than the first two.

Symptoms that may indicate the presence of this disease are a lump that does not disappear, wrinkling or retraction of the skin, peeling of the skin around the nipple, a change in the shape of the mammary gland, bloody discharge from the nipples. In the prevention of breast tumors, the role of self-control and self-examination, regular medical examinations, and the implementation of the reproductive function of women at the optimum time is important.

Mental disorders– it is a disturbance in thinking, emotion and behavior. Such disorders are caused by a combination of many somatic, mental, social, cultural and hereditary factors, the nature of the interaction of which is very complex.

Classification mental illness constantly improved. In recent years, concepts such as "neurosis" or "psychosis" have been replaced by the term "disorder", which is reflected in the ICD-10. Psychiatric pathology includes psychosomatic, somatoform and anxiety disorders, depression and mania, suicidal behavior, personality disorders, dissociative disorders, schizophrenia and delusional disorders, as well as behavioral disorders associated with eating and sexual function.

When psychosomatic diseases the development of primary organic pathology occurs under the influence of mental factors. In the process of developing such diseases, exacerbation clinical manifestations provoked by neuropsychic stress or some other psychogenic factor. This mechanism is called conversion (conversion).

When anxiety disorders the clinical picture is dominated by anxiety of varying severity (from barely conscious sensations to panic fear). This group of mental illnesses includes numerous phobias, for example, fear of heights, confined spaces, infection infectious disease, post-traumatic stress disorder as a complex symptom complex of a mental and neuro-vegetative nature that arises after emergencies in victims or in military personnel who participated in military conflicts outside their country.

Depression and mania are two polar mood disorders. They manifest mental disorders, in which emotional disturbances are noted in the form of prolonged periods of decreased (depression) or increased (mania) mood. The incidence of this bipolar disorder is 0.6–0.9%.

Depression Is a state of deep sadness that develops after a recent loss or other sad event, or after anxiety. Depression occurs in 10% of all people, more often between 20 and 50 years old, the causes of which may be experienced losses, hormonal changes in the body, thyroid diseases, pain syndromes, alcoholism. Depression is characterized by melancholy, "withdrawal", refusal to eat, insomnia, slowing down of movements and the process of thinking, the appearance of suicidal thoughts, loss of sexual desire.

Mania - it is excessive, not corresponding to the situation and realities of life, gaiety, excessive physical activity and speed of thinking. Mania is less common than depression. In bipolar disorder, depressive and manic stages alternate. A number of patients have either depression or mania.

A man in a state of mania is euphoric, often irritable, hostile to others, he does not have a critical attitude towards the disease. Mental activity is high, often taking the form of a "leap of ideas". Patients are continually and excessively involved in adventurous activities and gambling... The duration of manic periods is shorter than depressive ones, their completion is more abrupt.

With manias, psychotic symptoms can be observed: delusions of exceptional talent, exceptional physical capabilities, wealth, aristocratic pedigree, as well as auditory and visual hallucinations.

Schizophrenia Is a disease that occurs with psychotic symptoms and is characterized by loss of connection with reality, hallucinations, delusions, impaired thinking and human activity in the professional and social spheres.

This disease is a complex medical and social problem. About 1% of the world's population suffers from schizophrenia, more than half of which needs hospitalization. The causes of the disease are not known. The first signs of schizophrenia appear in men at the age of 18–25 years, and in women at the age of 26–45 years. Features of the course of the disease have individual symptoms. In general, all manifestations of schizophrenia can be divided into three groups of symptoms: 1) delirium, hallucinations and pseudo-hallucinations; 2) impaired thinking and eccentric behavior; 3) deficiency symptoms.

Delusions are false beliefs and statements that represent a misunderstanding and rethinking of the information received. With schizophrenic delirium, there is a re-designation of already known objects and phenomena. This makes it difficult to analyze the information received and the subsequent decision-making. Hallucinations (fictional influences from the outside) are a big problem, which, according to the patient, make his own thoughts open to outsiders.

Pseudo-hallucinations (deceptions of perception) are most often expressed in the form of voices commenting on the patient's behavior or making a remark to him. Violation of thinking is manifested by its disorganization: from slight inconsistency and ornate judgments to complete meaninglessness.

Eccentric behavior can take the form of excitement, eccentricity, poor hygiene and inadequate appearance... Extreme forms of behavior are catatonia (prolonged immobility) or motor senseless hyperactivity. Emotional dullness manifests itself in an inadequate assessment of the phenomena of reality (joy and grief, perceived healthy people, do not cause any reactions in the patient). Poverty of speech is expressed by the brevity and monosyllabic answers to questions. Anhedonia is also characteristic as an inability to experience pleasure and asociality as a lack of interest in communicating with other people.

People with schizophrenia often commit suicide. Their life expectancy is reduced by an average of 10 years. Along with drug treatment, patients need psychological and social rehabilitation... Development and execution control individual program rehabilitation of patients with schizophrenia is entrusted to medical and social workers.

The described diseases are almost always accompanied by the formation of complex social problems in patients. In particular, the incidence of type 1 diabetes mellitus (insulin-dependent) type, which is observed either from birth or develops in the first years of a child's life, increases. The same picture is observed in some forms of leukemia. This leads to the disability of young people and children.

In general, for all socially significant non-communicable diseases, the level of disability is very high, which is the result of an unfavorable course of diseases, their late diagnosis and treatment. The receipt of disability by patients is accompanied by the formation of significant financial problems for them, since the size of the pension does not allow them to maintain a certain standard of living.

For the state, the problem of reducing the number of able-bodied citizens is further aggravated. The financial problems of patients and their families are exacerbated as the spectrum expands paid servicesprovided by medical institutions.

Persons suffering from socially significant diseases have the right to receive free drugs and medical supplies, however, they can acquire only four such items per month, which is insufficient for effective correction of the disease. For example, with diabetes mellitus, patients are given 2-3 types of insulin preparations, syringes and diagnostic strips for a glycometer. At the same time, patients need vitamins, trace elements, anti-inflammatory drugs, medicines to improve blood circulation. They are acquired by the patient himself.

In addition, foods that form the basis of the diet of diabetics (vegetables, fruits, meat, fish) are very expensive. It should be noted that the purchase of glycometers and test strips for them for retirees is a significant financial problem.

The high incidence of socially significant pathology exacerbates the difficult demographic situation in modern Russia. Families in which a spouse falls ill from this group are more likely to disintegrate, fewer children are born and sick children are born more often.

Patients with mental pathology can pose a safety risk to others. They often violate public order, create everyday problems for their neighbors, and various property disputes often arise in their families. Patients of a psychiatric profile with sexual pathology (pedophiles, sexual maniacs) should be under the supervision of medical workers and law enforcement officers for almost life.

To solve various social problems of this group of diseases, an integral system of social events is required, formed at the federal, territorial and municipal levels. This system should include information and educational programs on the emergence, diagnosis and treatment of diseases, their prevention, psychological, social and professional rehabilitation.

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In the second third of the XX century. in most economically developed countries, a change in the incidence profile has been clearly defined due to a sharp increase in the number of non-communicable diseases. “The nature of disease is changing rapidly. It seems that the struggle with the old deadly diseases, widespread during our childhood, was so successful that nature took revenge by pulling up reserves trained to attack from completely new positions ”(D. Stump).

In recent decades, more and more people began to talk about the onset of the era of "diseases of civilization", especially diseases of the cardiovascular system. It is no coincidence that they talk about the epidemic of these diseases, which came out on top in the structure of the incidence of the world's population. It is no coincidence that these diseases are called "diseases of civilization" (more precisely, diseases from civilization). We are talking about the predominance of disorders associated with scientific and technological progress, violations of ecological balance, ultimately with intense changes in conditions and lifestyle modern man in economically developed countries. It is curious that A.P. Chekhov spoke of this kind of disease. He begins his story “The Case of Mania Grandioga” as follows: “That civilization, in addition to benefits, has brought terrible harm to humanity, no one will doubt. Especially physicians insist on this, not without reason seeing in progress the cause of nervous disorders, so often observed in the past decades. "

The group of so-called "diseases of civilization" includes diseases of the cardiovascular system (hypertension, myocardial infarction, coronary heart disease, vascular lesions of the brain), malignant tumors, neuropsychiatric disorders, metabolic diseases (atherosclerosis, diabetes mellitus, etc.), trauma.

A special role belongs to diseases of the heart and blood vessels, which occupy a leading place in the structure of morbidity in the population of economically developed countries. It is no accident that the importance of these diseases has grown to the No. 1 problem of modern medicine. The prevalence of these diseases and the damage from them are such that they have become a big social problem.

Examples of

According to published data, more than 25% of the population in the USSR suffered from cardiovascular diseases; these diseases were noted in about every fourth inhabitant of the country. Hypertopic disease affects 5-6% of the population of economically developed countries. In the United States, the number of people with high blood pressure is 23 million.

Diseases of the cardiovascular system are the cause of high mortality in the population and in 1973 they accounted for 88.4% of all causes of death. In the USSR in 1974, 1.5 times more people died from coronary heart disease alone than from all types of malignant tumors. Statistics show that the mortality rate of the urban population from heart and vascular diseases is increasing every decade. In the United States, mortality from heart disease ranked fourth among the causes of death of the population, and by 1940, this figure came out on top. The proportion of deaths from cardiovascular diseases increased by 1959 to 36%, and in 1971 it was already more than 47%.

The “onslaught” of chronically occurring non-communicable diseases has a solid “rear”, which can be considered the most characteristic demographic processes for the modern period, and above all the aging of the population in economically developed countries. The aging process of the population most actively affects the structure of mortality and morbidity. At the same time, there is a tendency towards “rejuvenation” of chronic non-infectious diseases, especially diseases of the heart and blood vessels. Cases of myocardial infarction and cerebral stroke are increasingly occurring in young people. For 15-20 years, the morbidity and mortality rates in this age group have increased by about 2 times.

Undoubtedly, diseases of the cardiovascular system existed in the distant past, but they were hidden from us by the flow of infectious diseases and were poorly diagnosed. A.I. Kuprin in his story "Death of a Fighter" classically described the clinical picture of angina pectoris (angina pectoris). However, at present, high rates of heart and vascular diseases are explained not only by more perfect diagnostics, but also by their true increase in absolute terms.

Diseases of the cardiovascular system cause the most tangible damage to human health, labor resources and the economy of countries (temporary and permanent disability, disability). Thus, in the GDR in 1971, the rate of disability due to diseases of the cardiovascular system was 10-12 million lost working days per year for 340,000 people; approximately 43% of all cases of disability in men were caused by diseases of the heart and blood vessels. According to our scientists, 57% of male patients with diseases of the cardiovascular system receive a disability at working age (pre-retirement).

It should also be noted that there is a great economic damage caused by diseases of the heart and blood vessels. So, foreign experts are trying to calculate the economic losses from these diseases. For example, US publications report that due to premature death from heart and vascular disease in this country, labor losses per year amount to approximately 2 million lost years. Diseases of the cardiovascular system account for more than 40% of all labor losses in the United States due to deaths. In 1973, the damage caused to this country in connection with diseases of the heart and blood vessels, reached 40 billion dollars.

Diseases of civilization reflect modern views based on ideas about the unity of social and biological factors in the formation, development and existence of a person. It was the living conditions of modern man that began to come into some conflict with the requirements (capabilities) of his biological nature. Human biological nature is largely conservative and it would be unwise to forget about its possibilities.

The type of modern man essentially does not differ from the type of Cro-Magnon who lived 100 thousand years ago. During this period, many social and social structures have changed, but the biological nature of man has practically remained unchanged. Nature has its own requirements. We forget about them, and she takes revenge on us with the diseases of civilization.

Diseases of civilization are directly or indirectly related to the development of the modern world community. Thus, the way of life and behavior of the population has been transformed or are being transformed in connection with urbanization, chemicalization and other artificial changes in the external environment, in connection with the intensification of production processes. In turn, these factors contribute to inadequate neuro-emotional reactions, psychological and other stresses, sharp changes in the nutritional balance, information overload, physical immobility. Thus, the diseases of civilization are not a fatal predetermination, but a consequence of the actions of the people themselves. Therefore, the prevention of these diseases is quite real.

Diseases of civilization depend mainly on the impact of environmental factors. We are talking about the impact of a complex of factors, and above all about a set of exogenous socio-economic factors and a changed lifestyle. On the paramount importance of socio-economic factors in the spread of a number chronic diseases evidence of a sharp increase in the incidence of these diseases and mortality from them in a very short period of time, during which such intensive genetic transformations in humans are inconceivable. In just one generation, under the influence of stormy socio-economic, scientific, technical, political and other changes, the morbidity picture in economically developed countries has changed, the profile of diseases has changed. The leading link in the structure of morbidity and mortality was chronic diseases, especially the heart and blood vessels.

Nervous overload and physical underload, polluted air of big cities, malnutrition, smoking and alcoholism of adults - all these costs of civilization hit the child's still not strong body especially painfully. And the smaller the child, the more severe the consequences of such blows. Infants and unborn children are especially vulnerable. Nine months of intrauterine development largely determines the fate of the unborn child. During this first period of life, the human body is most susceptible to various damage.

Now many people on our planet have realized the danger of an irresponsible attitude towards the natural environment, the consequences of which are detrimental to human health, and therefore they started talking loudly about protection. This formulation contributes to a deep understanding of the causes of many diseases and their timely prevention. The great Russian physiologist I.P. Pavlov said: “... do not usually the causes of the disease creep in and begin to act in the body before the patient becomes the object of medical attention? And knowledge of the causes is, of course, the most essential matter of medicine. Firstly, only knowing the cause, one can aptly rush against it, and secondly, and this is even more important, one can prevent it from acting, before invading the body. Only after knowing all the causes of diseases, real medicine turns into the medicine of the future, i.e. in hygiene in the broad sense of the word ”.

The emergence and development of ideas about primary prevention is inextricably linked with the search for the causes of the onset and spread of diseases in the process of fundamental epidemiological, socio-hygienic, theoretical, experimental and clinical and social research. These studies are aimed at establishing the true extent of the prevalence of non-communicable diseases, at identifying primary deviations from the normal course of life processes, on studying the triggering mechanisms of the development of painful processes leading to the onset of various diseases, as well as to establish a connection between the body and the impact of various environmental factors.

Prevention should include the sum of activities aimed at studying the environment and changing it, systematic impact on the environment in order to eradicate conditions that contribute to the occurrence of diseases. Primary prevention measures should be of both a general health nature, contributing to the improvement of living conditions and health of the population as a whole, and a strictly targeted purpose to prevent specific diseases, in particular, eliminate risk factors. At the same time, the best results can be obtained with the comprehensive implementation of preventive measures that simultaneously ensure changes in working and living conditions, protect the body from external pathogenic influences, eliminate the risk of disease and increase resistance to these factors on the basis of the mobilization of the biological adaptive mechanisms of the body.

This approach determines the need to regulate, with a preventive purpose, many factors of everyday life and professional activity that form the conditions and way of human life and related to the ecological and industrial environment, living conditions, nutrition, spiritual and physical culture, etc.

Lisovskiy V.A., Evseev S.P., Golofeevskiy V.Yu., Mironenko A.N.