Doc. MUDr. Jindra Šmejkalová, CSc. Primary and early secondary prevention of cardiovascular diseases. The screeninig investigation of risk factors of ischemic heart disease in students (practical part). The risk factors of cardiovascular disease Non- preventable gender- males age
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Primary and early secondary prevention of cardiovascular diseases.The screeninig investigation of risk factors of ischemic heart disease in students (practical part).
Overweight means excessive weight, obesity means the fat tissue accumulation.
To define and assess the grade of obesity there exist various criterions.
According to the relative overweight we distinguish:
light obesity with 120 – 140 % of ideal weight
medium obesity with 140 – 200 %
morbid obesity above 200 %.
Body mass index (BMI)
is calculated by weight in kg / height in m2.
BMI does not take into account fat distribution and it is much harder to interpret in children
BMI evaluation :The criterions of the total population:
< 18.5 underweight;
18.5 – 24.9 normal weight;
25.0 – 29.9 overweight
30.0 – 34.9 the 1st degree of obesity / light obesity
35.0 – 39.9 the 2nd degree obesity / marked obesity
> 40 the 3rd degree obesity / malignant / morbid obesity
Optimal BMI in accordance with age:
Age (years) BMI (kg/m2)
19 – 24 19 – 24
25 – 34 20 – 25
35 – 44 21 – 26
45 – 54 22 – 27
55 – 65 23 – 28
> 65 let 24 – 29
Assessment of the % of body tissue
women max. 25% of body fat
In diagnostics of obesity there is important not only the percentage of fat tissue but also its distribution.
Body fat distribution
= accumulation of fat in the visceral region.
Risk of complications is higher in this type.
= depositionoffatpreferentially into the buttocks
Often inherit from mother to daughter.
The central type of obesity may be determined by measuring circumference of waist and hips.
Proportion of these measures in cm is called:
WHR(waist hip ratio).
WHR > 0,95 in men
> 0,85 in women
> 102 cm in men indicated risk even if BMI is normal
> 88 cm in women
biliary tract cancer, breast cancer,
endometrial and cervix uteri cancer
Benefits: 10 kg loss in weight can lead to
an improvement in following:
Doctor and nurse working in the sphere of primary prevention should:
- modification of diet with the restriction of energy intake
- an increase of movement activity.
Blood pressure (mmHg) SBP DBP
Normal: < 140 < 90
Low hypertension: 140 – 180 90 – 105
Middle or serious hypertension: > 180> 105
Isolate systolic hypertension: > 140 > 90
Persons withsystolic BP 140 – 160 mmHg and diastolic BP 90 – 95 mmHg are indicated for non-pharmaceutical treatment.
Hypertension is one of the most important risk factors of atherosclerosis, myocardial infarction and ictus.
Risk of cardiovascular diseases increases mainly in concurrent influence of smoking, hyperlipoproteinemia or diabetes.
Risk factors of hypertension:
Recommendation concerning decrease of blood pressure:
changes of nutritional habits, increase of physical activity,
Non pharmacological treatment of hypertension atherosclerosis, myocardial infarction and ictus. includes:
Non pharmacological procedures may quite normalize a light hypertension and support the pharmacotherapy of more advanced hypertension.
High level of cholesterol atherosclerosis, myocardial infarction and ictus.
Blood level of cholesterol represents one of the basic indicators of CVD risk.
Within the life span the level of total blood cholesterol increases from 2,8 mmol/l in small children up to 6,2 in elderly.
Higher LDL cholesterol level represents the risk factor of CVD, an increased HDL cholesterol level on the contrary acts protectively.
Total cholesterol (mmol/l): normal level under 5,2
(better still under 4,1!)
limit level 5,21 – 6,49
high risk above 6,5
In people under 30 years of age we recommend the level being bellow 4,2 mmol/l
The LDL concentration in patients with already present cardiac ischemic disease should not exceed 2,6 mmol/l, in patients without ischemiabut with two risk factors present 3,4 mmol/l and in others 4,1 mmol/l.
Note: For all physical function maintenance LDL concentration 0.7
mmol/l is sufficient.
HDL (mmol/l) : men: normal level: > 1,62
level of mild risk: 1,62 – 0, 91
high risk: < 0,9
women: normal level: > 1,68
level of mild risk: 1,67 – 1,17
high risk: < 1,16
LDL (mmol/l) normal level: < 3,4
level of mild risk: 3,4 – 4,1
high risk: > 4,5
Triacylglycerols (mmol/l) normal level: < 2,3
level of mild risk: 2,31 – 4,5
high risk: > 4,5
The risk of CVD is markedly higher, if there are present even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
From the point of view of the risk and development of arteriosclerosis the cholesterol intake in food is not that important. Important is saturated fat acids and the high energetic intake.
Possibilities of hypercholesterolemia prevention
There exist three basic intervention approaches:
Preventive procedures recommended in primary care: even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
The persons with a high risk are indicated for the preferential investigation. These high risks are:
HDL even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others. – transports cholesterol from the peripheral tissues into the liver. The HDL concentration should be 0,9 mmol/l at least.
Reasons for lower level of HDL:
- after meal (as much as for 10%)
- android type of obesity,
- some drugs (beta blocators)
- genetic disposition.
To increase the HDL is possible by
- Reduction of weight;
- Sufficient movement activity;
- spirits consuming;
- some hypolipidemics (statins, fibrates, nicotin acid).
Aterogenic index: ratio between total cholesterol to HDL
– it should be<5,5
Cigarets smoking: even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
Smoking takes part in both the origin of atherosclerosis and its
If the smoker quits smoking, within 2-3 years his endothelium recovers.
High alcohol consumption even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
The total amount of alcohol consumed is important.
Ways of quantification of alcohol consumption even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
1 unit 1 unit – more precisely
- estimation (cca 10 g pure alcohol)
Beer 1 glass12º: 1 unit = 250 ml (0,5 l = 2 units)
10º: 1 unit = 330 ml (0,5 l = 1,5 units)
Vine 1 glass 100 ml
Spirits 1 glass small dram (jigger): 25 ml
great dram (jigger): 50 ml = 2 units
Health assessment of alcohol consumption even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
21 units per week for men.
Lack of physical activity, sedentary way of life
Recommendation: - 1 hour of quick walking every day
+ 1 hour of intensive physical training per week;
- 4 hours of „non-sedentary“ activities per day.
A-type of behaviour even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.-Bortner questionnaire
Behaviour with a high activation of neurological system. Inner need to reach ever more and more results with still shorter time intervals.
This behaviour is typical with: high ambitions, competition, vigour, aggression, easily roused hostility, ever lasting feelings of lack of time, permanent time planning and organizing, impatience.
Among the specific manifestations of type A behaviour there belong a fast pace of most of the activities and permanent readiness. Also typical are loud, quick and emphatic speech and strained muscles. In emotional answers irritability, anger and hostility are easy to be traced.
Type A behaviour is a complex reaction and results from a number of personal and social environment components.
Prevention of cardiovascular diseases even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.
Strategy has been established on the modification of CVD causes.
Etiology of CVD is often multifactorial, while combination of riskfactors (RF) brings an increased risk.
Each individual RF has the gradual characterization (light and grave smoking, overweight and obesity, light and heavy hypertension).).
The systems for scoring the RF were created. These take into account their gradual character and interactivity, and they thus help in stating priorities of interventions. E.g.:
- „Dundee coronary risk score“ (age, smoking, blood pressure, cholesterolaemia).
- „GP score“ – enables to select a group of middle aged people, who are most endangered by myocardial infarction and who will benefit from intervention most.
Table of coronary risks even other risk factors, as hypertension, left ventricle hypertrophy, glucose intolerance, obesity, smoking, and others.(see bellow) – estimationofischemic heart disease risks inpatients, who still have no ischemic disease manifestation. This serves to the determination of absolute risk of ischemeic cardiac disease during the next 10 years.
Into the group with the high risk there belong asymptomatic individuals, whose absolute risk reaches 20 % and more within the next 10 years or in the younger age projected into 60 years reaches 22% or more.
In accordance with the fact that ischemic cardiac disease is conditioned multifactorially, the prevention should not stress too much any individual risk factor.
On the basis of assessment of presence and gravity of all the main risk factors to point out the individuals with an increased absolute risk.
Level of risk:low - slightly increased - medium- high - very high