Bad eating habits, lack of exercise, and smoking are the most common negligence that lead to cardiovascular diseases. Lifestyle changes are worth making at any time, but of course the sooner you do it, the better.
Already at school age, we encounter a huge problem of obesity among children. I consider promoting healthy eating in this age group to be one of the most important activities that have a real impact on improving health and reducing the risk of heart attacks in the future - says Prof. Maciej Wybraniec, head of the Intensive Cardiological Surveillance Unit at the Upper Silesian Medical Center in Katowice-Ochojec.
The cardiologist emphasizes that the same applies to physical activity: We should move for 30 minutes at least several times a week - WHO guidelines say five times, but any amount of moderate-intensity exercise will be beneficial. These are actions we can take every day without contacting a doctor. Health is in our hands - says prof. Chosen.
It is also not worth delaying the decision to quit smoking: Smoking cigarettes and e-cigarettes are addictions that shorten life significantly - adds the specialist.
For heart health, you also need to ensure regular, sufficiently long, uninterrupted sleep.
Awareness is growing. 30-40-year-olds want to get tested
People aged approximately 30-40 years old, who, even if they do not have any symptoms, want to undergo basic tests, are increasingly coming to the cardiology clinic.
In recent years, awareness of the risk of cardiovascular diseases has increased significantly - says Prof. Maciej Wybraniec and recommends: assessment of blood pressure, heart rate and cholesterol levels in the blood.
We can measure blood pressure ourselves at home. Home measurements are more accurate. If the values exceed 140/90 mmHg, we should consult a doctor - explains the cardiologist.
Heart rate is also easy to check at home. This is made easier by, for example, smartwatches, which many people use. Prof. The chosen one emphasizes that checking whether the heart rate is regular is especially important in the older age group - over 60 years of age.
If these people have complete arrhythmia, i.e. the intervals between heart beats are different, this may be the first symptom of atrial fibrillation. This is a heart arrhythmia that occurs in up to 5%. people over 60 years of age, i.e. every 20th person has this problem. Meanwhile, atrial fibrillation dramatically increases the risk of ischemic stroke. By quickly implementing anticoagulant and blood-thinning treatment, we can prevent strokes. We can also prevent another stroke. At the Upper Silesian Medical Center, we are conducting a randomized project in which we use modern surgical treatment in patients with atrial fibrillation after a stroke to prevent it from occurring again. This is the PILOS AF study and we invite all patients after ischemic stroke with atrial fibrillation - we offer them modern treatment - explains Prof. Chosen.
Important parameters: cholesterol, triglycerides and lipoprotein(a)
In addition to monitoring blood pressure and heart rate, cholesterol levels in the blood should be checked. After the age of 40, we should be examined at least once a year.
The higher the cholesterol, the greater the risk of serious cardiac complications - heart attack and ischemic stroke. The lower cholesterol, the longer we live, says a cardiologist.
There are many myths around this issue. Prof. Maciej Wybraniec dispels doubts: Certainly high total cholesterol and high so-called bad cholesterol (LDL) are determinants of poor prognosis. However, if the so-called good cholesterol (HDL) is high, that's good, but that doesn't mean we can feel comfortable just because of it. High HDL does not have a protective effect when total and LDL cholesterol levels are elevated, he explains.
He also emphasizes that the low level of the so-called good cholesterol is a risk factor: We also know that there are certain HDL cholesterol fractions, which are unfortunately also harmful and increase the risk of cholesterol deposition in the vascular wall, which translates into the risk of heart attack - sums up the cardiologist.
Another element of the lipid profile are triglycerides. The higher their level, the worse it is, the greater the risk of a heart attack: This is a parameter that changes much more from day to day, from week to week, and correlates much more with the diet and the way we live every day - says Prof. Chosen.
The blood test can also measure a new parameter - lipoprotein (a). This is not a routine test, but according to cardiologists it should be performed at least once in a lifetime: It is believed that a high level of lipoprotein (a) indicates people who have a much higher risk of cardiac events throughout their life and these events will occur at a younger age. Of course, this is only a risk indicator, not a prediction. What is important is that we do not have much ability to modify the concentration of lipoprotein (a). If it is high, it should motivate us to take care of our health and modify all other risk factors - explains the specialist.
Cholesterol under control
Not every person with elevated cholesterol requires drug treatment. If the first marking is incorrect, you need to consider the scale of exceeding the norm.
If the norm is exceeded by 10-30%, then in patients who do not have numerous other diseases, it is worth implementing a healthy lifestyle, primarily a diet limiting animal fats, rich in vegetables, fruits and low-fat dairy products - says Prof. Maciej Wybraniec.
However, if after changing your diet and introducing regular physical exercise, your cholesterol level is still high or even increases after 3-6 months, you should consider treatment.
Statins are not that scary
Cardiologists emphasize that there are many myths about the alleged harmfulness of statins, i.e. drugs that lower blood cholesterol levels.
This is one of the biggest problems in everyday contact with patients. Meanwhile, statins are undoubtedly drugs that effectively lower total and LDL cholesterol. They are the basic, generally available, cheap method of lowering LDL cholesterol. If someone has high cholesterol and takes statins, they will live longer - explains Prof. Maciej Wybraniec.
He adds that the use of statins, like any therapy, may cause some side effects, but they are very rare: They most often affect the muscles - they cause muscle pain, which occurs in 5-10 percent. patients treated with statins. Usually, the pain goes away on its own or requires a reduction in the dose of the drug. The risk of serious complications, as with all drugs we use, even aspirin or paracetamol, which we can buy without a prescription, of course exists, but it is very small. Let's not be afraid of the medicine, let's be afraid of the disease. Hyperlipidemia is a disorder that may ultimately lead to: atherosclerosis, heart attack, stroke. It is a disorder that we can control - sums up the cardiologist.
The target blood cholesterol concentration depends on several factors and is related to the risk of a specific patient.
The more comorbidities he has, the older he is or has already had cardiac incidents, if he has diabetes or smokes cigarettes, he should have much lower cholesterol than a young person, without other problems, without comorbidities, non-smoker and regularly exercising - explains the specialist.
It is best to target "bad" cholesterol: LDL concentration in the general population should be below 115 mg/deciliter. In middle-aged patients with single risk factors, hypertension - less than 100 mg/deciliter. However, if someone has had a heart attack, stroke, or has atherosclerosis, we aim for LDL cholesterol below 55 mg/deciliter. This standard is very high, but this is because we know that lowering cholesterol below this value is a key element in the prevention of heart attack and stroke. Lowering cholesterol greatly reduces the risk of the first incident, postpones it, and in people who have already had a heart attack, it is a key element in preventing another heart attack - emphasizes the cardiologist.
Diet matters - watch out for yellow cheese!
There is a lot of talk that the Mediterranean diet is the best for heart health. It is also said that you should limit eating red meat. However, we rarely hear about the harmful effects of yellow cheese.
Yellow cheese contains a lot of exogenous cholesterol. Regular, daily consumption of e.g. a slice for breakfast, a second breakfast, another two slices for dinner may be important. Everything in the diet is acceptable, it's a matter of quantity. We should consider whether it is necessary to eat yellow cheese every day. Maybe every second or third day is better, in smaller amounts. I would definitely prefer white cheese as an element of a diet that has a better impact on the lipid profile - advises the expert. It is also worth limiting the consumption of long-ripened blue cheeses.
However, you definitely don't have to eliminate eggs from your diet. They also have a lot of cholesterol, but they contain lecithin, which limits its absorption.
Of course, people who have hyperlipidemia should not eat too many eggs - up to 2 a day is a reasonable dose - explains the cardiologist.
He strongly recommends limiting the consumption of simple sugars: This is evil. Simple sugars contained, for example, in sweet, carbonated drinks, ready-made juices in cartons or in sweets, first of all, increase the risk of obesity. Secondly, they worsen the lipid profile because they have a huge impact on the level of triglycerides - warns prof. Chosen.
He emphasizes that we should eat as simply as possible: When we think about a healthy diet, it is important that it contains simple, unprocessed products, preferably natural, from local suppliers.
Don't ignore these symptoms. It could be a heart attack!
Some people may experience symptoms preceding a heart attack.
A squeezing, burning pain in the chest that intensifies with physical activity, movement, climbing stairs, walking faster - if it appears, especially if it radiates to the left arm and jaw, it is actually a symptom of chronic coronary syndrome, i.e. stable coronary artery disease, which may at some point turn into a heart attack if the atherosclerotic plaque ruptures - explains Prof. Maciej Wybraniec and points out that many people do not have any previous symptoms.
These people simply wake up from day to day with chest pain. A heart attack most often occurs around 5.00-6.00 in the morning. This is an observation related to certain regulatory mechanisms in the body, he adds.
Severe stress may be a trigger for the rupture of atherosclerotic plaque. In people with atherosclerosis, this may happen when blood pressure increases as a result of emotional or physical stress, e.g. in the case of an infection.
We observed this during the Covid19 pandemic and with other infections, e.g. pneumonia - explains Prof. Chosen.
The cardiologist adds that stress can also lead to an incident that resembles a heart attack, but is not one: This is the so-called broken heart syndrome. In the event of emotional disappointment or the loss of a loved one, the heart suddenly begins to contract abnormally and such people have typical symptoms of a heart attack. Only in the hospital after tests are we able to say that someone has broken heart syndrome. Fortunately, the symptoms disappear and the heart regenerates. Therefore, for heart health, it is important that we take care of our relationships and mental health.
Women later consult a doctor with a heart attack
Symptoms of a heart attack in women and men are usually similar: chest pain at rest that does not go away within 20 minutes, waking you from sleep, burning and/or squeezing. However, it also often happens that women experience atypical symptoms.
Firstly, if there is pain, it is, for example, more stabbing and located in a slightly different place, i.e. not behind the sternum. Much more often, due to a higher pain threshold, women experience not pain, but shortness of breath or a feeling of lack of air. This may cause diagnostic errors. Symptoms are more often located in the back, around the shoulder blade. You need to be careful because these unusual symptoms, especially in middle-aged women, may be confused with symptoms of menopause, says the cardiologist.
Due to the higher pain threshold and the above-mentioned unusual symptoms, women with a heart attack report to a doctor later.
Quick return to activity after a heart attack
Over the last 30 years, there have been many changes in the treatment of patients with heart attack.
In terms of tablet treatment, we used to only have a few medications. Currently, in the event of a heart attack, we take immediate action. Within two hours, the patient should be on the hemodynamic table - there is a very dense network of cardiac catheterization laboratories throughout Poland. We do not perform surgery, only minimally invasive procedures. We prick the arm, sometimes the leg, and pass a catheter through the keyhole into the coronary arteries, then we unblock the artery, open the artery, administer appropriate drugs, and often implant a stent, i.e. a frame, into the coronary artery from the inside to make it unobstructed. The procedure usually takes an hour, sometimes a little longer, and the patient's pain subsides on the same day. If the procedure is performed quickly enough, the heart is completely saved and there is no damage or scar formation. The heart then contracts well for years. If we delay seeing a doctor, a part of the heart may die, which will result in poorer contractility and the development of heart failure - explains Prof. Maciej Wybraniec.
There are more changes in treatment. In the early 1990s, after a heart attack, patients were advised to stay in bed for 2-3 weeks so that the heart could regenerate, says the cardiologist.
Today, the aim is for the patient to quickly return to activity. In the first day after a heart attack, patients are connected to a monitor, sometimes they can walk with the monitor, but in fact, in the first day, a stationary, lying lifestyle is recommended. However, patients are started on the second or third day. This reduces the risk of complications, e.g. thrombosis, the doctor notes.
A great progress is the introduction of the KOS-zawał program, fully financed by the National Health Fund, i.e. a comprehensive care program for patients after a heart attack. Thanks to it, the patient does not end up in a vacuum after being discharged from the hospital.
