The whole world – to fight cholesterol!
Leading Russian scientists have united in the fight against the "silent killer" of the XXI century – cholesterolAnna Lyubovedskaya, Anatoly Kovalev, "National Health League"
The main cause of high mortality among the Russian population is cardiovascular diseases, of which 80% are caused by atherosclerosis.
One of the main risk factors for the progression of such diseases, primarily coronary heart disease, is an increase in cholesterol levels. Moreover, atherosclerosis often develops asymptomatically and manifests itself when it is already difficult to fight it.
Only recently, with the participation of the All-Russian public Organization "League of Health of the Nation", for the first time leading Russian specialists, academics working directly in this field seriously engaged in studying the global problem of "cholesterol health" of the population of the Russian Federation.
For a year and a half, fundamental research continued, the result of which was the National Scientific Report "Everything about Cholesterol", presented recently to the general public. The presentation of the report took place at the Institute of Modern Development, which is engaged in solving the most pressing problems of Russia.
The report "All about cholesterol" was published under the editorship of the President of the All-Russian Public Organization "League of the Nation's Health", Academician of the Russian Academy of Medical Sciences L.A. Bokeria and Director of the Federal State Institution "GNITS of Preventive Medicine", President of the All-Russian Scientific Society of Cardiology, Academician of the Russian Academy of Medical Sciences R.G. Oganov. The scientific editor was the Director of the State Research Institute of Nutrition of the Russian Academy of Medical Sciences, Academician of the Russian Academy of Medical Sciences V.A. Tutelyan, and the scientific consultant was the Director of the Institute of the National Health League, Professor I.N. Stupakov.
The presented global study reveals in detail all aspects of the problem of the occurrence, prevention and treatment of cardiovascular diseases caused by elevated cholesterol levels.
The report contains practical recommendations, special diets, reveals the peculiarities of the course of diseases caused by excess cholesterol. It examines in detail the physiology of processes in the body, compares geographical, age, genetic factors of influence, provides fresh statistical data and analyzes the results of numerous studies. Particular attention is paid to risk factors, methods of correction of lipid metabolism for various groups of the population.
At the presentation of the Report, the President of the All-Russian Public Organization "National Health League", Academician of the Russian Academy of Medical Sciences Leo Bokeria stressed that to begin with, each individual needs to realize the importance of this problem: "Today we are approaching a global problem that sits in each of us. This is the problem of fighting cholesterol. It's even strange to say that we have to fight with ourselves. But the fact remains. And the reason is that we have a huge set of bad habits, that we don't want to listen to reasonable advice."
For example, epidemiological studies show that only a third of patients with dyslipidemia are aware of the negative role of lipid metabolism disorders in the development of CVD.
Patients' non–compliance with recommendations is a big and real problem - the health of patients is deteriorating, health resources are being used inefficiently.
President of the All-Russian Scientific Society of Cardiology, Academician of the Russian Academy of Medical Sciences Raphael Oganov said that in economically developed countries cardiovascular diseases are the number one cause of death of the population. "Every year in the world, about 17.5 million people die from these diseases. This is significantly more than from all malignant neoplasms, chronic bronchopulmonary diseases, diabetes mellitus, therefore, today these diseases are called epidemics," says the academician of the Russian Academy of Medical Sciences.
In the Russian Federation, the share of deaths from cardiovascular diseases in the structure of total mortality in the 70s of the last century was 46.3%, in the early 80s - 52-53%, in 2003 - 56.1%, in 2006 - 56.9%. A higher proportion (up to 60%) of cardiovascular diseases in the structure of mortality is noted only in the countries that were part of the USSR - Ukraine, Moldova, Kazakhstan, Turkmenistan. In economically developed countries over the past three decades, there has been a clear trend towards a decrease in the share of cardiovascular diseases in the structure of total mortality, their share does not exceed 40% and only 1 out of 5 deaths occurs before the age of 70. At the same time, in the Russian Federation, almost every third death for this reason occurs before the age of 70.
The prevalence of CVD mainly depends on lifestyle characteristics and associated risk factors. Lifestyle modification and reduction of risk factors can slow down the development of the disease both before and after the onset of clinical symptoms.
Recall that one of the main risk factors for death from cardiovascular diseases is an increased level of cholesterol.
"If you look at the structure of mortality from CVD, it is obvious that two groups of diseases, in general, create this problem. These are various forms of coronary heart disease and cerebrovascular diseases. They account for 85% of all deaths, therefore, when we talk about the problem of combating CVD, then, of course, first of all, we mean these two groups of diseases, which are based on atherosclerosis, and hypercholesterolemia is the basis of atherosclerosis," says RAMS academician Rafael Oganov.
Moreover, if other risk factors are added to cholesterol, the risk of death increases dramatically. With the same cholesterol level, the risk of dying from CVD in 10 years may be 47%, or it may be as low as 17%, depending on what the person's blood pressure level is. The risk in people who do not have coronary heart disease increases by 1.6 times, and in people with coronary heart disease by 6.1 times.
"Every year 7 million people die in the world. from high blood pressure, 5 million from smoking, 4.5 million from high cholesterol. This trio is, in general, the main killer, and a killer who causes a lot of damage all over the world," RAMS academician Raphael Oganov cites even more impressive statistics.
In addition, in a number of studies that have studied the natural course of atherosclerosis, it has been shown that the pathological process leading to damage to the coronary and cerebral vessels begins already in childhood and continues to progress as they grow older, while its connection with known risk factors is found. About 250 million people worldwide are at high risk of early development of atherosclerosis due to inheritance of defective genes regulating the metabolism of lipids and lipoproteins.
What is the situation with cholesterol in Russia?
We pay undeservedly little attention to the problem of cholesterol and proper nutrition inextricably linked with it.
"Only, probably, the state of falling in love on both sides requires careful attention to yourself, support the figure and show your strength and health, etc. But, as soon as the first results are achieved, motivation drops sharply. Some public professions are a powerful motivating factor for maintaining health, and require you to take care of yourself. And then we have no motivation. Even in the army, militia, and internal troops. For example, in China, the weight of an officer should not exceed a certain indicator. If it exceeds, then you cannot serve as an officer. Look, our officers, starting even with an ensign or traffic police inspectors, are the most powerful contingent. I'm not even talking about officials. We are often faced with the fact that people are overweight and obese, and this is about 55% of people over 30 years old. Until the age of 20, you keep your weight almost perfect, do sports one way or another, and by the age of 30, having achieved something, you lose these motivations and gain weight," says Viktor Tutelyan, Director of the State Research Institute of Nutrition of the Russian Academy of Medical Sciences, Academician of the Russian Academy of Medical Sciences.
According to the data of the State Research Center for Preventive Medicine, about 60% of the adult population of Russia have an increase in the concentration of total cholesterol, and in 20% this level corresponds to a high risk of developing cardiovascular diseases. This means that 60% of the able–bodied population of the country need at least dietary, and 15% - 20% need medical treatment of the problem.
In addition to nutrition, other factors affect the excess of cholesterol in the body. "We don't move much, we eat who knows what. Thus, in addition to natural risk factors to which we are accustomed – laziness, lack of mobility, bad habits, external factors that are especially present in society, in the country, for the last 25-30 years, also join," says Leo Bokeria, academician of the Russian Academy of Medical Sciences.
"A healthy lifestyle cannot be formed only by doctors, pharmacists, food manufacturers. It is important to realize that a healthy lifestyle should become the main thing for a person in his idea of life," concludes the famous cardiac surgeon.
What can we really do today?
For a person who has an elevated cholesterol level in the blood, the recommendations are quite simple: diet therapy, physical activity, giving up bad habits.
"Correction of hypercholesterolemia always begins with recommendations on nutrition, on diet," says RAMS academician Rafael Oganov.
The general principles of a low-fat diet are as follows: daily fat intake should not exceed 30% of the total calories of food, saturated fat 10% and cholesterol in food 300 mg / day. Saturated fats should be replaced with monounsaturated and polyunsaturated (omega-3, omega-6) fats and oils.
"The first thing we always recommend is to limit the consumption of animal products rich in cholesterol. This will allow for a 10-15% reduction in cholesterol and saturated fats by another 15-20%," says RAMS academician Rafael Oganov. These are fatty meats, lard, butter, sour cream, egg yolk, fat cheese, sausages, sausages, all offal, fish caviar, shrimp, squid. At the same time, it is recommended to replace animal fat with vegetable fat, since the latter is rich in anti-atherogenic unsaturated fats. The diet should include olive oil, which contains a sufficient amount of anti-atherogenic monounsaturated oleic acid.
"Our second recommendation is to increase the consumption of plant–based products that can bind and remove cholesterol from the body. This is, first of all, dietary fiber – more than 30 grams per day. They are found in large quantities in fruits (pears, apples, oranges, peaches), berries (raspberries, strawberries, blueberries), vegetables (cauliflower, broccoli, green beans) and legumes (peas, lentils, beans). These are pectins more than 15 grams per day – they are contained in fresh fruits (apples, plums, apricots, peaches), berries (black currants) and vegetables (carrots, table beets). And a very interesting class is vegetable stanols and sterols (contained in soybean and rapeseed oils, extracts of coniferous oils). They are recommended to take at least three grams a day. This is interesting, because they have now learned how to add them to food products – margarine, fermented milk products, etc. This makes it possible to have a very wide impact on the population, since the population actively uses these products. They reduce cholesterol levels by about 10%," adds RAMS academician Rafael Oganov.
Academician of the Russian Academy of Sciences Viktor Tutelyan notes that we eat very little vegetables and fruits – two, three times less than necessary: "In general, it is considered necessary to consume 600 grams of vegetables and fruits every day – this is ideal, but 400 grams is minimal, and we barely stretch 300 grams on average."
To prevent atherosclerosis, it is recommended to eat more fruits – at least 400 g or 5 servings per day: 1 serving = 1 apple / 1 banana / 1 orange / 1 pear / 2 kiwis / 2 plums / 1 tablespoon of dried fruits / 1 large slice of melon or pineapple / 1 glass of juice. The amount of cooked or fresh vegetables in the diet should be at least 400 g.
"It is interesting that if you look at the world map, it becomes obvious that the epidemic of atherosclerosis is raging in those countries where the population eats mainly animal products. These are Russia, some countries of Western Europe, America, Canada, Australia. This epidemic does not exist in those countries where the population eats mainly plant products or marine products, even though in these countries there is a high prevalence of other risk factors, such as smoking and arterial hypertension. These are countries such as Japan, China, and a number of Mediterranean countries. This once again suggests that cholesterol is still a key risk factor, and if there is no hypercholesterolemia, then other risk factors have a much weaker effect on the development of atherosclerosis," said RAMS Academician Rafael Oganov.
Below are the basic principles of the diet recommended for the prevention of atherosclerosis:
1) regular consumption of a variety of vegetables, fruits (fresh vegetables for dessert);
2) the ratio between saturated, mono- and polyunsaturated fats should be 1:1:1;
3) moderate consumption of dairy products (skimmed milk, low-fat cheese and low-fat yogurt);
4) give preference to fish and poultry (without skin) over meat products;
5) choose lean meat from meat products, without layers of fat;
6) consume no more than 2-3 eggs per week (the use of yolks is limited, but not protein, which can not be limited);
7) alcohol (preferably dry red wine) should be consumed with meals.
Also, Academician of the Russian Academy of Medical Sciences Viktor Tutelyan urges to be careful when choosing products in the store: "What should you pay attention to? Not whether there are dietary supplements or not. This is the task of the state, solved at the international level, the control system. What is allowed is safe for us and future generations. You need to look at the shelf life and the content, primarily fat and cholesterol. This is indicated on the label. And, of course, most of us, especially those over the age of 25, need to take low-fat foods. And you can model the taste yourself, there is a choice. There are a number of fortified products, enriched, so-called functional foods, in our opinion, in the old–fashioned way - these are products of therapeutic, dietary nutrition.
The industry should create products that are easily digestible and balanced in the way necessary for a certain pathology. There are such experiments, they are widely used abroad, but we are only in its infancy."
If patients fail to normalize cholesterol levels with the help of dietary measures, then they resort to drug therapy.
There are a number of drugs – statins, fibrates, nicotinic acid, omega-3 polyunsaturated fatty acids, inhibitors of intestinal absorption of cholesterol.
However, hypolipidemic agents, including statins, have quite a large number of side effects and restrictions to use, therefore, in recent years, non-drug approaches to reduce the atherogenic properties of blood plasma have attracted quite a lot of attention. One of these methods is the consumption of foods that reduce cholesterol.
As for the rest of the recommendations, people without clinical manifestations of coronary heart disease can be recommended the types of aerobic exercise available to them: walking, cycling, swimming, skiing, jogging. The frequency of training sessions should be at least 3 times a week, lasting 45-50 minutes, including the warm-up period and "cooling down". The intensity of physical activity should not exceed 60-75% of the maximum heart rate (the maximum heart rate for a given age is calculated by subtracting from 220 the patient's age in years). For patients with coronary heart disease and other cardiovascular diseases, the regime of training loads is selected strictly individually, taking into account the results of the exercise test (treadmill). Meta-analysis of the results of 22 studies showed that under the influence of moderate intensity physical training, there is a decrease in overall mortality by 23% and sudden death by 37% in patients who have had a myocardial infarction in the past.
Quitting smoking is accompanied by a decrease in cholesterol levels after one month. Quitting smoking for two years leads to a 36% reduction in the risk of coronary death and a 32% reduction in non-fatal myocardial infarction.
It is known that the disease is easier to prevent than to cure
"Why do we focus on prevention all the time? Pathologies are usually based on atherosclerosis, which has been going on covertly for many years and, as a rule, is already strongly pronounced when symptoms manifest. Death, myocardial infarction and stroke are often caused suddenly when medical care is not available and therefore many therapeutic interventions are not applicable. Modern methods of treatment – medical, endovascular, surgical do not eliminate the cause of cardiovascular diseases, so the risk of vascular catastrophes remains high," says RAMS Academician Rafael Oganov.
Are there affordable and effective prevention strategies?
Based on the concept of risk factors, there are three strategies for prevention worldwide: population-based, high-risk and secondary prevention.
1. The population-based prevention strategy is to influence lifestyle and environmental factors, as well as their social and economic determinants, which increase the risk of developing diseases caused by atherosclerosis among the entire population. The advantage of this strategy is to reduce the prevalence of risk factors and improve the health of a large part of the population. The disadvantage is low motivation and, often, an inconspicuous benefit for an individual in society.
2. The high-risk strategy is to identify individuals with risk factors and non-drug (lifestyle improvement) and drug correction of risk factors. The effectiveness of the strategy is to achieve and maintain the target levels of risk factors.
3. Secondary prevention consists in identifying persons with early stages of diseases and carrying out therapeutic and preventive measures, including lifestyle improvement, to prevent the progression of cardiovascular diseases caused by atherosclerosis.
These three strategies should not be opposed, they complement each other and the maximum effect is achieved when using all three strategies.
Improvement of the situation regarding the impact of cardiovascular diseases on the health of the Russian population is possible through joint actions of the healthcare system and other governmental, private and public organizations for the prevention and correction of risk factors and early stages of diseases.
"In the end, neither the state by itself, nor an individual by himself, nor any group of people can change the situation until there is clarity in the minds of the entire civil society about how we should live in order to live long and qualitatively," sums up Academician of the Russian Academy of Sciences Leo Bokeria.
On the website of the National Health League, you can read or download the text of the National Scientific Report "All about Cholesterol" (180 pages, pdf, 0.8 M), as well as the texts of speeches (including drawings from presentations) by Rafael Oganov (doc, 3 M) and Viktor Tutelyan (doc, 0.9 M).
Portal "Eternal youth" http://vechnayamolodost.ru08.04.2010