Chi va piano, va Sano e va lontano
It is better to change slowly but durably
This article is a continuation of the previous one: Check-up : Cardiovascular prevention I.
How can we reduce our risk of suffering a Myocardial infarction (IM) or a Stroke In the future?
- Improving the Lifestyle
- Reduce your cholesterol level LDL If necessary
- Controlling a possible High blood pressure (HTA) (<140/90 mmHg)
- Control of a possible diabetes
First of all, it is necessary to know what is the individual cardiovascular risk in order to define the objectives. The more risk factors are present and important, the more we can lower the risk of IM and stroke.
What are the risk categories?
Very high risk:
- Already existing cardiovascular disease
- Presence of an aortic aneurysm
- Proven atherosclerotic Plates
- Insuffisance rénale importante (GFR <30ml/min)
- 10-year coronary risk calculated by the physician at 30% or more *
- Family hypercholesterolemia (to suspect if LDL > 5mmol/L)
- Severe hypertension
- Insuffisance rénale modérée (GFR <60ml/min)
- 10-year coronary risk calculated by the physician at 20% or more *
- 10-year coronary risk calculated by the physician at 10% or more *
- 10-year coronary risk calculated by the physician less than 10% *
* The Doctor can calculate the coronary risk using formulas
Improving the Lifestyle
We will try to change some of the habits as much as possible. It will vary from one person to another. The objectives will be adapted according to the current lifestyle and its own ability to change over the long term. What is important is to make changes that are sufficiently bearable to be able to hold them in the long term.
Thus, the intensive regimes are discouraged because if the short-term effect may seem significant, in the long term they are not sustainable and are likely to be rather deleterious. An example, a 10 kg loss in three months will be followed by an increase of 15 kg over the year.
As a general rule, it is a question of avoiding excesses, in terms of alcohol consumption, for example, reducing or quitting smoking, eating healthier than before and moving more.
- Varied food
- Promote fruits and vegetables
- Consuming complete cereals and legumes
- Promoting fatty fish for the benefit of red meat
- Consume olive oil and rapeseed as well as nuts and almonds
Objectives in terms of physical activity:
- Integrating physical activity in the daily life (for example: Take the stairs to the place of the elevator, get off the bus a stop in advance, go up to the subway a stop after, move on foot, bike (even electric))
- Manage to add about 2 hours per week of moderate physical activity (walking) or 1 hour per week of intense physical activity (jogging)
Reaching its LDL cholesterol target
As a general rule, the lower the LDL cholesterol, the lower the risk of IM and stroke.
Improved lifestyle and diet will have a beneficial impact on LDL blood levels, but to a lesser extent. To achieve a significant reduction, which is often necessary, and in familial hypercholesterolaemia, drugs such as Statins for example.
How much do we have to shoot the LDL?
Target values based on cardiovascular risk (see above):
Très haut risque : <1.8 mmol/l
Haut risque : <2.6 mmol/l
Risque modéré : <3 mmol/l
Les statines sont une classe de médicament qui permet de réduire le mauvais cholestérol et ainsi diminuer le risque de faire un infarctus ou un AVC. Elles empêchent le cholestérol de se reposer dans les artères et les boucher. Seul des taux de LDL bas (<1.8 mmol/l) enlèvent le cholestérol des plaques déjà constituées.
For those with high cholesterol, often the only way to get to the target values is with the statins. This is a drug rather on in terms of risk/benefit and very well known. Well used in well-selected patients, statins save lives and decrease hospitalizations and complications. To have an important impact you have to take the parking lot for several years.
Who should take a statin?
We cannot generalize everyone and the decision has to be personalized.
Secondary prevention : Anyone who has ever suffered from an IM or stroke will have a significant benefit.
Primary prevention : Those who have not had neither myocardial infarction nor stroke, must discuss with their doctor to decide according to the risk.
- Everyone can benefit from an improvement in the lifestyle.
- Those with higher cardiovascular risk will benefit the most.
- The lower the LDL cholesterol, the more important the benefit.
- As a complex subject, the decision to use pharmacological intervention Must be discussed with a doctor.
Piepoli MF et al, 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of The European Society of Cardiology and Other Societies on cardiovascular disease prevention in Clinical practice (prostituted by Representatives of 10 societies and by invited experts: developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol. 2016 Jul; 23 (11)
Nagi D, cardiovascular prevention at the firm. Medical Gazette. Vol .6 _ N ° 1_janvier/February 2017. 15-17.
Collins R, interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016 Nov 19; 388 (10059): 2532-2561
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