* President of the Italian Cardiology Society
Exercise
Reduces mortality from cardiovascular disease by at least 20%. It helps to control blood pressure, “bad” cholesterol (LDL), weight and to fight diabetes. At least 150 minutes per week of moderate aerobic physical activity (30 minutes for 5 days / week) or 75 minutes of vigorous aerobic physical activity (15 minutes for 5 days / week) or a combination is recommended.
Not smoking
Smoking favors the development of atherosclerosis, thrombosis and superimposed thrombotic phenomena. In addition, it negatively affects the function of the endothelium (inner membrane of the vessel), coagulation, the elasticity of the muscles of the artery. Quitting means seeing these effects subside, but obviously better not to start.
Eat healthy
Eating habits influence cardiovascular risk by acting on factors such as cholesterol, physical activity, weight and diabetes. It is better to limit calories, pay attention to fats (preferably polyunsaturated), consume less than 5 grams of salt a day, at least two or three portions of fruit, including nuts, and as many vegetables. Fish, once or twice a week.
Check the pressure
The risk of death from cardiovascular disease increases progressively and linearly with the increase in pressure values. The doctor’s decision to initiate treatment depends on the level of blood pressure and the total cardiovascular risk. The optimal values for the maximum are 130 millimeters of mercury, for the minimum 80.
Beware of alcohol
It helps to raise blood pressure, promotes weight gain, modifies insulin response, damages liver function and interferes with the metabolism of many drugs. Abuse, in addition to causing alcoholic myocardiopathy, increases the risk of atrial fibrillation, myocardial infarction and heart failure. For men: maximum two glasses of wine; for women: one.
Lower bad cholesterol
The key trigger in arterial plaque formation is the retention of cholesterol-rich lipoproteins within the arterial wall. For this reason the LDL in low-risk people should be less than 115 mg / dL, in those at high risk less than 70 mg / dL and in those at very high risk less than 55 mg / dL. Until further down in specific populations.
Check the weight
Prolonged weight gain increases the risk of cardiovascular disease also because it is often associated with hypercholesterolemia, hypertriglyceridemia and hyperglycemia. The cardiovascular risk therefore increases as the body mass index and abdominal circumference increase. This value should be less than 94 centimeters for men and 80 for women.
Beware of diabetes
Type 2 diabetes is characterized by insulin resistance and consequent hyperglycemia. It is directly linked to diet, physical activity and body weight. Therefore, weight loss is an essential treatment component for type 2 diabetes, also in terms of food choice and in particular carbohydrates. Additionally, an exercise program improves glycemic control and reduces cardiovascular risk.
Respect the care
In heart patients, survival is reduced in patients who stop therapy, but also in those who do not constantly take the drug. Therapeutic adherence is fundamental for the control of risk factors and starts from knowledge of the situation: many patients do not have clear blood pressure and LDL cholesterol values to be achieved.
Fighting Stress
As well as anxiety and depression, it increases the risk of heart disease and stroke. Chronic stress tends to increase pressure and consequently the risk of heart attack and stroke. In addition, those who are stressed are more likely to have bad behaviors, such as smoking, overeating, not exercising, being overweight. These elements also affect adherence to care.
Stroke unit: where they save our lives
They did not win the Nobel Prize, John W. Norris and Vladimir Hachinski. But these two Canadian neurologists have marked a real change of pace in the urgent care of stroke, regardless of its ischemic or hemorrhagic origin, and in patients’ ability to heal and return to a normal life. Thanks to them, in fact, the so-called “Stroke Units” were born. As happens for the heart when, after a heart attack, the patient is taken to the coronary unit to check the vital functions (constantly monitoring the heart activity), in the same way after a stroke the control of the vital and cerebral functions of the affected person, and the possibility of taking the necessary measures in urgency is fundamental.
In particular, it is extremely important that the patient’s blood pressure, heart rate, respiration and neurological functions related to the brain area affected by the event are constantly monitored.
Thanks to hospitalization in a facility of this type (in Italy they are called “Stroke Centers or Neurovascular Units”), mortality can be reduced, as well as long-term disabling consequences, with obvious repercussions on people’s health, but also have important economic savings for the National Health Service.
In any case, the time variable remains fundamental (experts define stroke as a “time-dependent pathology”). The sooner you intervene, the more effective the treatments can be and therefore the chances of recovery of the affected brain area. As soon as he arrives at the hospital, the patient undergoes a brain CT scan (or, only in special cases, magnetic resonance imaging) to first assess whether the event is due to ischemia or cerebral hemorrhage.
In case of ischemia, the treatment consists in removing the occlusion of the obstructed vessel: the therapies of the ischemic stroke are aimed at pharmacologically “dissolving” the thrombus occluding the vessel, or to remove it mechanically; which occurs both with the use of specific drugs (thrombolytics) capable of dissolving the blood clot and, in selected cases, also with a “mechanical” treatment, mostly associated with the same drug therapy, in temporal succession. The technique that allows to dissolve the thrombi is called thrombectomy and involves the removal of the thrombus from inside the vessel, with the use of probes introduced directly into the arterial tree, in the absence of surgery.
Both treatments are effective but must be practiced in the first hours after the onset of symptoms. Thrombolysis and thrombectomy are then followed by therapies aimed at increasing blood fluidity and other therapies, evaluated case by case by the neurologist specialist.
In the case of hemorrhagic stroke, however, it is essential to understand, with an accurate diagnosis, the site and extent of the injury. Specialists are increasingly trying to avoid neurosurgical interventions to evacuate the haemorrhage, which are now limited to superficial haemorrhages or those affecting specific areas of the central nervous system. Therefore the initial goal is to understand the cause of the bleeding, which at times can be spontaneous, at other times due to the anticoagulant drugs administered to the patient, for example for the prophylaxis of those suffering from atrial fibrillation. For some of these drugs (direct anticoagulants) specific “antidotes” are already available, while for other drugs these pharmacological countermeasures are in the pipeline.
As with ischemic stroke, people with cerebral haemorrhage also benefit from hospitalization in the “Neurovascular Units”, where the goals of therapy are the reduction of cerebral edema (mostly with the use of diuretic drugs) and control blood pressure monitored. Furthermore, thanks to specific tests such as cerebral angio-Tac (which allows to visualize the vessels through a contrast medium) it is possible to detect early signs of the enlargement of the haemorrhage itself, such as to require particularly aggressive therapies. In general terms, although mortality from cerebral haemorrhage is higher than that from ischemic stroke, it too is greatly reduced thanks to hospitalization and early intervention in the “Stroke Centers”.
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