Russia (bbabo.net) - Cardiovascular diseases (CVD) remain the leading cause of death in the population. There is a negative trend in the world in terms of mortality from diseases of the circulatory system, which from 2000 to 2019 increased by almost 7 million. In 2020, according to the WHO, the main "killer" was coronary heart disease, which accounted for 16% in terms of all-cause mortality. In 2030, according to the WHO forecast, about 23.6 million people will die from CVD.

Such disappointing figures suggest that the fight against CVD is a fight for the population health of the population around the world. For many countries, including Russia, improving health indicators for these diseases is among the first priorities of the health care system. For this, national programs are being implemented to improve the primary and secondary prevention of CVD, their detection, continuity of treatment and rehabilitation.

Sufficient number of cardiologists and specialist centers

"When we talk about cardiovascular events (CVD), there are several things to keep in mind: how to prevent them, what is necessary to survive the first event, and what is required to avoid allow subsequent ones, which are often fatal to the patient, "draws the attention of Kosick Ray, professor of public health and adviser in cardiology at Imperial College London, President of the European Atherosclerosis Society

According to the expert, 20 years ago, there were not enough cardiology specialists in the UK to provide emergency care for a patient who developed a serious cardiovascular event. “We have increased the number of cardiologists, opened specialized centers throughout the UK, and today, if a patient, for example, has a coronary artery thrombosis, medical care will be provided urgently, no matter where he is in the country. Assistance will be provided to the patient within 10 minutes after the call, "- said Kosik Ray.

In the prevention of cardiovascular events, in the UK, a large role is played by general practitioners who are admitted to the community. They are encouraged to educate patients about the need for healthy lifestyles and regular screening, which includes determining the level of total cholesterol. Recently, information materials have been developed and a special motivational system has been introduced, which encourages doctors to pay great attention to monitoring the condition and therapy of patients with high risk of CVD: annual check of cholesterol and blood pressure levels, as well as the appointment of specific therapy and control of risk factors. “Basically, if a doctor looks after 10,000 patients, such as those with diabetes, and regularly checks their total cholesterol and blood pressure levels, then each year, one patient can be paid a few pounds. : both patients and doctors ", - gave the example of Kosik Ray.

Cholesterol Control

Measuring and controlling total cholesterol levels is essential to reduce the risk of a cardiovascular event. Low density lipoprotein cholesterol (LDL cholesterol), or "bad" cholesterol, directly affects the development of atherosclerosis, which is the leading cause of death among all CVDs. Atherosclerosis is called the "silent killer" because of its ability to develop asymptomatically for many years while an atherosclerotic plaque forms.

There are several groups of patients who need constant monitoring of their "bad" cholesterol levels, Dr. Ray points out.

The first group includes patients from the secondary prevention group who have their LDL cholesterol reduced with drug therapy. For this, one, two, or even three drugs can be prescribed, so the main issue here is the availability of drug therapy.

The second group includes patients with high LDL cholesterol levels due to hereditary hypercholesteremia, which occurs in 1 in 311 people.

The third group consists of people with concomitant diseases, for example, diabetes mellitus, arterial hypertension, kidney disease, etc.

And finally, the last group is the largest of all, it includes patients from the primary prevention group who do not have a predisposition, but there is a combination of many other factors that, together, threaten the development of atherosclerosis in the future. These are, for example, smokers, people who are overweight or who do not lead the healthiest lifestyle.

Cholesterol Vaccine

NHS, as part of the National Long-Term Plan, has entered into an innovative collaboration on population health outcomes management. Within the framework of this agreement, it is expected to achieve target for the health care system indicators of reducing the risk of CVD in a population of patients with high levels of low-density lipoprotein cholesterol.

The partnership between NHS England and Novartis will provide access to the company's innovative molecule to 300,000 cardiovascular patients over the next three years. “The reason the government is going to make it available is because two injections of the drug a year will lower LDL cholesterol by 50%, in addition to statin therapy,” said Professor Ray.

“Let's imagine that we have a quarter of a million patients who have had a cardiovascular event. Even if they take statins and regularly control their cholesterol levels, within 10 years, 30% of them will have a second cardiovascular event, which is about 80 The average LDL cholesterol level in these patients is 100-110 mg / dL, despite first-line statin therapy.But if this drug is added to the first line of therapy, then the LDL-C level can drop to 50-60 mg / dL, and instead of 80 thousand potential cardiovascular events, only 50-60 thousand will occur, "the President of the European Atherosclerosis Society quoted the figures. ..

In Russia, according to official statistics for 2020, CVD accounted for 47% of deaths and 30% of newly diagnosed disabilities. Moreover, mortality from CVD in Russia is 3 times higher than in other European countries: 640 deaths per 100 thousand of the population, while in Western Europe - less than 200. Moreover, the working-age population in the 25-59 age group suffers more than others. : among them, mortality from CVD is 4.5 times higher than in Western Europe. In terms of disability, CVD is second only to oncological diseases - they lead to disability up to 170 thousand people a year.

However, experts say that two out of three premature deaths caused by CVD could have been prevented if the population had sought medical attention in advance. In Russia, great attention is paid to the development of services of lipid centers and offices, which are responsible for identifying patients with lipid metabolism disorders. In this matter, it is extremely important to ensure effective interaction between outpatient and inpatient health care. The patient must undergo an outpatient examination before hospitalization, and after it go under dispensary observation. To achieve control over dyslipidemia, it is important at the earliest stage to slow down the rate of progression of the atherosclerotic process, including through the timely achievement of the target level of "bad" cholesterol and maintenance of this level throughout life. This is possible due to the intensification of lipid-lowering therapy and the appointment of early combination targeted therapy.

This raises the question of the availability of the necessary therapy for the entire group of patients who need it. Perhaps the example of a British cooperation agreement will be indicative for other countries, including Russia, in terms of developing comprehensive scientific, industrial and commercial cooperation to improve national health indicators.

“I think that if most of the countries in the world followed the UK's experience in this matter, we could radically change the existing reality. Imagine a 60-year-old patient with coronary heart disease who underwent myocardial infarction and coronary artery bypass surgery. Subcutaneous injection two once a year will not only lower his LDL-C level, but will also significantly reduce cardiovascular risk, hospitalization costs, and the number of surgeries over the next 20 years with easy-to-follow treatment. "

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