Despite significant progress in the treatment of patients with cardiovascular and other chronic non-infectious diseases, the risk of mortality from them remains high even with drug therapy and invasive interventions. “So, in people with diabetes when treated with statins* the risk of developing CVD is reduced by only 22%, although this group of patients is more susceptible to the development of such pathologies than others,” said Andrei Obrezan. As the cardiologist explained, existing treatment standards do not sufficiently reduce the likelihood of complications associated with damage to large and small vessels. Such “residual” risks that persist after therapy are also called “residual”.
A similar situation is observed in patients with other diseases. Reducing low-density lipoprotein (LDL, or “bad cholesterol”) concentrations and controlling blood pressure and blood glucose levels do not completely reduce the risk. “A 25% decrease in the concentration of LDL in the blood reduces the likelihood of dangerous cardiovascular diseases by 20%. When “bad cholesterol” decreases by another 25%, the risk drops by only 15%. With a further decrease in LDL, the risk of cardiovascular pathologies decreases by an even smaller amount,” noted Andrei Obrezan.
The strategy for reducing residual risk is based primarily on additional and intensive lifestyle modification measures, the doctor believes. “When making nutritional corrections, it is important to reduce the amount of saturated fat consumed, add vegetables and fruits, fish to the diet, and consume more whole grains,” he said. — Another effective way to reduce residual risk is physical activity. A week of 150-300 minutes of moderate aerobic activity or 75-150 minutes of high-intensity activity is recommended, and ideally a combination of both. It is also necessary to control weight, maintaining a body mass index within 20-25 kg/m2 with a waist circumference of less than 94 cm for men and no more than 80 cm for women.”
In addition, according to the cardiologist, completely stopping tobacco smoking is the optimal way to reduce the risk of developing all CVDs. “In the case of patients who are not motivated to quit a bad habit, as part of the concept of reducing harm from smoking, it is worth considering switching to smokeless tobacco products,” Andrei Obrezan emphasized. “It modifies the risk associated with smoking by significantly reducing the amount of harmful components inhaled compared to the smoke of conventional cigarettes.”
“Despite the fact that today there is a large number of studies confirming the effectiveness of smokeless nicotine-containing products in reducing harm to the health of smokers, the state does not differentiate in any way between electronic tobacco products and conventional cigarettes,” the doctor stated. “This approach makes it difficult to inform smokers with severe tobacco addiction about the existence of less harmful alternatives and indirectly privileges the most harmful product – cigarettes.”
It is not possible to completely get rid of risks even for patients motivated to change their lifestyle, says Andrei Obrezan. To do this, you need to take into account a huge variety of behavioral, social, biological and other factors. “And if it is impossible to completely get rid of risks, then modifying them is quite possible,” the cardiologist sums up. “This is by far the most accessible and effective tactic that modern doctors should adhere to when working with their patients.”