Preventing cardiovascular diseases

World Heart day is witnessed every year on 29th September with the aim of informing and raising awareness of the importance of cardiovascular diseases prevention.
Cardiovascular diseases are characterized by a multifactorial etiology: that is, they are determined by multiple risk factors that contribute to their development.

Nonmodifiable risk factors

Some risk factors, i.e. characteristics that increase the probability of the onset of the disease, are nonmodifiable:

• age: the risk of developing cardiovascular disease increases progressively with advancing age;
• male sex: men generally have a higher risk than women of developing cardiovascular disease. In women the risk increases after menopause;
• family history: the risk of cardiovascular events increases if there is a certain family history (i.e., when you have one or both parents, or brothers/sisters with such diseases).

Modifiable risk factors

Other risk factors, however, are modifiable: this means that by changing your lifestyle, it is possible to reduce or prevent the risk of cardiovascular diseases. Some modifiable risk factors are:

Smoking

If you are a smoker, quitting is the greatest gift you can give to your heart, for yourself and for those around you. The carcinogenic and inflammatory substances contained in cigarette smoke are the main cause or contributory cause of lung tumors, obstructive bronchitis, emphysema, heart attack and stroke: for example, nicotine accelerates the heartbeat, while carbon monoxide decreases the amount of oxygen present in the blood favoring the development of atherosclerosis.

Furthermore, smoking interferes with the function of platelets, the blood cells that activate coagulation: this facilitates the formation of a thrombus inside the coronary artery, with consequent blockage of flow to the muscle "nourished" by the coronary artery and the development of a damage: myocardial infarction. In a patient who smokes, the probability of having a heart attack is 10 years earlier than in a non-smoker, all other risk factors being equal.

If you decide to quit smoking, you will see benefits right away: already within a few days or weeks your senses of taste and smell will improve, you will breathe more easily, and you will have more energy. Other benefits will follow, including: improved blood circulation and better lung function, resulting in less coughing, wheezing or other breathing problems. After one year, your risk of heart attack is halved compared to that of a smoker; after 15 years, your risk of heart attack drops to the same level as someone who has never smoked.

Se decidi di smettere di fumare, vedrai benefici fin da subito: già entro pochi giorni o settimane miglioreranno i sensi di gusto e olfatto, respirerai più facilmente e avrai più energia. Seguiranno altri vantaggi, tra cui: migliore circolazione del sangue e migliore funzionalità polmonare, con conseguente riduzione di tosse, respiro sibilante o altri problemi respiratori. Dopo un anno il rischio di infarto si dimezza rispetto a quello di un fumatore; dopo 15 anni il rischio di infarto scende allo stesso livello di chi non ha mai fumato.

Physical activity

Regular exercise has multiple beneficial effects on metabolism (blood sugar and lipids), blood pressure, strengthens the heart through training, and improves blood circulation by acting directly on small arteries. According to the World Health Organization, physical activity is defined as "any bodily movement produced by skeletal muscles that requires energy expenditure".

The simplest rule for effective physical activity is to do it for 30' at least 5 times a week. "Intense" activity is not necessary, but aerobic activity is needed, which increases the body's demand for oxygen, making circulation more efficient.

Balanced diet

What we eat plays a crucial role in our heart health. Try to eat a varied diet, which includes regular consumption of legumes, fish, fresh fruit, vegetables, favor vegetable oils (not processed into saturated fats like margarine), foods rich in starch and lean meats.

On the contrary, limit the consumption of sausages and cheeses, sweets and foods with high cholesterol content. Also reduce the consumption of sugary drinks and alcoholic beverages, and limit the consumption of salt in foods (studies such as Intersalt have shown that in some populations the increase in blood pressure largely depends on the consumption of salt in the diet).

Reducing salt intake, regular physical activity and a balanced diet can overall significantly reduce cardiovascular risk.

Regular heart health checks

It's important to monitor your blood pressure and cholesterol levels, both significant risk factors for heart disease. High blood pressure contributes to up to 40% of all major cardiovascular events: heart attack, stroke and their even fatal consequences. For this reason, hypertension is called the "silent killer". In Italy alone there are over 15 million hypertensive people and only one third of them have blood pressure normalized by therapeutic strategies (lifestyles and adequate medications); instead, decreasing blood pressure by even just 5-10 mmHg can reduce the risk of heart attack and stroke by 20-25%.

Great attention must also be paid to cholesterol levels (a substance naturally present in the body): the greater its quantity in the blood, the higher the risk that it will be deposited in the walls of blood vessels, clogging them. HDL cholesterolemia is also relevant. HDL (high density lipoproteins) are defined as "good cholesterol": they are in fact lipoproteins (i.e. "aggregates" of proteins and cholesterol) that transport excess cholesterol from the tissues to the liver for elimination. The lower the amount of HDL, the greater the cardiovascular risk. Cardiovascular prevention must maintain levels of non-HDL cholesterol (or LDL, low density lipoprotein, the harmful component of cholesterol) and triglycerides within optimal levels for the person's individual risk profile. 

1. Tireless pump: The human heart is an incredibly efficient pump: in a single day it beats about 100,000 times, pushing blood through thousands of miles of blood vessels.
2. Natural electricity: The heart has an internal electrical production and conduction system: this system generates electrical impulses that, as they spread out, cause the heart's chambers to contract in a harmonious and coordinated manner, allowing blood to be pumped efficiently.
3. Amazing power: Relative to its size, the heart is an incredibly powerful organ: it is approximately the size of a closed fist and weighs about 250-350 grams.
4. Sensitive and emotional: Associating the heart with emotions is not just a metaphor. Emotions such as stress and excitement can affect heart rhythm-that's why we tend to feel them "in the heart."
5. Self-regulation: The heart is able to regulate its own rhythm in response to the body's needs. For example, during exercise, the heart increases the number of beats per minute to deliver more blood and oxygen to working muscles.

Article written in collaboration with Prof. Domenico Cianflone, Associate of Cardiovascular diseases at UniSR.

For further information:

• https://www.heartfoundation.org.au/bundles/healthy-living-and-eating/healthy-eating
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399440/
• https://www.who.int/news-room/fact-sheets/detail/physical-activity
• https://www.cdc.gov/cholesterol/ldl_hdl.htm
• https://www.nhs.uk/better-health/quit-smoking/benefits-of-quitting-smoking/