Prevention of cardiovascular diseases
One of the most important features of the ASTF checkup relates to the prevention of cardiovascular diseases. The risk factors for a cardiovascular disease are determined and discussed during the consultation.
Since 1948, the National Heart Institute has been following a population of some 5,000 persons in the town of Framingham to determine the causal factors of cardiovascular illnesses which have been largely unknown up to now. The study is now in its 3rd generation and has enabled the following risk factors to be defined:
Two groups of risk factor can be identified. The classical cardiovascular risk factors are those whose predictive value has been largely proven:
- Age and gender
- Family history
- Tobacco use
- High blood pressure
- Sedentary lifestyle
- Nutritional factors
There are other risk factors which are currently being validated and are not yet being used on a large scale such as homocystein and CRP. That list is by no means exhaustive … but we cannot discuss all these factors here.
Age and gender
Obviously the cardiovascular risk increases with age. Before the age of 50 men are distinctly more exposed than women. The risk level in women gradually rises until it becomes the same as that for men a few years after the menopause.
Only cardiovascular accidents which occurred in parents of the first degree, i.e. the father before the age of 55 and the mother before 65 are taken into consideration.
The risk of coronary disease in smokers is three times greater than in the case of non-smokers. They are particularly exposed to the risk of heart attacks and sudden death.
High blood pressure
The risk is regarded as negligible when the blood pressure is below 130/85 mm Hg.
This is the main form by which cholesterol is conveyed in the organism. It must be kept as low as possible. The target value to be reached varies, however, depending on the number of other risk factors which are present.
This is involved in the “reverse” transport of cholesterol enabling it to be recaptured and conveyed towards the paths of elimination. Its increase is protective and its threshold level must be at least 40 mg/100 ml.
The presence of diabetes multiplies the risk of cardiovascular disease by three in women and by two in men. It is vital in this case to check blood pressure, blood lipids and weight and to take regular physical activity.
The degree by which the person is overweight is assessed overall by the body mass index:
- BMI 20-25 = > normal weight
- BMI 25 – 30 = > overweight
- BMI 30 – 40 = > obesity
- BMI > 40 = > morbid obesity
Above a BMI of 25, the risk of coronary heart disease increases, partly, however, because of the impact of the weight burden on the other risk factors such as hypertension, diabetes and dyslipaemia.
The distribution of body fat also has a significant impact on the cardiovascular risk. It is increased above all by abdominal adiposity. An abdominal girth of > 102 cm in men and > 88 cm in women must therefore be regarded as significant.
In the “Interheart” study a relationship between professional, family and financial stress and infarct has been clearly shown. The percentage of cases of infarct for which stress is responsible seems to be in the order of 37%. This places it in the same ranking as tobacco use, diabetes, obesity or hypertension in the prevention of cardiovascular diseases.
The general nutritional recommendations for the prevention of cardiovascular illnesses are set out below:
- Greatly reduced consumption of saturated fats of dairy origin (butter, cream, cheese) or of meat and charcuterie products.
- Regular consumption of fish and poultry.
- Daily consumption of cereals, fruit and vegetables.
- Regular use of polyunsaturated fats, such as olive oil or walnut oil.
- In the event of hypertension, reduce your weight, limit alcohol consumption and salt use, increase the input of calcium and potassium.
Physical exercise plays an important role in the prevention of cardiovascular disorders. The more intensive the training, the more effective it will be in terms of prevention of mortality and morbidity. However, walking at a sustained pace for half an hour a day is
already sufficient to have a positive influence on the cardiovascular risk. What is important is that it must be endurance training, i.e. with an aerobic character.
An active daily life must be added to these recommendations: walk, use the stairs, work in the garden, perform do-it-yourself activities etc.
Persons above the age of forty who begin systematic training must first undergo an effort test with a cardiologist.