Prof. dr Dragan Dinčić

It is hard to believe that you know someone who, at the same time, is not obese, does not smoke cigarettes, does not have elevated blood pressure, sugar or cholesterol, is not nervous or depressed, does not have a family history of heart or blood vessel disease. Everyone has their own difficult times, and for us, the current one is, realistically, the most difficult, because we live in the time of at least two pandemics: COVID-19 and the pandemic of ischemic heart and brain diseases. Unfortunately, we don't know much about the first one, and we could say we know more about the second one, and yet we can't prevent the fact that in 2030, the largest number of deaths will be due to heart or brain infarction.

Maybe we should go back to the well-known popular fact that "prevention is better than cure". To prevent that means to 'put a stop to something', so the question arises: what is the prevention of cardiovascular disease, who benefits from prevention, when and how to assess the risks and priorities and what should be done in order to preserve, in addition to the external beauty, which is not easy to preserve, the primal, basic , cellular, vascular or internal strength and beauty.

The essence can be seen in two Chinese philosophies: "HOLISM" and "TAOISM". A holistic approach means looking at a person in all its entirety, while Taoism advocates the preservation of every cellular, physical, mental and spiritual balance.

This is the only way we can try to alleviate the already known fact that the "exposure" of the amount of CVD risk and undetected CVD pathology has afflicted the entire world. The fact that nearly 70% of American adults are obese. That at any given time, 55% of the population is on a weight loss diet. That less than 15% of adults or children exercise enough, and over 60% do not engage in intense activity. Among adults, 11%–13% have diabetes, and 36% have prediabetes, 34% have high blood pressure, 12% have both prediabetes and prehypertension, and 15% of the population with diabetes, hypertension, or dyslipidemia is undiagnosed. Approximately one third of the adult population and 80% of obese people have a fatty liver. With 34% of children overweight or obese, the number of children with diabetes, hypertension and dyslipidemia is at an all-time high. Half of adults have at least one cardiovascular risk factor. In large studies, more than 91% of subjects have two or three risk factors. Not even 1% of the population achieves ideal cardiovascular health.

Despite the decline in coronary death rates due to better treatment, the death rate from heart attacks among younger women in the US may increase due to the obesity epidemic. Up to 65% of patients do not have their conventional risk biomarkers under control, and only 30% of patients at high risk for heart disease achieve aggressive lowering of low-density lipoprotein (LDL) concentrations. Even when we do a lot, up to 70% of cardiac events go unaddressed. In 50% of people, high blood pressure is not recognized, if it is recognized, half of them are not treated properly.

About two-thirds of patients do not take the necessary medication for dyslipidemia, and patients adhere to the advice in less than 50%, which adds to the difficulties.

The situation is similar all over the world, and it is especially difficult in countries with a high risk for diseases of blood vessels of the heart and brain, which certainly includes our country.

Pathological and epidemiological data confirm that atherosclerosis begins in early childhood and progresses imperceptibly and inexorably throughout life. Risk factors in childhood are similar to those in adulthood. When indicated, aggressive treatment should begin at the earliest indication and continue for years. For those patients at intermediate risk according to global risk scores, C-reactive protein (CRP), coronary artery calcium (CAC), and carotid intima-media thickness (CIMT) are available for further stratification.

Healthy lifestyle habits, as well as physical activity, significantly improve important risk factors. The consequences of delay and inaction can be catastrophic, and the sense of urgency is constantly increasing. The use of statins for primary prevention is recommended in guidelines, prevalent, but remains underprescribed.

Not only the risk factors are worrying, but also the weak implementation of preventive measures. The effectiveness of prevention is reflected in the elimination of harmful lifestyle habits, which can prevent up to 80% of CVD.

A woman's heart is a "special heart", somewhat at a lower risk, but, unfortunately, more women than men still die from CVD. Assessment of cardiovascular risk over a 10-year period, using scoring systems such as Framingham or SCORE, continues to be widely used and recommended for all adults. So, as always – the more we know, the more we realize how much we don't know. It remains for us to use what we know and thus help ourselves and others as much as we can. We will hope and rejoice and God will determine our paths.

Prof. dr Dragan Dinčić