He is 40 years old, a man with high blood pressure and too high cholesterol, which he may not know, smokes, moves little and is obese. It is a picture of a Pole most exposed to cardiovascular diseases, which are taking the most deadly toll in our country. Why are they the main cause of Poles’ deaths? How to improve the condition of our hearts? In an interview with Medonet, prof. Adam Witkowski, President of the Polish Society of Cardiology.
- Cardiovascular diseases are responsible for almost half of all deaths in Poland. The first two places are occupied by coronary artery disease and heart failure
- Prof. Adam Witkowski: Poles don’t care about their hearts. Patients are not particularly interested in their health, thinking that if they have had the acute phase of a heart attack, then everything should be fine – which is, of course, not true. On the other hand, doctors are too passive
- The Pole most exposed to heart disease is a forty-year-old man who has arterial hypertension, which he may not know, and hypercholesterolemia, which he may not be aware of. This man smokes cigarettes, moves little and is obese
- Heart failure is an epidemic of the XNUMXst century. Prof. Witkowski: Currently, there are about a million people with this disease in Poland and this number will grow. According to forecasts, among the current XNUMX-year-olds, every fourth man and every fifth woman will develop heart failure in her life.
- Prof. Adam Witkowski: if someone has severe chest pains, severe shortness of breath, speech disorders or paresis, he should not delay calling an ambulance
- You can find more up-to-date information on the TvoiLokony home page
is the head of the Institute of Cardiology Primate of the Millennium Stefan Cardinal Wyszyński and the President of the Polish Society of Cardiology.
Monika Mikołajska, Medonet: Cardiovascular diseases are responsible for almost half of all deaths in Poland. Mortality rates from heart disease in general place us among the world’s best, although diagnostics and treatment continue to improve. Why is it so bad? Poles don’t care about their hearts?
Prof. dr hab. n. med. Adam Witkowski: Poles don’t care about their hearts, that’s true. Patients are not particularly interested in their health, thinking that if they have had the acute phase of a heart attack, then everything should be fine – which is, of course, not true. On the other hand, doctors are also too passive, especially those working in outpatient clinics – i.e. both general practitioners and specialists in internal medicine or in the field of cardiology.
Too high mortality in patients who were saved after a heart attack …
We have had very good acute myocardial infarction treatment results for many years, with very low mortality. However, the number of deaths rose sharply in the years following treatment. It was very disturbing. It turned out that these patients did not have adequately controlled risk factors (overweight, hypertension, diabetes, smoking – ed.).
The introduction of Comprehensive Patient Care after Zawała, i.e. the KOS-Zawał program, helped. It was supposed to organize and integrate the care of patients after a heart attack. For at least a year after the treatment of the acute phase of myocardial infarction, KOS-Zawał sets up visits to the outpatient clinic, proposes appropriate rehabilitation, control of the already mentioned risk factors, and provides the possibility of the next stages of coronary revascularization and implantation procedures necessary in electrotherapy of the heart.
- Pain in a heart attack
What are the effects of KOS-Zawał?
KOS-Zawał passes the exam. Patients who entered the program died much less frequently than those who did not. So the program showed that patients after a heart attack do not have to die after leaving the hospitalthat integrated care over a cardiological patient allows to reduce mortality one year after the acute phase of myocardial infarction. It is a prosthesis placed on the system, but as it turns out – effective.
It can therefore be said that the KOS-Zawał Program saves lives. Who can use it?
The program is intended for every patient who has suffered a heart attack. The problem is that there are not so many centers involved in the program yet. There is also a problem with non-public centers, which – at least so far – could not include patients in KOS-Zawał, which is particularly unfair for the patients of these centers.
Among the causes of death of Poles, ischemic heart disease (coronary artery disease) is the dominant one, especially among men.
Women are hormonally protected until the age of menopause. Unfortunately, the decline in mortality due to coronary heart disease has slowed down in the last two years.
Let us remember that in Poland we have a lot of patients with risk factors for ischemic heart disease, but also for other diseases of the cardiovascular system. We have 9,5 million people with hypertension, about 18 million people with hypercholesterolemia (excessive cholesterol in the blood – editorial note), most of which do not know about it, we still have about 8 million smokers, 3 million people with diabetes and about 6 million overweight people.
Treatment of these risk factors in people who have experienced an ischemic episode such as a heart attack or stroke is extremely important. As is primary prevention for people who do not have symptoms yet.
Should we start with the kids?
Of course. It is worth showing children what a healthy lifestyle is, also at school. Additionally, making sure that they are not obese … If we do not correct these risk factors in children, we will have sick adults in the future. This means increasing costs of treatment, but also – and this especially applies to men – more people of working age who, due to their health condition, will be forced to leave the labor market. So there are also economic reasons.
If you were to draw a picture of a Pole most vulnerable to heart disease, what would he look like?
He’s a XNUMX-year-old man who has high blood pressure that he may not know, and hypercholesterolaemia that he may not be aware of. This man smokes cigarettes, moves little and is obese.
If he has already had an acute incident, such as a heart attack or stroke, he already knows that he has a problem and what he should do to prevent it from happening again. On the other hand, he may not have the willpower to deal with these risk factors. Here we come back to the role of health education, the need for constant care and controlling the factors that increase the risk of disease. If this is not the case, such a man will continue to be exposed to cardiovascular events and eventually die prematurely of it.
What is the importance of drinking alcohol? Some even say that it serves the circulatory system in moderate amounts.
Some studies have indeed suggested so, especially in the case of red wine. About a year ago, a large-population study was published that said alcohol consumption is bad for you, and that people who consume it live shorter lives. Not necessarily because there are more heart attacks or strokes among them, because alcohol also damages other organs – the liver, kidneys …
Of course, it is difficult to expect everyone to give up alcohol completely. There is no doubt, however, that if someone drinks too much, sooner or later he will shorten his life. Especially strong drinks – if necessary, use only to a limited extent. Beer is probably healthier, but it promotes overweight; Therefore, diabetes or hypertension may be in the future, conducive to heart attacks or strokes.
You say that many people are unaware that they have a problem with the heart and circulatory system. How to detect a threat in time, and the best way to reduce it to a minimum?
Blood pressure should be measured at least once a year and blood tests should be performed once a year, also for cholesterol. You have to move a lot, avoid obesity, and give up cigarettes. These simple things are really effective.
Does the body send signals that our circulatory system is not working properly?
They may or may not appear. Sometimes a heart attack is the first manifestation of coronary artery disease, and a stroke is the first sign of an atrial fibrillation attack. In general, however, patients have previous symptoms that should be alarming. These include chest pains, shortness of breath, swelling of the lower legs. All this should prompt you to see a doctor.
Coronary heart disease kills the most cardiac patients in Poland. Is heart failure in second place? I even heard the statement that we have an epidemic of heart failure in Poland. What is this disease?
Heart failure is a disorder of the organ’s function as a pump that pumps blood to all other organs and tissues in the body. The heart starts to work worse. Heart failure also happens in people after a heart attack.
Indeed, heart failure is an epidemic of the XNUMXst century. Currently, there are about a million people with heart failure in Poland and this number will grow. According to forecasts, among the current XNUMX-year-olds, every fourth man and every fifth woman will develop heart failure in her life. If we don’t do something about it, if we don’t start treating these sick people, things will get worse.
Heart failure is not an easy disease to treat.
There is an enormous amount of work to be done here. Firstly, it is diagnosed too late, and secondly, patients are not educated on how to maneuver themselves with doses of drugs, mainly dehydrating drugs. There is also no monitoring of therapy in heart failure, there are also no one-day hospitalization wards – where the patient could stay during an exacerbation of the disease and where the therapy could be intensified and, after improving, the patient could be released home. In addition, there is a lack of continuity of care after hospitalization, not all treatments indicated by the European Society of Cardiology are available. These are all just examples.
Hence the next program for cardiac patients – this time KONS …
KONS, i.e. the Program of Comprehensive Care for People with Heart Failure. Logistically, it is more complicated than in the case of KOS-Zawał, because the patients are also more complicated – they have more comorbidities and, as we have already said, heart failure is generally a disease that is difficult to treat.
From 2016, we tried to introduce the KONS. In 2018, the then Minister of Health, Prof. Szumowski inaugurated this program at the Ministry of Health. It already seemed that everything was clear, but still the program has not come into effect. We will try to meet the current Minister of Health to find out when we can count on launching the program.
What is KONS supposed to be about?
It is about cooperation between primary and specialist health care clinics and clinics. Thanks to this, GPs of primary care, doctors of AOS (Outpatient Specialist Care) will cooperate with each other, all this will be coordinated by a hospital center. he would also run a one-day hospitalization unit.
These activities are expected to reduce mortality among patients, improve the quality of life of patients and their families, reduce the number of hospitalizations and make better use of available funds for the treatment of patients. All of this is intended to help stop the epidemic of heart failure.
- Seven symptoms of a silent heart attack
We hear that many cardiac patients stop taking their cardiac medications on their own. According to the National Health Fund, in 2019, even before the outbreak of the pandemic, as much as 24 percent. patients with newly diagnosed arterial hypertension have not purchased a prescription prescribed by doctors or postponed a follow-up visit for fear of COVID-19. Are Poles difficult patients and I do not want to cooperate with a doctor?
This phenomenon is common all over the world – patients who need multi-drug therapy, as it happens with hypertension, do not want to take medications – believe that there is too much of it. Therefore, now there are many drugs for hypertension that are combined preparations. There are several antihypertensives in one lozenge.
Another reason may be that not everyone can afford to meet all prescriptions. Because if someone has a small pension and even if they use reimbursement or free drugs, when they collect all the costs of the drugs, it may turn out that buying them is beyond the possibility.
The third thing, the COVID-19 epidemic saw patients, especially the elderly, visit pharmacies less often – especially at the beginning. Today, this fear has subsided and drug sales are rising again.
We also know from the reports of the patients themselves that, for example, feeling severe chest pain, they delayed calling an ambulance or gave it up at all, fearing infection in the hospital. So they had a heart attack that went untreated. Mortality is then 40 percent, while a heart attack in the case of a hospital treated is 5 percent. In general, we have observed a large decrease in acute myocardial infarctions treated interventional in the hospital. From mid-March to mid-May, these cases were down 35 percent. less. Other European countries, the United States, also recorded a decline.
- SARS-CoV-2 coronavirus infection can damage heart even in people with mild COVID-19 symptoms
So let’s emphasize: patients do not have to be afraid of calling an ambulance and visiting the hospital.
My appeal refers to the campaign that, as the Polish Cardiac Society, we conducted together with the Ministry of Health: do not stay at home with a heart attack.
If someone has severe chest pains, severe shortness of breath, speech disorders or paresis, he should not delay calling an ambulance. Currently, hospitals have separate ‘pathways’ for patients without viral infection and for those who are suspected or known to have COVID-19 infection, there are special isolators for them.
We should remember that patients with acute myocardial infarction, but also, for example, with acute pulmonary embolism, must immediately undergo treatment, otherwise they may face severe complications and even death. And the risk of their occurrence is much greater in the case of sudden cardiovascular events than in the case of coronavirus infections.
Patients with heart disease are at increased risk of contracting SARS-CoV-2 virus and are at greater risk of mortality from COVID-19. Why does coronavirus hit more heart disease patients? How can they best protect themselves?
The coronavirus can attack the heart cells directly (through the same receptors through which it enters the alveolar cells in the lungs). Myocarditis may be the result. In some people, excessive immune response to the presence of SARS-CoV-2, i.e. a cytokine storm can also damage the heart.
Therefore, if there is no such need, you should not go to the clinic or HED. If we can solve the problem through teleportation – let’s use it. We should also remember about masks in public places, about keeping distance.
- How does the coronavirus attack the body and “open the door” to infection?
And now the most important question: how to improve the health of Poles and the condition of our hearts?
This is where primary prevention fails the most, that is, we simply lead an unhealthy lifestyle and do not try to change it. Let us remind you – a healthy heart benefits from a proper body weight, not smoking, and checkups. At least once a year, let’s do blood tests, measure the level of sugar, cholesterol or creatinine in the blood, measure blood pressure.
For people who have already fallen ill, secondary prevention is of great importance, i.e. controlling risk factors, which is necessary to keep them in check.
At the top of this pyramid is treatment – first in clinics and clinics, i.e. outpatient care, and if necessary – treatment in a hospital and unlimited access to procedures such as pacemaker implantation, revascularization or coronary angiography, also now non-invasive – using computed tomography. All this should be coordinated, because patients with coronary artery disease, especially the elderly, also have other health problems. The point is that these patients do not wander around various specialists on their own and do not wait too long for appropriate diagnostics and treatment. This is to be ensured by the National Cardiovascular Disease Program, which we hope will be introduced soon.
A healthy lifestyle and a balanced diet are factors that support the heart. It is worth supporting them with appropriate supplementation. Therefore, on Medonet Market you can now buy a set of natural dietary supplements for the heart with potassium, magnesium, B vitamins and vitamin E – click and check the offer.
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