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We die of lung cancer and heart attacks. Smog is killing us. Poland is the leader of the infamous World Health Organization ranking – we have the most polluted cities in Europe. What does this mean for our health? We ask prof. dr. hab. med. Piotr Jankowski from the Jagiellonian University in Krakow.
Cardiovascular diseases remain the leading cause of death in Poland. Let’s talk about the main risk factors – SCORE (Systematic Coronary Risk Evaluation).
Prof. Piotr Jankowski: Unfortunately, cardiovascular disease is a real scourge; because of them every second person dies in Poland. Heart and vascular diseases are also one of the main causes of disability and inability to work. It is estimated that about 10-20 percent. “bad” genes are responsible for the risk of a heart attack, and 80 percent. the so-called risk factors, including inhalation of tobacco smoke, unhealthy diet, lack of regular physical activity and hypertension, hypercholesterolaemia, diabetes and obesity as a consequence of an unhealthy lifestyle. Environmental factors also play a role.
About 10 million Poles have arterial hypertension, about 18 million have high cholesterol, about 3 million have diabetes, and about 9 million smoke cigarettes. The so-called risk factors lead to heart attacks, heart failure, strokes, which are the most important direct causes of death in Poles.
From the individual’s point of view, it is important to assess cardiovascular risk, that is, the risk of dying from cardiovascular disease. The easiest and best way to do this is based on the Pol-SCORE tables, which can be found, for example, on the website of the Polish Society of Cardiology. Anyone can assess their risk of death by using these tables based on their age, gender, systolic blood pressure, and total cholesterol levels, as well as smoking. Although this tool has been created for doctors and nurses (with its use, decisions are made, among others, regarding the pharmacological treatment of hypertension and hypercholesterolaemia), each person can assess their risk and even assess the age of their heart. The age of the heart is the age of a person with the same cardiovascular risk, but with optimal blood pressure, optimal cholesterol, and non-smoking tobacco. For example, a 40-year-old smoker with high blood pressure and high cholesterol has a cardiovascular risk like a 60-year-old nonsmoker with normal blood pressure and cholesterol levels. In other words: the age of the XNUMX-year-old’s heart is XNUMX! I encourage all MedTvoiLokony readers to assess the age of their heart.
For years, Poland has been on the infamous podium of European countries with the most polluted air. To what extent can harmful substances influence the incidence and development of cardiovascular diseases?
The sources of air pollution are: low emissions (heating homes with coal and sometimes even garbage), transport, industry, fires, but also various natural processes. It is indicated that the easiest way to improve air quality is to reduce the so-called low emissions. In general, air pollution is divided into dust and gas. Both dusts (especially those with the smallest particle diameter) as well as ozone, carbon monoxide, nitrogen oxides, sulfur oxides and others are harmful. We know the most about the mechanisms of harmful action of dusts. First of all, dust settling in the lungs causes the production of many substances that have a negative effect on the circulatory system. These substances, among other things, tend to form clots in the blood, damage the so-called The vascular endothelium (the layer that lines the inside of the arteries) accelerates the development of atherosclerosis. They also raise cholesterol levels and contribute to the development of diabetes. Secondly, these dusts stimulate receptors in the lung tissue, which in turn causes the arteries to contract, increasing blood pressure and pulse. It can also contribute to the development of life-threatening arrhythmias. Third and finally, the smallest diameter dust can enter the bloodstream from the lungs and directly damage the walls of the arteries, promoting the development of atherosclerosis. It is estimated that increasing the amount of dust in the air by 10 µ / m3, lasting up to several days, increases the risk of death by 1%. On the other hand, longer breathing in polluted air increases the risk of death by about 10%.
Almost half (exactly 48%) of the inhabitants of the Małopolskie Voivodeship die from cardiovascular diseases. What precautions should be taken by a resident of Krakow and any other city where the air quality is so bad?
Cardiovascular diseases are the most important cause of death not only in Małopolska. Neoplasms are in second place, causing twice as many deaths. It is true that in many large cities air quality is poor and Krakow is one of the cities with the lowest air quality. However, it should be remembered that the inhabitants of Krakow live the longest among the inhabitants of large Polish cities (also the life expectancy in Małopolska is the highest in Poland). Hence, it is easy to draw the conclusion that living in Krakow is associated with many health benefits outweighing the negative effects of air pollution.
Every resident of a large city should pay attention to air quality. In most large Polish cities, as well as in many smaller centers, air quality is regularly tested, and the test results are most often available on the Internet. It is worth adjusting your activity to the measurement results. It is always worth avoiding being near busy streets, expressways and highways. It is believed that high physical activity should be avoided less than 400 meters from busy traffic routes. It is also good not to live next to neighbors who use garbage to heat the house.
Is it worth being active in a situation of poor air quality? Or maybe it is better to go to the swimming pool instead of running and cycling?
In answering this question, it is important to emphasize the great health benefits of regular physical activity. However, in fact, in times of increased pollution, physical activity in the fresh air should be limited. You can go to the swimming pool, gym or fitness club. It is also worth considering outdoor activities during the day when the amount of unhealthy substances in the air is relatively low, e.g. in the morning.
Is there a group of people who should give up physical activity in polluted cities? I mean children, pregnant women, the elderly, people with asthma, allergies, cardiovascular problems or with an increased BMI.
Many studies have shown that air pollution carries a particularly high risk for children, but also for the elderly, pregnant women, and people suffering from cardiovascular and pulmonary diseases and diabetes. Recent studies also show an increased risk in obese people. However, it should be remembered that for most of the groups mentioned, regular physical activity is a condition for maintaining health and maintaining good shape. Therefore, giving up all physical activity, even if it concerns a city dweller, is not beneficial to health.
During days with high concentrations of air pollutants, there is a noticeable increase in hospitalization for respiratory disorders. What about patients with cardiovascular disease?
Increasing the concentration of air pollutants results in an increased number of hospitalizations due to cardiological problems. For example, increasing the content of small diameter dusts (the so-called PM2,5) by 5%. is associated with a 13% increase in the risk of a heart attack. The risk of arrhythmias, such as atrial fibrillation, also increases.
Knowing the scale of the problem and the health risk, the question remains – can we prevent cardiovascular diseases and how?
It is worth comparing the dangers of poor air quality with the dangers of smoking, a sedentary lifestyle, an unhealthy diet, and hypertension, hypercholesterolaemia, diabetes and obesity resulting mostly from unhealthy habits. It is estimated that a person exposed to low-quality air breathing inhales much less than 1 mg of suspended dust per day, a person exposed to passive smoking about 1 mg / d, and a person who smokes cigarettes inhales dusts in the amount of 200 mg / d. Air pollution is not among the top 10 causes of lost years of life (simplified: years of life lost due to diseases or accidents) of Poles. The most important causes are: hypertension, smoking, obesity, alcohol abuse and hypercholesterolaemia. These factors lead to the onset of cardiovascular diseases. Another way of formulating the conclusion: our daily choices are mainly responsible for the occurrence of a heart attack or stroke: what we eat, whether we are physically active, whether we are physically active, whether we “inhale” tobacco smoke, etc. Of course, the quality of the air we breathe is also important.
What diet should we choose?
A healthy diet is primarily a varied diet. It is also a low salt, low-fat diet (low in animal fats). While fats are essential for the body to function properly, excess animal fats increase the risk of developing atherosclerosis, heart attack and stroke. Remember that sweets are another threat to our health. You should also avoid consuming sweetened drinks. Currently, it is recommended to limit the consumption of table salt to less than 5g / day. We consume this amount of salt, avoiding salt-preserved products and not using a salt shaker at home. Daily eat at least 200g of fruit and at least 200g of vegetables, preferably twice as much. Remember that healthy people with a varied diet do not need vitamin or mineral supplementation.
What about sports?
Regular physical activity protects against cardiovascular disease in many ways, including has a positive effect on blood cholesterol levels. Walking, jogging, jogging, cycling, swimming, team games and dancing are all healthy. People without cardiovascular disease are recommended to be physically active most days of the week (almost daily), a total of 2,5-5 hours a week of at least moderate intensity physical activity or 1-1,5 hours a week of high or very high intensity activity. People leading a sedentary lifestyle should remember to gradually increase the intensity and duration of physical exertion. Finally, it is worth emphasizing: it is healthier to breathe clean air.