Cardiovascular disease is the leading cause of mortality among middle-aged adults and elderly in most European countries. In the cardiovascular pathology atherosclerosis is involved, a systemic disease with onset during childhood (so-called fatty streaks) but which becomes symptomatic during adulthood, when the stage of development is already advanced.
The current goal in modern cardiology, taking into account the SCORE study (Systemic Coronary Risk Evaluation), is to devise criteria for cardiovascular disease prevention in clinical practice by including both symptomatic patients (patients with proven coronary artery disease, peripheral vascular disease, cerebrovascular illness) and asymptomatic patients with increased risk of developing cardiovascular disease.
Uncorrected risk factors may act as a barrier to any effort to improve the quality of life of patients and stop the progression of the disease.
Cardiovascular inpatient rehabilitation programs aim to identify early the apparently healthy patients who have asymptomatic arterial disease along with the desire to induce regression and to reduce the risk of clinical manifestations.
The objectives of cardiovascular rehabilitation
– Changing the lifestyle (quitting smoking, regular physical activity, orientation towards a Mediterranean type of diet).
– Correcting dyslipidemia: total cholesterol <190 mg / dL, HDL cholesterol> 40 mg / dl, LDL cholesterol <115mg / dl.
• The treatment of hypertension with a low-salt diet and medication.
Blood pressure is considered normal around 130 / 85 mmHg, and in patients with type II diabetes and renal impairment, 125 / 75mmHg, values difficult to obtain in clinical practice in patients with hypertension. PROGRESS study showed that maintaining the value of 125 mmHg systolic blood pressure significantly decreased the incidence of stroke.
• The treatment of diabetes and achieving a metabolic balance expressed by having Hb A1c <6,5mg / dl, in order to avoid the installation of micro and macro angiopathic complications.
– preventing obesity through weight reduction, reducing the mass index to 30 kg / m2, waist circumference reduction (in women <88 cm, in men <102cm)
• The treatment of each specific early clinically manifested cardiovascular disease.
Based on these considerations, the doctor-patient relationship becomes very important, making the answers to these questions available:
1.The evidence whereby a risk factor can lead to cardiovascular disease
2.The evidence that specific risk factors have different importance among those who develop cardiovascular disease than in those who do not develop cardiovascular disease
3.The evidence that reducing the risk factors can stop the development of cardiovascular disease.
The availability of an increasing number of diagnostic and treatment technologies coupled with consideration of the rising of health costs generated particular interest in terms of efficiency within cardiology care. The most commonly used diagnostic method is noninvasive: EKG, Holter ECG, Holter BP, echocardiogram, myocardial scintigraphy. Recently, new techniques have become available for detecting coronary lesions. Tissue Doppler method is increasingly used in medical practice, and recent studies have shown that it can be located on the same plane with nuclear magnetic resonance in terms of viability, ischemia and myocardial necrosis.