There exist factors of external environment and that of internal, aiding the development of ischemic heart disease (IHD).
For successful IHD control one should understand the causes of its development. But in the basis of IHD lies not one cause, but a whole complex of various factors. Thus, in many infectious diseases with the certain causative agent, its presence not necessarily predetermines the start of the disease. The disease develops only in the case when together with a microbe there will be overcooling, tiredness, vitamin deficiency, weakening of immune barriers and other step-down factors of body resistance.
A history of tuberculosis is a good illustration to this. Did tuberculosis exist in Middle Ages? Certainly, it did. But only in the XIX-th century tuberculosis arrived at huge expansion, when it took hold of a sad fame of the curse of mankind, especially cruelly mowing off urban population. Where is the origin of that problem? Rapid growth of industry, urban population concentration, horrible living conditions, monotonous and low diet, employment of young children, deficiency of hygiene, dustiness, lack of medical aid – all that created conditions for unprecedented propagation of tuberculosis.
Thus, the point is not only in a mycobacterium of tuberculosis, which still infects most people.
As for non-infection diseases, in particular, IHD, at this point the situation is more complicated. Nowadays scientists can not specify the main cause with which one can connect the development of IHD, because such causes are plenty. Apparently there exist a long chain of the factors, which acting individually and all together, results in disease. Moreover, for different persons different combinations of factors are of primary importance. As a result of long-term influence of such factors, called in medicinal literature “risk factors”, concentration of cholesterino-bringing lipoprotein particles in blood plasma gradually increases, or the condition of the arterial wall changes in such a manner that these lipoprotein particles will penetrate into it more easily and stay in it longer, even if their concentration is not high. In this case this factors somewhat promote the opening of a “go-out” and transition of a part of lipoproteins from blood plasma to the arterial wall.
It is ought to point up, that lipoproteins, especially the ones rich of cholesterin are the primary material substratum, which, having entered the arterial wall in big quantities and accumulated in it, give rise to atherosclerotic disorders. In this, as is common to speak in medical science, there lies a basis of atherosclerosis followed by IHD. However, there exists a big number of the risk factors – penetration and accumulation enhancers of lipoproteins in the vessel wall, and, therefore, accelerating the development of atherosclerotic process.
The first factor.
Now hypercholestemia, or elevated content of cholesterin in blood, is considered as one of the key factors in the development of atherosclerotic processes. With cholesterin rich diet its content in blood may increase. If intake of big quantities of food with cholesterin continues for a long time, the so called, food hypocholestemia may develop. Hypocholestemia may develop as a result of some diseases (for example, in case of hypothyroid). It may be inborn. In such cases the body synthesizes superfluous quantities of cholesterin or metabolizes (processes) it slowly.
Whatever is the nature of hypercholestemia it is dangerous for health. Statistics shows that there is a direct relation between the level of cholesterin and frequency of IHD in various groups of population. Low cholesterin level in blood (less than 200 mg% ) is found among the population of the countries where ischemic disease is uncommon, high cholesterin level (more than 250 mg%) is in the population of the regions where the disease is common. That is why high cholesterin content is considered as one of the main factors of IHD. In these conditions cholesterin as a part of lipoproteins penetrates to a wall of arteries, accumulates in it and induces the growth of connective tissue, favoring the forming of plagues. It results in luminal occlusion of the vessel, circulation loss of blood and cardiac muscle feed difficulty.
Hypertriglyceridemia. This term is used in a special medicine literature to denote high level of triglycerides (neutral fats) in blood. In many cases the rise of triglycerides concentration at the same time goes together with the rise of cholesterin, but the cases of “pure” hypertriglyceridemia are more often. The blood of such people has the main carriers of triglycerides (prebeta-lipoproteins) which have the same athrogenic properties, as cholesterin-rich lipoproteins. Clinical impressions confirm that high level of triglycerides in blood is often accompanied with IHD development, predominantly in people upwards 45 years of age.
Triglycerides level in blood is subject to significant individual fluctuations. That is why it is difficult to specify the lines of demarcation beyond which the values characterized as “high level” follow. Nevertheless, on the ground of clinical impressions and population-based studies one may conclude that triglycerides content in blood more than 140 mg% is undesirable, and more than 190 mg% is dangerous from the point of view of atherosclerosis development. The cause of hypertriglyceridemia is the metabolic imbalance of triglycerides, which may be provoked or escalated by improper feeding, alcohol consumption – and in women – the use of contraceptive hormonal medications and other causes.
High level of triglycerides in blood is registered in cases of some diseases: diabetes, nephritic syndrome, hypothyreoidism, gout, etc.
Hypoalphalipoproteidemia (low content of alpha-lipoproteins in blood). It is noticed that some IHD patients have low content of alpha-lipoproteins rather than high content of cholesterin or triglycerides, or, to be more precise, beta- and prebeta-lipoproteins, in blood plasma. Alpha-lipoproteins unlike beta- and prebeta-lipoproteins protect a vessel wall from the development of atherosclerosis, and now decrease of level of alpha-lipoproteins in blood (hypoalphalipoproteidemia) may be considered as atherosclerosis risk factor. How works antiatherogenic effect of alpha-lipoproteins still is not known with certainty. It is assumed that alpha-proteins containing much proteins and phospholipids, having penetrated into arterial wall, “take away” overstock of cholesterin and carry it through circulatory and lymphatic system of outer coat of vessel, preventing in such a manner the development of atherosclerotic process. There is a strong possibility that rare IHD sickness rate in pre-menopause women in comparison with men is due to the fact that just in this period women have the level of alpha-lipoproteins in blood higher that that of in men.
Thus, the threat of atherosclerosis development increases with low content of alpha-lipoproteins in blood and imbalance between the level of beta- and prebeta-lipoproteins from one hand and the level of alpha-lipoproteins from the other hand.
The second factor.
Family background. It was noticed long ago that IHD is common in close family members. Familiar instances when myocardial infarction was the cause of death of three generations of relatives: from grandfather to grandsons. In hereditary line, principally, any model of lipid storage disease may be inherited, primarily demonstrated in the increase of lipoproteins level in blood (hypolipoproteidemia). Moreover cholesterin content or that of triglycerides or the both increase at the same time. In most cases such pathology bases on a genetic (hereditary) fermentative defect.
In other cases there may be inherited another type of metabolic imbalance, in which high level of cholesterin and transferring it lipoprotein particles from an early age.
Whatever is the reason, a hereditary hypercholesterinemia, especially a homozygotic (inherited from the both parents) one – is very worrisome. The level of cholesterin with homozygotic hypercholesterinemia may reach abnormally high values – 700-800 mg% (the normal one is not higher than 220 mg% ). Such high level of cholesterin set in childhood is manifested by lipids concretion in the form of xanthomas – specific formations swelling over the surface of eye-lids, on the skin of arms and legs, in the area of attachment of muscular tendons, for instance, along the Achilles tendon. Also quite often cholesterin will concrete on the margin of cornea of the both eyes by type of lipoid arches. IHD in these cases develops very early (often before 20 years of age) and later results in myocardial infarction and other complications, if left unchecked.
Considerable importance of the complex of hereditary features in the development of atherosclerosis is shown in a special medical science literature, related to the descriptions of early development of myocardial infarction in a pair of twins with genetic disorders of lipid exchange.
Without doubt, hereditary features may make some people more IHD vulnerable than the other people. Though, it is difficult to imagine that genetic background of generations has changed so rapidly that it is the only explanation of the prevalence of IHD nowadays.
The third factor.
Food. Food habit is a very important matter in discussions of the reasons of IHD development. First of all, the harm of imbalanced overeating, which makes possible not only obsession, but the rise of lipids level, must be emphasized. Triglycerides content in blood rises especially easily, if the food contains much fat of any origin. In the process of consumption of cholesterin rich food – egg yolks, caviar, liver and brains of animals – the level of it will be rising.
There are many experimental findings and clinical impressions testifying that the replacement of saturated animal fats by unsaturated vegetable oils promotes the lowering of cholesterin level in blood and blocks the development of atherosclerotic process. For that matter dietarians of all the world point out the necessity of substitution of a part of animal fats by vegetable oils in a daily diet aiming to prevent and cure IHD (here it is important to emphasize that this means substitution, but not a mere addition of vegetable oils to animal fats).
The main sources of saturated fats in food are meat, butter, other animal fats and milk. It is interesting to note, that domestic animals meat contains more saturated fats than that of wild ones. Comparative sluggishness of domestic animals, wide use of combination fodder and other food supplements for their feeding (under the condition of gigantic sizes of modern intensification of animal breeding) contributes to this fact. Advance in living standards of population will surely promote consumption of meat and animal fats in increasing degree.
There appears a serious problem of limitation of food with animal fats without reduction protein in it. In Australia, for instance, where consumption of products of animal origin is extremely high, and IHD is widespread, an unconventional way of fortification of animal fats by the unsaturated fat acids, indispensable for people, has been proposed. Its point is in the following.
In vivo unsaturated fats contained in green fodders in stomachs of grazing animals turn into saturated ones (bacterial change). In order to increase a part of unsaturated fat acids in milk, meat and fat in beef and sheep small doses of unsaturated vegetable oils, for instance, sunflower oil, is added to their diet. To what extent it is promising – it remains to be seen. Nowadays the problem provision of the most sensible nutrition by vegetable fats by means of reduction of the consumption of animal fats is more and more acute. Speaking on the role of food in IHD development, it is necessary to mention another fact. In the food requirements of modern life highly purified and conserved food predominates with increasing frequency. When this happens the consumption of products rich with green dietary fiber reduces. Green dietary fiber offers properties to bind cholesterin (100 g of dietary fiber can bind 100 mg of cholesterin) and speed up intestinal transit. It turns out that consumption of food rich with dietary fiber will promote slowing down of absorption of cholesterin in bowels and speed up its fecal excretion. Moreover, in the eyes of scholars, elimination of the so called rough food and transition to a “tender” one results in overeating, which promotes high level of cholesterin and triglycerides in blood. At last, some methods of purification of food products result in the loss of a series of vitamins and minerals, the shortage of which induces the development of IHD.
Also over consumption of meat induces the development of IHD. Unfortunately, scientists do not know the reason of it yet, though a great number of observations on animals and on people, convincingly shown that consumption of animal proteins, and meat proteins in particular, as opposed to vegetable proteins, induces the development of hypercholesterinemia, have been done. Apparently, this is the explanation of a long ago noticed correlation between the level of uric acid (it is high in meat eaters) and prevalence rate of IHD. There is much evidence that vegetarians have lesser lipid level in blood than that of in people who eat mixed (green and meat) food. It does not mean that a human being must make a switch over to vegetable food, but it serves as a warning against overuse of meat products. It is significant that milk consumption even in big quantities does not result in increase of cholesterin level in blood. It came from the fact that milk contains an oppressive factor of cholesterin synthesis.
Scientists from the United Kingdom think that consumption of great quantities of sugar is significant for the level rise of lipids in blood. On their estimations in the last two centuries people increase sugar consumption by 25 times in their daily ration. Fat and carbohydrates metabolism is closely related. Superfluity of carbohydrates creates favorable conditions for blocking and accumulation of fats. Action of carbohydrates is most noticeable in people with high level of prebeta-lipoproteins and triglycerides in blood: after carbohydrates intake the content of them in blood grows up increasingly higher.
Indeed, one should not ignore the fact that sugar was the new food product, which appeared in Europe only in XYI century, and actually was widespread only in XIX century, when sugar beet was used for sugar production. Sugar consumption curve per head of population steadily continues to creep upward up to nowadays. Thus, according to the data from statisticians in the USA sugar consumption per head of population is 50 kg. In addition it is well to bear in mind that in the last years sugar consumption grows in the form of confectionary, sugar syrups, tinned berries and fruits, ice cream, etc. rather than in a pure form.
Mark you, that a refined sugar (affination sugar) does not contain chrome, (the microelement which is lost during sugar refinery) which is critical for metabolism (exchange) of sugar in the body. For this reason when big quantities of refined sugar are consumed, chrome will be mobilized from body’s tissue. Chrome deficiency, aggravating the development of diabetes and IHD, may occur. On recommendation of medical doctors in some countries along with refined sugar native “green” sugar becomes to be used again. Nevertheless, in over consumption of sugar in whatsoever form every blow tells. Here involuntary come to mind the curves of steady growth of diabetes and IHD, which are registered in most countries of Europe and America.
The fourth factor.
Diabetes. On estimate of medical statistics in the world there are more than 70 mln diabetics with obvious clinical forms; however, every 10 years the figure doubles. Moreover, there are many people with the so called potential or latent forms of diabetes. In the first place, there are hereditary tainted people, whose parents or other close relatives were diabetics, likewise obesity people or people with high body mass. In order to reveal latent diabetes, the persons who may expect this disease are loaded with sugar, then fluctuation of level of sugar in blood; if necessary and when possible insulin content is examined. Early such forms of diabetes detection allow the aid of dietetic treatment preventing disease progression and avoiding major complications in the vast majority of cases. The main principle of such preventive diet is the principle of sparing of insular apparatus of pancreas, which is attainable by limitation or exception of regular consumption of sweets or the products rich in quick easy absorbing carbohydrates.
Thus, carbohydrates exchange and their utilization are largely regulated by hormones, primarily, by a pancreas hormone – insulin. This hormone is also able to influence on fats exchange, creating conditions for their retention in tissues. Excessive production of insulin, as a rule, results in retention of fats and lipoids in tissue repository, likewise in a vessel wall, which provides atherosclerotic plagues. Yet, insulin release conditions are rather frequent: obesity, overeating, consumption of big quantities of sweets, starchy foods, sweet fruits, potatoes. If overeating becomes a habit and is maintained for a long period of time, suitable conditions for the development of diabetes, obesity, IHD may be formed.
Nowadays it is well known that diabetes may create specific conditions enabling intense production of cholesterin and triglycerides. Moreover, diabetes oftentimes causes dystrophic affections of great arteries and little ones. Due to all that a hazard chance of diabetic coronary heart disease abruptly increases.
Light forms of diabetes may remain compensated due to safety margins of the body for a long time. In this case pancreas releases insulin in higher quantity; its concentration in blood increases, allowing the body to master the difficulties, which arise on the way of glucose uptake. Along with this in the process of elevated concentration of insulin turning of glucose into fats increases, i.e. synthesis of triglycerides increases, condition for longer delay of them in fat depot and in the vessel wall. That is why light forms of diabetes may play not a smaller role, and may be a bigger one in IHD progression, than a moderately grave diabetes, or a grave one. In light form of diabetes strict and steady diet alone will help to avoid increasing of insulin secretion, and, by that protects from a massive inner risk factor of IHD development and from turning of latent diabetes into overt one.
As for grave forms of diabetes running with absolute reduction of insulin level in blood, they often accompanied by increasing of cholesterin synthesis in liver, likewise by increased mobilization of free fat acids from fat depots. At the same time clotting possibility increases rather than development of IHD, tendency to rapid blood clotting increases, and if a patient has even small atherosclerotic plagues in coronary arteries, they become the center of clotting. This drastically increases the danger of blocking of a lumen of coronary arteries and induces myocardial infarction.
The fifth factor.
Failure of physical activity. When we analyze the difference of the life of people in economically developed countries of the XX century from that of XYII-XIX centuries, the difference from the point of view of a physiologist will be in the following. Civilization results in a drastic reduction of muscular energy and to a substantial increase of caloric content of food, in particular, to intense consumption of animal fats and highly purified carbohydrates. As far back as in the middle of the XIX century 96% of all the energy was produced with the help of human muscle force or that of domestic animals, and only 4% was due to machinery. Nowadays these relations have acquired directly opposed value.
All this leads to little movement and little physical work of humans, which results in an affected cardio-vascular system. Evolutionarily cardio-vascular human system, as that of many animals, adapted for constant physical loads. Nowadays sportspeople – distance runners, skiers and other athletes provide a good example for it. Their cardio-vascular system successfully masters hard physical loads.
What happens if an untrained sedentary life-styled person will swiftly walk only 200-300 m? He or she will have heartbeats, a number of heartbeats will increase up to 120-125 per minute, and the time of diastole (compliance of heart) will significantly reduce. Then, due to non-fitness of the vessel apparatus of cardiac muscle, due to undeveloped collaterals (bypasses), heart blood supply, must increase several times, but does not attain the desired level. As the result, there come oxygen lack of cardiac muscle, general muscular fatigue and impossibility to keep on the exercise. It is not the case with the heart of a trained person: it will receive oxygen in full, besides, the same level of physical load will induce lesser acceleration of heart rate. Thus, sportspeople have substantially higher physical capacities than untrained persons.
Cardiologists call a modern human “an active idler”: work and everyday life of whom is mainly connected with efforts of nervous system, whereas a muscle apparatus and a cardiac muscle develop looseness because of idleness. Heart force decreases. The condition which develops may be characterized as detraining of the heart. That is why the heart of a sedentary life person in a great measure is an IHD subject. One may dare to assert that a person who goes to work by car, interoffice moves by elevator, and at home sits glued to the TV, sooner or later will have IHD.
Physical activity should be considered as one of effective means of IHD prevention. According to doctor’s observations those people who practice physical exercises hard are exposed to danger of cardiac disease 3 times less. Therefore, sports and athletic games, especially swimming, tennis, football, running, walking, cycling is a good practice. In short, we are referring to much more training loads than morning exercises. It is most typically that the animals accustomed to move constantly or make big physical work (for instance, horses) have a big quantity of alpha-lipoproteins in blood, whereas not enough exercising animals (for instance, pigs) predominantly have beta- and prebeta- lipoproteins in blood. Horses, unlike pigs are not amenable to atherosclerosis at all.
The sixth factor.
Obesity. Nowadays obesity becomes social problem, since it covers wide population segments of economically developed countries. May be the words “obesity” and “social problem” sounds paradoxically in this setting, since up to now hunger has been considered a social problem, but not in the least obesity, owing to overeating. But let us refer to statistics.
In the USA from 35% to 50% of middle-aged Americans and from 10% to 20% of children suffer from obesity. In German Federal Republic every second citizen has excessive body mass. According to the data of population examinations in some regions of Russia, excessive body mass is reported in 50% of women, 39% of men and 10% of children. It is possible to continue statistic data lists on the widespread of obesity (corpulence) among population of various countries.
The origin of fat in practically health persons is the excessive consumption of food which exceeds metabolic cost. In many cases it is observed in people regarding food intake as delight or one of the modes of personal misfortunes. In some people obesity develops with the increase of years, with seemingly regular nutrition mode. For better understanding of the reasons of age-related obesity let us consider in general terms how regulation of appetite takes place.
There is a special lump of the brain – hypothalamus – where the regulating center of food consumption. Glucose reduction in blood (in fasting period) stimulates activity of this center, gives an appetite and induces a person to food intake. The moment glucose content in blood (in the process of food intake) attains a particular level; oppression of food center sets in. Provided this regulation system is properly adjusted, in most cases, the body keeps stable weight. But not in all cases one may rely on appetite. In the mean time, with advancing age there reduces sensitivity of food center to the action of glucose, i.e. a sense of fullness comes when more food is consumed. Without a due control of food habits gradual increase of body weight may start from a definite period of life.
Food center may also “mislead” persons of a relatively young age. Thus, for instance, obesity often is observed in transition from physical acting to sedentary lifestyle, when the old level of excitability of food center and former appetite remains, while energy usage of the body substantially reduces. Reduction of energetic cost of the body is typical for elderly and old people; binge eating will result in obesity. Occasionally, an overeating habit is acquired as early as from childhood, when in the family it is customary to consume surplus amount of sweets, backed products from white flour, fat food. Indeed, nowadays a lot of families eat everyday as before one has eaten on holidays. In many cases beer and other alcoholic drinks abuse results in obesity, as from one hand these drinks contain big quantity of calories, from the other hand they increase appetite and provoke overeating. 0,5 l of beer, 200 g of sweet wine, 100 g of vodka or 80 g of cognac, liquor or rum contain about 300 kkal. Therefore the bodies of “alcohol lovers” receive by 20-30% and sometimes even more needed calories only due to alcoholic drinks. Oftentimes after alcohol intake one eats so much food, that a good half of it runs to fat. Increase in volume of fat tissue needs additional blood supply and, hence, creates addition load on heart. Moreover, depot fat lifts diaphragm, curbs chest excursion, displaces the heart, interfering its work. As already stated, excess of dietary carbohydrates (starch and sugar) induces intense production of the insulin, which stimulates transition of carbohydrates into fats. Subsequently, alongside with storage of fat, concentration of fat acids in blood increases, and the level of triglycerides and lipoproteins comes up. Fat acids of blood reduce insulin activity, whereas increasing body mass demands more insulin. As a result, pancreas gland is overstressed, little by little its capabilities are exhausted, insulin production drops, and a latent diabetes becomes an overt one. This entails new dangers in the run of the disease and new complications in the form of IHD.
Obesity is often followed by latent diabetes and a high level of lipids in blood, in other words, a corpulent person is more predisposed to IHD than a person with normal weight. It is no wonder that corpulent people have myocardial infarction 4-fold more frequently. Obesity, diabetes, high level of lipids in blood, atherosclerosis – all that occasionally are links of “a chain reaction”, which basically has the constitutional predisposition to metabolic disorder, coupled with improper lifestyle, in the first place, with overeating.
This is a reason why obesity control by balanced food and physical exercises have immense force. Physical exercises should be considered as a means of maintenance of constant weight, in other words, as a means of obesity prevention. Curb of food consumption is the most effective measure of obesity control.
Obesity prevention should be started from childhood and there the parents should play the key role. It is established that if the both parents of a future child are in flesh, in two cases out of three the child faces fatness; if one of the parents is fat, the probability of fatness is one case out of three for the child; if the both parents have normal weight, the probability of fatness is only one case to two hundred. The reason lies not in genetic predisposition to fatness, but in the habitual nutritional system in family, which the child faces from the early age. It is the parents, who, unconsciously, plant high sensitivity for food motivations to the child, or, in other words, they plant “lack of capacity to temperance”.
As a result of overeating, in the child’s body there increases a number of the cells, which “demand” a constant renewal of fats. A chain reaction starts: “fat makes fat”, which results in the increase of consumption and development of fat and its accumulation in the body. When the quantity of fat increases more insulin develops, and this in its turn sends up appetite – and further – deposition of cholesterin in vessels.
A number of fat cell in a child’s body depends on the diet. According to the data of American scientists the cells, once appeared, remain in human’s body till the end of life, and there is no possibility to “drive them away”. Moreover, fat cells of fat people are increased in size. Reduction of weight in adult means a mere change of the quantity of fat in each of the already-existing cells. But it is not so easy to attain such fat reduction in a cell. Therefore it is clear the necessity of obesity prevention from childhood.
The seventh factor.
Psychological. Some research people, studying the causes of IHD, connected with neurohumoral regulation disorders, evaluate the problem of retention emotions, i.e. not found external expression ones. Indeed, in civilized environment a lot of emotions of anger, anxiety, threat etc. do not ultimate, as in our remote ancestors, in releasing motor actions (fight, running etc.) and corresponding metabolic shifts. In such situations a body accumulates excess of the substance close in its properties to adrenalin. They abruptly increase oxygen demand of cardiac muscle, which in the context of IHD escalates the danger of myocardial infarction.
Adrenaline-like agents, moreover, provoke mobilization of the fat acids from depot fat, the level of which may be increased in blood. With corresponding predisposition it may result in arrhythmia of heart’s action.
Inoxidised released fat acid ultimately passes to the liver and are used for the synthesis of triglycerides, and triglycerides are used for the formation of prebeta-lipoproteins, which comes from the liver to blood and turn into beta-lipoproteins. By these complicated way an emotional outburst is able to speed up forming and passing into blood of atherogenic lipoproteins. The distinctive characteristic of life of modern civilized society is the challenging, filled with emotions of various kinds and rash lifestyle. Growth of urban population, sophistication of process of production, utmost implementation of high-speed vehicles, radio, TV, information flow augmenting etc. will help all this.
According to observances of most research workers upstaters have 10-12 times less cases of myocardial infarction than city-folk. It is bound up with the idea of heavy “pressure” upon the central nervous system of an urbanized person.
In a series of studies the connection between profession and the illness frequency of IHD is reported. According of observations of the WHO mortality is higher (36%) among graduates (engineers, works managers) and much more lower (20%) among average technicians (employees) and workers (18%). These long-term data are based on the results of the examination of the population of San-Francisco.
In England one more occupational characteristic has been found out recently. Bus drivers have IHD far oftener than fare inspectors (we mean men of the same age group). A drivers’ occupation is surely more stress-filled and “nervous” than that of fare inspectors, which is reflected in a high IHD illness frequency of drivers in comparison with fare inspectors.
Sociologists notice that native population in any given region is taken ill with IHD less than that of migrant. There seems that adaptation period inevitable for alien population is more “costly” for nervous system and makes new arrivals more vulnerable.
In predisposition to IHD chronic psychoemotional factors, as the feeling of dissatisfaction of job and job position, loss of face and discontent of a settled life are of a great importance. In this regard changes in usual mode of life cause concern, in particular, transition from active job to pension provision. Obviously, every person should be prepared to that moment beforehand, so that this change takes place with the list damage.
In 1936-1940 a Canadian physiologist G.Selye promoted a concept that for an animal’s body and that of a human’s stereotyped physiological reactions to the action of a variety of irritants – stressors are common. Neurohumoral shifts complex as feedback to a strong irritating agent gets the name of stress. Stress is designed to prepare the body to environmental impact. That is why the physiologic processes which take place in various stressing situations may be considered as adaptive ones. Stress involving anxiety states, aggression and other emotions are likely to make for survival of an individual and a tribe, when people of Stone Age, for instance, came up against a predator or were on the track of a prey. Right now, when a person gets into a traffic block and conflicts with an offensively-spirited driver or passenger, a stressing reaction is unlikely to clear up with a muscular effect. So that generally such reaction for a civilized human has lost its biological advisability. Therefore some physiologists and pathologists are inclined to consider a modern human, in a way, as a victim of emotional stresses. Negative emotional stresses a number of authors refer to as “distresses” (an English word “distress” means “grief, suffering”). Distress may be induced by family-household, on-the-job and other disorders and anxieties, not to mention big emotional traumas.
In many cases just distressing conditions induce the development of IHD. In such a case, firstly, vascular tone, arterial pressure, cardiac rhythm change, the level of glucose, fat acids, atherogenic lipoproteins rises in blood. The facts of cholesterin level rise in practically healthy people in periods of intense neuropsychic activity, for instance, in student during examination period, in accountants during drawing up of annual accounts etc. are well-known.
“Distress” – a strain of nervous system – stenocardia or myocardial infarction – such is the scenario of reactions proceeding in human a lot of times. This makes one to give much priority to such moments as social climate, atmosphere both in family and at work, individual perception of whatever is around and what is going on, while analyzing the causes of IHD.
Constitutionally predisposed and fully formed during human life, higher nervous activity character, as the factor, reducing or increasing the probability of some diseases, in particular, IHD is of great importance.
In the works of a Russian physiologist of genius I.P.Pavlov for the first time ever there was introduced a scientifically grounded concept on the signification of higher nervous activity in the origin of some illnesses. The persons with specific constitution of psychoemotional sphere are particularly predisposed to the disturbances of physiologic processes in brain cortex and in lower center. In 1959 American scientists Friedman and Rosenman proposed to distinguish 2 antitypes of persons: “A” and “B” in term of their psychic personality characteristics.
The authors classify type “A” as the persons notable for an exquisitely advanced sense of responsibility, tremendous ambition, constant striving for success. It is a type of an efficient person, always with a full load of work, paying no regard for relaxation, in many cases sacrifices own holidays, vacations to the work. Such persons remain under continuous time pressure, and almost unable to relieve down to the limit challenging pace of life.
Type “B” is specified by an opposite mental make-up: they are quiet, unhurried, equable people, hardly ever committing with tight deadlines, never undertaking overtime work or surcharges, enjoying rest and knowing how to rest. Such people are seldom in a hurry, they always find time for recreational activities, and they undergo hardships or ills of life more easily.
In stressing condition a type “A” person devotes all energy to get through a tight situation, but when he or she can not find the resolution, then in the midst of constant anxiety and concern there may occur a nervous breakdown, helplessness state, sometimes sense of desperation, which involves calamities, for instance, IHD development, as mentioned above, for many people extreme nerve strain is characterized with rise of arterial tension, growth of cholesterin level in blood, rise of blood coagulability, i.e. with a complex of the factors, which upon certain conditions (atherosclerosis of coronary arteries, critical physical overwork etc.) may provoke myocardial infarction.
The eighth factor.
Hypertension. High arterial tension oftentimes is the driving member of the development of such disease as IHD. Hypertension is accompanied with a constant strain of a vessel wall, which results in the damage of its endothelial blanket, thickening of middle and inner layers and nutrition decline of the vessel at large. All that favors, from one hand, more intensive penetration of lipoproteins inside the vessel from blood, and on the other hand, retention and accumulation of lipoproteins in the vessel; besides, both these processes may run not only with high level of lipids in blood, but in the cases, when their concentration not exceed the limits of normal fluctuations.
Hypertension increases the risk of the development of atherosclerotic vessel impairments in persons with normal lipids content in blood, whereas persons with high concentration of lipids may be sicken of IHD. When the both factors (hypertension and hyperlipidemia) go together, the probability of the development of IHD increases several times. Which arterial tension should be considered normal? The Expert Body of the World Health Organization recommends considering normal an arterial tension less than 140/90 of mercury column. The first figure shows blood pressure in large-caliber arteries in the period of heart contraction, or systole, i.e. systolic (maximal) pressure; the second figure points out the value of pressure during compliance of the heart, or diastole, i.e. diastolic (minimal) pressure. Arterial tension more than 160/95 of mercury column is considered as surely elevated. The values of arterial tension within the bounds of 140-160/90-95 of mercury column are referred to the so called intermediate zone. The persons having such moderate elevation of arterial tension are apt to have hypertensive disease developed in future.
According to the data from a recent survey of about 8000 men of 40-60 years of age in Moscow, elevated arterial pressure (for the norm there was taken systolic pressure of 160 mm mercury column and diastolic one of 95 mm mercury column) was observed in the third of the examined persons. However, a lot of them got to know that they had arterial hypertension for the first time ever, others knew but made little of it, the third ones started the treatment one day, but after improving of well-being and reduced in pressure, which, naturally, resulted in initial hypertension.
Medical science unfortunately indisposes the remedy which can once for all release a person from hypertension disease. A patient is to administer “maintenance” doses of a medication on a regular basis over a number of years. In this case a hypertension disease patient may secure oneself against a variety of complications. There experimental evidences that when diastolic arterial pressure more than 105 mm of mercury column myocardial infarction will develop 3 times as often as when diastolic pressure is less than 90 mm of mercury column.
Harmful influence of hypertension is relative not only to intensive rate of development of arterial sclerotic disease, but also to increased tendency of arteries to the idiospasms, during which blood flow in the basin of such arteries abruptly reduces and a piece of tissue, for instance of the cardiac muscle or the brain will be badly supplied with blood.
In the process of lengthy hypertension the heart constantly works with additional loading, as it is bound to drive blood against increased resistance. Thus, a hypertension needs cure.
It should be stressed that a person with elevated arterial pressure must be thoroughly examined for the disease causation. Often chronic kidney disease, less frequently, endocrine glands diseases and other sicknesses form the basis for hypertension disease. In some cases hypertensive disease develops due to mental stresses, overfatigue, acute or repeated psychic traumas, and non-resolved life conflicts for a long time. Timely elimination of the factors inducing elevation of arterial tension, and constant treatment of already developed hypertension are IHD and other complications prophylaxis.
The ninth factor.
Smoking stimulated the intense release of adrenaline-like agents into blood, which in many cases results in trauma of vessel wall and cardiac muscle. Moreover, nicotine itself acts extremely unfavorably on vessel wall; in particular, it is conductive to spasms of cardiac arteries and lower limbs.
All that, highly facilitates penetration of cholesterin and other lipids into vessel wall, which may serve a direct cause of the development of infarction, having plagues in lumen of coronary arteries. To this must be added that nicotine, passing to blood in the time of smoking increases the ability of blood plates (thrombocytes) to glueing, which may result in the formation of clots (thrombs) in vessels. Stimulating adrenalin emission, nicotine abruptly increases the need of cardiac muscle in oxygen, which is rather dangerous in the setting of functionally bad coronary arteries.
One smoked out cigarette in many cases increases the frequency of heart beats by 8-10 beats a minute. It has been established by researchers that the vessels of an old hand smoker “wear down” by 10-12 years earlier. According to the data from the twenty-year extended examination, recently completed in the United Kingdom, in which 35 thousand of medical doctors have taken part, every smoking man at the age under 70 has twice as much chance to die than a non-smoker. Upon the statement of the USA Minister of Health, Education and Social Security 37 mln of living Americans will die prematurely because of smoking. There are good grounds that the members of a rather popular in the USA of the “anticoronary club” start their activity in the club, in the first instance that they give up smoking. Unfortunately, smoking nowadays has grown into epidemic. In Moscow, nowadays, 85% of men and more than 30% of women smoke. In German Federal Republic the third of men and 20-25% of women smoke. High percentage of smokers is reported among adults of the USA and Western Europe. Thus, in the USA among men the number of smokers reaches 39%, whereas among women that of 29%. In whole 54 mln of Americans are smokers. Of even greater concern is that school-aged children are acquiring a smoking behavior. According to the data of the National Center of Smoking and Health in the USA more than 15% of boys and girls in the age of 13-14 smoke on a regular basis.
The smoking problem is not limited to the persons smoking regularly and systematically. Nowadays the concern of public health authorities of a lot of countries is the problem of so to say passive smoking. It is found that almost 70% of the smoke of a lighted cigarette and breathed out by smokers goes into environment, polluting it with tars, nicotine, carbon oxide and other contaminants. Indoor smoking poses especially seriously injure for wider public. Thus, stay of non-smokers in closed parlors where other people smoke during an hour, corresponds to smoke out four cigarettes.
Meanwhile, it is well known that smoking drastically increases the risk of lung cancer, contaminates nervous system, etc. It will be remembered that one cubic centimeter of fume contains 200-500 mln particles of soot. A person, daily smoking out 20 cigarettes during twenty years, “lays off” in the lungs 6 kg of soot. Expertise of various countries has calculated that one smoked out cigarette shortens life by 5-15 minutes. It is no wonder that smoking has come to be called “long-delayed suicide”.
In conclusion one may give a weighty opinion of the World Health Organization on smoking hazards: “There exist indisputable scientific evidences that tobacco smoking is one of the central causes of chronic bronchitis, lungs emphysema and cancer, also it is the most important risk factor of IHD disease.
The tenth factor.
Alcohol. At this point one must say about the consequence of alcoholic abuse in the development of lipid storage disease. Persons, consuming alcoholic drinks on a regular basis, have high level of lipoproteins (prebeta-lipoproteins) and triglycerides in blood, i.e. there set up grave factors for IHD development. Chronic alcohol consumption oftentimes is followed by overeating, which results in obesity with all ensuing consequences concerning cardiovascular diseases. Beyond that point, immediately after alcohol intake, in most cases, the arterial tension arises, which develops overloads for cardiac muscle and increases by that the fear of coronary complications.
A lot of evidences are collected of a direct toxic impact of alcohol on heart. In particular, it is established that alcohol reduces the heart force, and under the conditions of long-term intake induces the structural changes in the cardiac muscle which may result in break in rhythm of heart contractions and other cardiac abnormalities, dubbed alcoholic cardiopathy. Alcoholic cardiopathy is a lot of alcohol addicts.
Eleventh factor.
Coffee. Coffee and tea sprang up in Europe in XYIII century. Opponents of coffee and tea called them poison. One of the legends had it that Gustav III, a Swedish king, decided to check what was more dangerous for health: coffee or tea. It happened that at the time two twin brothers, condemned to death for a certain crime, were in a Swedish prison. The king granted them life, provided that one of the brothers should have duink several cups of coffee every day all the life, and the other brother should have drunk several cups of tea. The both brothers lived till great age. From that time on (it is hard to tell whether it is associated with the legend) tea and coffee took the widest propagation in Sweden. In the period after the Second World War coffee is ousting tea. Coffee became very popular almost in all the countries of Europe and Middle East, in Australia, not to mention America. It is well known that it is enough to drink a cup of coffee to feel awake and renew (without the signs of the present before that tiredness or drowsiness). For this reason coffee is getting to be drunk not only at home, but at work, arranging for this the so called coffee breaks. Coffee drinking becomes as much as ritual of all kinds of meetings, workshops, conferences and congresses. Some of coffee lovers drink up to 15-20 cups of the drink a day.
Several years ago Swedish scientists published the article in which reported that IHD more frequently was observed in persons who consumed a big quantity of coffee on a regular basis (5 cups a day and more). After that article there appeared similar messages in other countries. Quite possible that the people in whom neurogenic factor plays a key role in induction of IHD attacks, systematic consumption of a big quantity of coffee makes them more excitable. In that case, the action of a neurogenic factor in the direction of “distress – excitement of vegetative lower centers in the brain – IHD” will occur with more probability. Strong coffee promotes intense release of catechol amines in blood, which increase the need of cardiac muscle in caffeine.
Ischemic heart disease (IHD) declares itself in several clinical forms the most dangerous of which is myocardial infarction. The word “infarction” means “mortification” of a part of tissue in an internal of human body due to blocking of the blood vessels, which feed this tissue. Myocardial infarction means mortification of a part of the cardiac muscle (myocard). Apart from myocardial infarction there are infarctions of lungs, of kidneys, of spleen, etc. But due to morphologic and functional properties of cardiac muscle and supplying blood arteries the frequency of myocardial infarction is incomparably higher than disorders of such kind in other organs. In future on the place of mortification the scarry connective tissue is gradually developing, which functionally disagree with the cardiac muscle. That is why when the area of infarction is rather large, heart weakness usually occurs, often resulting in grave consequences.