“After the heart attack, it is important to prevent the development of aterotromboza, you need to ensure that the plaque is at least not increased, remained stable, said chief freelance specialist physician, Ministry of health of Russia, corresponding member of RAS Drapkina. – Of course, plays a big role in lifestyle changes, reduction of risk factors. From the contribution of the person, according to studies, depends about 50% success. It is very important indicator, which allows to estimate the risk of recurrent vascular events is the level of cholesterol in the blood. The high rate of low-density lipoprotein (LDL) dramatically increases the risk of relapse. The requirements on the part of cardiologists increase: three years ago, we aspired to the level of 1.8 mmol/l, but since last year, the recommendations were strengthened to 1.4 mmol/L. to Achieve this level, besides maintaining physical activity and proper diet helps therapy lipid-lowering drugs.”
in 2020, in Russia launched a program of secondary prevention of cardiovascular events: all who have had a heart attack, stroke and other acute vascular disorders, as well as operations on the heart and blood vessels, provide free essential drugs for outpatient treatment in the year following inpatient treatment. For these purposes this year allocated from the Federal budget of 10.15 billion. In the program, as reported in the Ministry of health, will take part about 800 thousand people annually.
“with regard to the appointment of lipid-lowering medications, they have to actively work with doctors. We now have a therapy receives only a third of the total number of patients who need it, – said Oksana Drapkina. But much also depends on the patient. Drug therapy, adherence to treatment, that is, careful observance of all recommendations of the doctor and a healthy lifestyle are the three main components of secondary prevention. It is necessary to explain to patients”.
Studies conducted by Russian scientists have shown that adherence to treatment in our country leaves much to be desired, many patients stop taking the drugs – sometimes from a misunderstanding of the consequences, sometimes because of lack of sufficient funds to purchase drugs. “Therefore, equally important and educational work with the patients and subsidized medicines. In the regions where they were carried out such pilot projects, the death rate from repeated cardiovascular events is below,” – said the head of the Department of pharmacy of the Medical Institute of continuous education of the “MGUPP” Ivan Krysanov. According to him, the study was a direct correlation between the medication and reduced mortality from cardiovascular�� disasters.
Now the program includes lipid-lowering first-line drugs – the statins. Thus to further reduce mortality, experts say, we need to introduce new methods of treatment, expanding the list of preferential medicines. Receiving drugs from the group of statins can lower cholesterol by about 50 percent, but not enough to achieve the desired clinical outcome in some patients. In such cases, doctors should be the ability to assign drugs of the 2nd line is not yet included in the list of preferential provision of outpatient persons after myocardial infarction.
“In Russia starinova therapy that allows you to control the level of cholesterol in the blood in patients with acute myocardial is predominant, but, unfortunately, up to 70 percent of patients do not reach target cholesterol levels despite taking statins, – said head of chair of therapy and endocrinology, Volgograd state medical University, Professor Sergey Nedogoda. – If, after cardiovascular event cholesterol is not reduced, then a very high probability of their repetition, and here it is necessary to resort to more powerful lepidotrigla therapy. Combination therapy – the use of drugs of a new class of PCSK9 in combination with statins – to help such patients 25 percent more effective than monotherapy with statins”.
High levels of cholesterol observed in 57% of inhabitants of Russia. Therefore, regular monitoring, performing analysis of blood, not only in total cholesterol but also of the wider lipid profile, is indispensable, – said the participants of the conference.
“If the cholesterol level is high and does not correspond to normal levels, and we understand that the patient has increased cardiovascular risk, the therapist in the framework of the MLA needs to look at lipid profiles, including cholesterol, low-density lipoproteins, – said Oksana Drapkina. – This is part of the clinical supervision”.
According to the chief therapist of the Ministry of health, lab support now available and the control of cholesterol levels, as other factors, should enter the program provide patients with free drug support.