The importance of implementing a healthy lifestyle for prevention

of cardiovascular diseases among adolescents

Dr. drd. Zuiac Silvia Sorina

Associate Professor drd. Universitatea „Eftimie Murgu”Resita
Drd. West University „Vasile Goldis” Arad
zuiac@yahoo.com

“ Every newborn child is entitled to live until the age of at least 65 years without
suffering a cardiovascular disease that can be prevented!”.
European Charter for cardiovascular health

The heart is a strong pump, muscular, the size of a fist that pumps blood through the
circulatory system. Every day, the heart beats (expands and contracts) by about 100,000 times
and pumps 7,200 gallons of blood. In a life of 70 years, the heart beats more than 2.5 billion
times.
The circulatory system is a network of elastic tubes through which blood, carrying
oxygen and nutrients to all body cells. It consists of the heart, lungs, arteries, arterioles (small
arteries), capillaries (the smallest blood vessels), Venu (small veins) and veins, which return
blood to the heart. If all blood vessels were laid end to end, would be 100,000 km, enough to
circle the Earth twice.
The blood distributes oxygen and nutrients to all organs and tissues, including heart. It
is loaded with waste products from cells, which will be eliminated by the kidneys, liver and
lungs.
Cardiovascular disease is a global problem, accounting for over 30% of deaths
worldwide. According to statistics, in Romania, every four minutes a man dies from
cardiovascular disease.
Cardiovascular diseases are the leading cause of premature death in Europe. They are
an important cause of disability and contributes substantially to the increasing costs of
healthcare.
Death from cardiovascular disease often occurs suddenly, before providing access to
healthcare, so many are inapplicable or palliative therapeutic interventions health system.
Cardiovascular disease is ranked as a leading cause of mortality in Europe in both
women and men.It is responsible for almost half of all deaths in Europe causing over 4.35
million deaths each year in the 53 Member States World Health Organization-European
Region and more than 1.9 million deaths each year in the EU. Cardiovascular disease is also a
major cause of disability and decreased quality of life. However, cardiovascular disease can
be prevented entirely. World Health Organization estimates that reducing blood pressure,
obesity, smoking and cholesterol will decrease by more than half the incidence of
cardiovascular disease.
While mortality and cardiovascular diseases are declining in northern, southern and
western Europe, central and eastern countries not only are falling, but in some cases are even
increasing. (European Heart Health Charter, the Charter of cardiovascular health-2007).
Even if the European Union, cardiovascular mortality rate is dropping, now the
number of patients (men and women) with cardiovascular disease is growing. This paradox is
due to increased longevity and improved survival in people with cardiovascular disease.
Cardiovascular disease kills more people than all cancers combined, with a percentage higher
among women (55% of deaths) than among men (43% of deaths) and increased mortality

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among patients with a low socio-economic position. (European Heart Health Charter, the
Charter of cardiovascular health - 2007).
Around the year 2000, cardiovascular diseases were the direct cause of over 4 million
deaths in Europe (1.9 million in the European Union), being responsible for 43% of all deaths
from all causes in men and 55% for women.
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cardiovascular diseases were, also the main cause of hospital discharge, with an average rate
of 2557 per 100 000 inhabitants around the year 2002. Of these, 659-100 000 were caused by
heart disease, 375-100 and 000 of stroke, but more than half were due to other forms of
chronic heart disease. Cardiovascular disease mortality rates vary by age, gender, socio-
economic status, ethnicity and geographic region. Mortality rates increase with age and are
higher in males, people with poor socio-economic status in Central and Eastern Europe and
South Asian immigrants home. There are marked variations between European countries in
terms of morbidity and mortality from cardiovascular diseases, which are partly explained by
socio-economic differences in conventional risk factors such as smoking, blood pressure,
cholesterol and glucose.
Since 1970, Western Europe, total cardiovascular disease mortality has declined
significantly, both the average ages and those advanced. Nine Central and Eastern Europe,
mortality began to decline only in recent years, but remained however, very high. Male
mortality by heart disease is still almost 10 times higher in Eastern Europe, compared with
France, for the age group 35-74 years, and in terms of stroke mortality, mortality is 6 times
higher .

Both Western Europe and in Eastern Europe, lower cardiovascular disease mortality is
linked to behavioral changes at the population level in terms of diet and smoking. In Western
Europe, there is also a reduction in the incidence of heart disease and stroke, but in other
countries, mainly in Eastern Europe and Spain, the incidence of heart disease is increasing.
(European guidelines for prevention cardiovascular disease in clinical practice-2007).
European Union Directives, especially the 2004 EU Council conclusions on promoting
heart health, emphasizes the importance of action at the population level both individually and
in particular by identifying individual risk factors.
Council Conclusions are adopted under the Irish Presidency and the European
Commission calls on Member States to ensure that appropriate measures are taken to address
cardiovascular disease.
Luxembourg Declaration, adopted under the Luxembourg presidency, has established
an agreement between representatives of the Ministry of Health, and national representatives
of European Societies of Cardiology and Foundations in the field of cardiology attending the
meeting in Luxembug. This agreement refers to initiating or strengthening tracking
cardiovascular prevention plans and to ensure that all European countries are implemented
effective measures are taken all the political and interventions required in this regard. Several
resolutions of the World Health Organization have been taken to effectively address
cardiovascular disease.
Furthermore, the purpose of health protection and improvement of quality of life in the
European population by reducing the impact that cardiovascular diseases were registered in
the European Union Pact and objectives of the Lisbon Agenda the European Union. This is
stipulated in the regulations and the integration of these measures in the health programs of
the Member States, expressed the European Council conclusions of 30 November 2006 under
the Finnish Presidency.
Cardiovascular disease is a multifactorial condition and it is essential that all
determinants of cardiovascular risk factors to be treated at both the individual and social.

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 Characteristics associated with cardiovascular health include:
- nonsmoking status;
- adequate physical activity: at least 30 minutes three times per week;
- healthy eating habits;
- without extra pounds;
- blood pressure below 140/90 mmHg;
- blood cholesterol <5 mmol / l (<190 mg / dl);
- adequate glucose metabolism;
- avoid excessive stress.

Risk factors associated with risk for cardiovascular events can be divided into three
categories: (European Heart Health Charter of cardiovascular health-charter-2007).

Biological determinated Determinants of life style General determinants

Unmodifiable Modifiable
TA ↑ Smoking Age capital

Glucose ↑ Unhealthy diet Genre Education

Blood cholesterol ↑ Unhealthy diet Genetic Conditions of

predisposition life
Excess weight / obesity Physical Inactivity Ethnicity Conditions of
work

Risk factors may be influenced by the action:

- policy makers by providing a suitable living environment - through legislation (including
fees and marketing) or through other specific measures;
- individual, through good behavior in favor of a healthy diet, maintaining status of
unsmoker and regular physical activity;
- doctors, by supporting, identification and treatment of persons at high risk.
It is necessary to address these risk factors beginning in childhood.
Liability posed cardiovascular disease may also be reduced through early diagnosis,
proper management of illness, recovery and prevention, including advice about lifestyle
organization.
It requires consideration of patient gender issues in health and cardiovascular diseases
The main objectives of prevention of cardiovascular disease: first clinical event
reduction in the incidence of recurrence due to cardiovascular and coronary disease, ischemic
stroke or peripheral arterial disease, prevention of disability caused by an acute cardiovascular
event, sudden death, with the ultimate goal of extending survival and increased quality of life.
In terms of prevention strategies, it defines two distinct but complementary action
pathways in Achieving cardiovascular prevention: a strategy of "population" - applied to the
overall population and individualized strategy "high risk" - to patients with known
cardiovascular disease or increased risk of developing cardiovascular disease in the future.
Population strategy to promote cardiovascular health stems from the fact that
numerous scientific studies supporting the effectiveness of interventions to change lifestyle
(mainly smoking cessation, diet and increased physical activity) to reduce the risk of
cardiovascular disease development.
In this connection European Consensus Cork (Ireland) established in February 2004
stipulates the measures to be applied at the population level in each European country to

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promote cardiovascular health. The most important measures include lifestyle modifications,
as follows:
1. Recommended measures to reduce smoking:
- forbidding of the ban advertisements for tobacco / cigarettes - a priority
recommendation;
- increasing taxes on tobacco, cigarettes;
- development of legislation on banning smoking in public places;
- the obligativity of the harmful effects of tobacco on all products it
containing;
- supplement funding for programs of health promotion and smoking cessation.
2. Recommendations for optimizing diet:
General measures at European level:
- promoting trans-fats and replacing saturated fat contained in foods with mono-and
polyunsaturated fats;
- adequate supply market sales of fruit and vegetables and encourage public access to
these products
- reduce salt content in foods sold through national action and regional cooperation in
order to obtain the producers;
- promote increased physical activity in everyday life role of the European population,
to reduce body mass index.
National Strategies:
- population approach;
- multidisciplinarity integrating various sectors involved and their complementary
action;
- interventions at different levels: industrial, community, political and environmental;
- synchronization monitoring systems at EU level;
- development of individual strategies on diet and physical activity for specific
categories;
- information and continuing education.
3. Recommended measures to promote physical activity
- awareness of physical activity in cardiovascular prevention among healthcare
personnel;
- informing the public about the role of physical activity benefit from even low
intensity, which can be achieved through integrated activities in daily life;
- developing ways and means to promote physical activity with community character,
allowing direct access of all population groups regardless of age, ethnicity, social status;
- design of draft amendments to the existing infrastructure to incorporate physical
activity in everyday life (eg going to work on foot or by bicycle, the possibility of physical
activity at work);
- construction of facilities for sport and recreational physical activities, not only for
individual participation by community members but also the whole family - the development
of educational and training programs that promote physical activity necompetiţional character
and develop skills and habits necessary for life physically active;
- encouraging the elderly and other groups at high risk of complications during
exercise (eg coronary patients) to participate in physical activities specifically designed for
them, to improve quality of life and independence in daily activities;
- creation of special sports programs for people with physical disabilities.
The strategy involves both high-risk general population screening to identify patients
at high risk of developing cardiovascular disease (objective met partly by the Ministry of
Health in 2007-2008 through the National Assessment of Health Status of Population, which

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allowed identification of high risk based on laboratory tests) and recommended the
establishment of preventive strategies in patients with increased cardiovascular risk.
Identifying high-risk patients is recommended to be based on global cardiovascular
risk assessment using risk charts SCORE (Systematic Coronary Risk Evaluation), which meet
and correlate statistical data from several large European prospective studies, and allow
prediction of fatal atherosclerotic events a period of 10 years. Risk factors are taken into
account: sex, age, smoking, systolic blood pressure, total cholesterol and geographic region
(part of Romania with high-risk populations in Europe). Threshold beyond which we can say
that the patient has a high risk of cardiovascular mortality in the next 10 years is defined as
being equal to or greater than 5%. (Cardiovascular disease prevention health promotion,
2007).
Recommended preventive measures in patients with high cardiovascular risk relating
to:
- Changing lifestyles by implementing the measures listed in the population strategy;
- optimum treatment of patients with hypertension, dyslipidemia and diabetes mellitus;
- selective use of prophylactic drug therapy with proven effect in preventing CV:
angiotensin converting enzyme inhibitors, lipid lowering agents, beta blockers and aspirin.

All these measures provided for Cardiovascular Disease Prevention European Guide
(2007), reduce morbidity and mortality in patients with cardiovascular diseases and also
reduce the risk of developing these diseases.

Conclusions:
Prevention is of primary importance in cardiovascular health and social life, and thus
recognized as an essential component in the management of patients at risk or with various
forms of cardiovascular disease. Applicability prevention entire life spans, as they represent
the most effective way of reducing the risk of cardiovascular disease.
Prevention is thus the most effective long term intervention on cardiac patients and
those with multiple cardiovascular risk factors.It needs a clear and effective strategies that
combine individual attitudes (assessment, cardiovascular risk stratification, the application of
intervention, reassessment results) with the population (increased accessibility to
cardiovascular prevention measures) against a socio-political framework conducive to
national and Europe aimed at fundamentally reducing morbidity and mortality.