How about prevention?
Prevention in medicine – the very thought, a yellowed sheet of a sanitary bulletin with official text and a set of banal advice and moralizing forlornly hanging on the wall in the clinic, comes to mind. Indeed, the ideas of medical prevention are declared in TV programs, in newspapers, magazines and even on cigarette packs, but in real life this does not change much in our usual (and often unrighteous) stereotypes of nutrition, physical activity, personal communication, leisure activities, sleep and rest patterns, bad habits, etc.
This is especially true for chronic cardiovascular disease which develops for a long time, sometimes several decades before the first clinical manifestations and a much-needed, but belated visit to a doctor. There is no doubt that the pandemic of cardiovascular diseases which has engulfed the entire modern civilized world (excluding the underdeveloped areas of Africa and Southeast Asia) has deep roots which lie not so much in the field of medicine as in the economy, ecology, modern lifestyle and social and personal psychology of the people. The fight against these diseases is a nationwide program for the improvement of society and goes far beyond narrowly specialized medical topics.
A sharp change in traditional nutritional stereotypes, a decrease in physical activity, an acceleration in the pace of life, a complication in labour activity and the mentality of a person in the 21st century have led to many undesirable consequences for health referred to in medical literature as “diseases of civilization”. They can equally be called “diseases of degeneration”, referring to the physical degeneration of a person as a biological species which, in its desire for a satiated and comfortable life, has violated the laws of biological existence commanded by nature and the experience of previous generations.
This category of diseases includes not only atherosclerosis in all its clinical manifestations, but also arterial hypertension, diabetes mellitus, osteochondrosis, arthrosis, osteoporosis, gout, cholelithiasis, vascular dementia, Alzheimer’s disease, Parkinson’s disease, constipation, impotence, premature ageing, etc., etc.
When it comes to the price that humanity is paying for an unprecedented rise in cardiovascular disease in the modern world, it is in the tens of millions of victims. Indeed, every 26 seconds somewhere in the world someone suffers from myocardial infarction and every 40 seconds a stroke which often results in death. These medical terms have long become familiar words of everyday speech. But human psychology is such that we are not ready to personally take the tragedies that happen to our acquaintances, friends, colleagues and relatives. When we think about ourselves, objectivity fails us. And the ability to learn from others and not from your own mistakes, as you know, is a sign of an intelligent person. As the English poet and preacher John Donne (1572 – 1631) once wrote: “The death of every Man detracts from me, for I am one with all Mankind and therefore never ask for whom the Bell tolls: it tolls for You.” That is why, when we see an ambulance flying at a crossroads with a flashing light and a siren blaring, we can definitely say, to paraphrase an English poet, “Don’t ask who the ambulance siren is howling for: it is howling for you.”
Each of us, having a natural mind, common sense and freedom of choice, can determine at what point in his life path he is “here and now.” A person always has the right to choose his actions and his own fate and health depend on the correct choice in life.
It has been proven that the use of current available methods for the prevention of cardiovascular accidents can increase life expectancy by 10, 20 or 30 years. Ignoring the achievements of science and the laws of nature, we shorten our lives by about the same time. It is for this banal reason (a disregard for one’s own health) that a person genetically programmed for 90 – 100 years of earthly life runs the risk of living 2 – 3 times less.
For example, in Russia the number of victims of cardiovascular diseases is the highest in Europe (about 1,000,000 annually). But how often is the fate of an individual lost behind dispassionate statistics and life tragically cut short by a cardiovascular catastrophe, leaving an unhealed scar in the memory of the people close to him. As the poet Heinrich Heine wrote: “Every person is a world that is born with him and dies with him; under every tombstone lies a world history.”
Each of us perceives the statistics of death in a completely different way – closer, sharper and more emotionally when it comes to our near and dear ones. It indicates that out of five living adults, three people will die from heart disease, one from cancer, and all other diseases and syndromes (there are about 10,000 of them) account for the remaining 20% of the total number of deaths.
According to scientists if it were possible to save humanity from a pandemic of diseases of the cardiovascular system average life expectancy would increase by 8 years. For comparison: the total victory of mankind over cancer would be marked by an increase in life expectancy of 3.5 years.
In science, as in life, when analyzing any events and phenomena it is sometimes difficult to distinguish where the cause and where the effect is. We are often misled by the ancient Latin wisdom “Post hoc ergo propter hoc” (after this, then because of this). Moreover, unlike simple everyday situations, it is a hundred times more difficult to analyze phenomena of a biological nature where the structural and functional integrity of a living organism is determined by the incomprehensible complexity of an organization, multi-level systems of regulation and the metabolic perfection of biochemical processes honed by millions of years of evolution. Here is an example: the complex processes of cholesterol biosynthesis in a negligibly small volume of the cell run in parallel and synchronously with 4500 (!) other vital biochemical reactions. Only our worldly and understandable craving for simplification and an unwillingness to look at the root of the problem allows us to take the obvious (in the literal sense of the word) phenomenon for truth, while the underlying pathogenetic mechanisms of the disease remain beyond our understanding.
Recall the famous expression of Rene Descartes: “De omnibus dibutandum” (question everything). This fully applies to the problem of atherosclerosis, the hypotheses of its occurrence and progression, analysis of the reasons why atherosclerosis from a rare disease in past centuries has now turned into a global non-infectious epidemic that has engulfed all industrialized countries. Every researcher faced with this problem faces many questions.
What is atherogenesis: is it a natural process of the natural ageing of the body (as, for example, our outstanding academician I.V. Davydovsky believed) or a disease caused by the entourage of a modern, “civilized” way of life alien to the biological nature of a person?
What underlies atherosclerosis: impaired cholesterol metabolism or the cumulative effect of more than two hundred risk factors described in the literature? Which ones are leading and which are secondary?
Is there a single key to the treatment of atherosclerosis and where can we expect success: in the widespread use of statins with fibrates, the miracles of coronary surgery or a radical rethinking of consumer attitudes to their own health and lifestyle. And is it worth opposing these two paths?