“Concentrate on managing high blood pressure, hyperlipidemia and diabetes, which are the root of heart and metabolic diseases”
Cardiovascular disease is ranked as the number one cause of death worldwide. The reason is that cardiovascular disease risk factors often coexist in patients, which increases the risk of cardiovascular disease. Cardiac metabolic diseases include metabolic abnormalities such as increased insulin resistance, hyperglycemia, visceral obesity, nonalcoholic fatty liver, dyslipidemia, and hypertension, which increase the risk of type 2 diabetes, including cardiovascular disease.
The risk of cardiovascular disease increases according to the interaction of cardiovascular risk factors, such as the complex entanglement of vascular disease and metabolic disease. If you have a lot of cardiovascular risk factors, even at a young age, vascular endothelial cell dysfunction worsens, develops into a chronic disease, and suffers from cardiovascular disease. Therefore, metabolic syndrome should be regarded as the root of cardiac metabolic disease and treatment patterns should be shifted to a comprehensive approach to risk factors. Hydak Cardiology Consulting Doctor Ryu Jae-chun (Ryu Jae-chun Internal Medicine Clinic) introduces the treatment and prevention methods for representative heart and metabolic diseases.
Cardiovascular disease risk factors
Cardiovascular disease has a tendency to exponentially increase the risk according to the number of risk factors expressed. In particular, when there are many risk factors such as ‘3 high’, which is the root of heart metabolic disease, ‘hypertension’, ‘hyperlipidemia’, ‘diabetes and obesity’, the risk factors mutually influence each other, exacerbating atherosclerotic plaques. increased risk of developing cardiovascular disease.
For example, the risk of cardiovascular disease is 2.8 times higher in smokers than in the general population, 2.4 times higher in diabetic patients, and 1.9 times higher in hypertensive patients. If these risk factors are expressed at once, the risk increases significantly and increases by 13 times. If lipid abnormality is added to this, the risk increases by 42.3 times, and in the case of abdominal obesity, the risk increases by 65.8 times. This means that risk factor management is essential to reduce the risk of cardiovascular disease.
metabolic syndrome
According to the Fact Sheet 2021 data of the Cardiac Metabolic Syndrome Society, the prevalence of metabolic syndrome in adults in Korea is 22.9%, and this number is steadily increasing. When looking at the prevalence of metabolic syndrome in Korean adult males, the trend is clear. It increased from 22.5% in 2007 to 27.8% in 2018, and these results show that the metabolic syndrome steadily increased from the 20s to the 40s.
Diagnosis of metabolic syndrome includes ‘HDL (High Density Lipoprotein) cholesterol level (40mg/dL for men, 50mg/dL or less for women)’, ‘blood pressure (130/85mmHg)’, ‘blood sugar (100mg/dL)’, ‘triglyceride (150mg)’ /dL)’ and ‘abdominal obesity (male 90cm, female 85cm or more)’, etc. are used, and if 3 or more of the above criteria are met, metabolic syndrome is considered.
Patients with metabolic syndrome have twice the risk of cardiovascular disease compared to the general population, and have a five times higher risk of developing type 2 diabetes. For this reason, efforts to prevent metabolic syndrome are of great help in preventing cardiovascular disease. In the treatment and prevention of metabolic syndrome, it is important to improve lifestyle to maintain an appropriate weight.
On average, an increase in body weight of 2.25 kg or more increases the risk of metabolic syndrome by 21-45%. Therefore, it is necessary to manage the weight through lifestyle changes such as diet control and exercise. However, losing weight too quickly has the potential to cause other health problems. Therefore, it is desirable to aim for a slow and healthy weight loss of 7-10% over 6 months to 1 year until the target body mass index is reached. Lifestyle recommendations for the prevention and treatment of metabolic syndrome are as follows.
1. Regular exercise: Regular exercise effectively prevents diabetes and metabolic syndrome. You should do moderate-intensity exercise at least 5 to 6 times a week, and it is recommended to do at least 30 minutes at a time.
2. Diet control: Reducing caloric intake is key to lower blood sugar and effectively improve inflammatory markers. A ‘low carb, ‘low fat’ diet and a Mediterranean diet are recommended.
3. Drug treatment: Diabetes treatment drugs ‘GLT2 inhibitor’ and ‘GLP1 receptor agonist’ have excellent blood sugar control and weight loss effects. It has a great effect in the treatment of patients with metabolic syndrome.
High blood pressure
57% of hypertensive patients also have diabetes or dyslipidemia. In order to prevent the occurrence of cardiovascular disease due to arteriosclerosis, management of hypertension should be preceded. High blood pressure management starts with lifestyle changes, including diet. If you have high blood pressure, you should choose a low-salt diet. Reducing salt intake by 4.4 g per day reduces mean blood pressure by 5.4/2.8 mmHg.
In addition, smoking cessation and managing the mass index and weight are essential. 1 kg of body weight lowers blood pressure by 1 mmHg. Aerobic exercise such as ‘breaking’, ‘jogging’, ‘biking’, ‘swimming’, ‘jumping rope’, ‘aerobic gymnastics’, etc. is recommended at least 6 times a week for at least 30 minutes at a time. Men should be less than 90 cm and women should be less than 85 cm. Alcohol consumption should be reduced to less than 40 g per day for men and 20 g per day for women.
As antihypertensive agents, ‘angiotensin-converting enzyme inhibitors’, ‘angiotensin receptor blockers’ or ‘calcium blockers’ should be considered first. If target blood pressure is not reached, combination therapy is recommended. Low-dose combination therapy and fixed-dose combination therapy can help improve patient compliance.
dyslipidemia
Dyslipidemia, one of the risk factors, is also essential to lifestyle improvement for management. For diet, total carbohydrate intake should not exceed 65% of total energy intake, and total fat intake should be limited to no more than 30% of total energy intake. In addition, dietary fiber intake should exceed at least 25g per day, and alcohol consumption should be reduced to less than 1-2 glasses per day. Regular exercise is recommended as it has the effect of lowering triglyceride levels and raising high-density diagnostic bag cholesterol.
For drug treatment, statins are used as the first-line treatment. Statins, which inhibit cholesterol synthesis in the liver, increase low-density lipoprotein (LDL) cholesterol levels. Here, ezetimibe, which has a cholesterol absorption inhibitory effect, can be used as a combination agent to supplement statins. Fenofibrate and omega-3 fatty acids are used as drugs to treat hypertriglyceridemia. Combination drugs or high-intensity statins may be administered if the treatment goal is unsuccessful. It is important to accurately assess the risk of cardiovascular disease in the treatment of maladies. Only accurate evaluation and appropriate prescription can reach the treatment goal.
The progression of atherosclerotic plaque exacerbation in cardiovascular disease is determined by risk factor management control. This means that thorough pre-management of risk factors for cardiovascular disease is important for the prevention of cardiovascular disease and improvement of prognosis. In addition to this, there is a need for interest in multi-drug combination therapy and combination drugs tailored to individual characteristics.
Help = Hidak Consulting Doctor Jae-Chun Ryu, Director
