Causes of atherosclerosis. Cholesterol doesn’t hurt

Heart and vascular diseases continue to lead among the causes of death among Russians. Why this happens and how to avoid it, explains Scientific director of the MEDSI Clinical and Diagnostic Center on Belorusskaya, Chairman of the MEDSI Academic Council, Doctor of Medical Sciences, Professor Gennady Aleksandrovich Konovalov​.

Insidious disease

Sergey Osipov, aif.ru: — Gennady Alexandrovich, how common are cardiovascular diseases in our country? What is their share in the mortality structure?

Gennady Konovalov: — In Russia, this is the main cause of death among the working-age population of both sexes aged 30 to 60 years. In 2021, they accounted for approximately 40% of all cases. The most dangerous disease in this group is coronary heart disease, which causes every fifth death in Russia.

– Why does such a misfortune arise?

— The main cause of cardiovascular diseases is atherosclerosis. Because of it, people have heart attacks, strokes and other problems. It, in turn, occurs due to the deposition of “bad” cholesterol in the vessels, which impedes blood flow and causes blockage of blood vessels. Plaques can grow and lead to blood clots. Blood clots can break off and end up where they shouldn’t: if in the brain, it’s a stroke, if in the heart, it’s a heart attack.

What are lipids?

— Why is humanity still unable to defeat atherosclerosis?

– There are several reasons. One of the main ones: cholesterol, unfortunately, does not hurt. For a long time, a person may not realize that because of this insidious disease, the blood vessels of his heart, brain, arms, legs and other organs are closing. According to statistics, every second resident of Russia has one or another lipid metabolism disorder.

— Please explain for our readers what this is.

— In the blood, cholesterol is found in complexes with other fat and protein molecules. They are called lipoproteins, and the process of transferring cholesterol to various parts of the body is called lipid metabolism.

There are many lipoproteins, about 80. There are male, female and others, but the most unpleasant of them are low-density lipoproteins and lipoprotein (a). Their excess in the body causes atherosclerosis. The rest may even be useful, as they are used by the body to create cell membranes, hormones, etc.

We know quite a lot about low-density lipoproteins: how to reduce their levels, how to treat them (for example, using statins). Less is known about lipoprotein (a), although this problem began to be addressed in our country about 40 years ago. It also causes thrombosis, heart attacks and strokes, but only about 1% of the required level is diagnosed in our country.

And there are still no effective medications to reduce its level, although many countries are working on it. This is a very “evil” lipoprotein.

However, non-drug methods, for example, the method of immunosorption of lipoprotein (a), help well against it. Essentially, this is a procedure during which the patient’s blood flows through special filters that specifically remove only “bad” cholesterol from the plasma. In an hour of operation, such a device can rid a person of 10 grams of dry matter cholesterol, and after the procedure is completed, reduce the level of “bad” cholesterol by 80%. “Good” cholesterol is returned to the body.

Final diagnosis

— Who is at risk for atherosclerosis?

– People with very high cholesterol levels who have earned it due to an unhealthy lifestyle, as well as people with diabetes. The second risk group is those to whom lipid metabolism disorders have been inherited.

First, about the first group – everything is more or less simple with it. It is necessary to eliminate the root cause of the increase in cholesterol: go on a diet, quit smoking, play sports or at least exercise… In short, lead the right lifestyle, no matter how trite.

But with the second group things are much worse. In the most unpleasant case, the child inherited the defective gene from both parents. Such children often die from a heart attack or stroke before reaching 10 years of age. But these are rare cases – approximately 1 in a million.

If only one of the parents is “to blame,” problems in children (usually in the form of coronary heart disease) arise somewhere around the age of 20-30. The prevalence of this pathology is much higher – 1 case per 160 people. If the diagnosis is not made on time, the life expectancy of such people is reduced by an average of 20-30 years.

– What if it’s on time?

– If the diagnosis is made correctly and on time, everything is not so bad, there are prospects for living a fairly long life. Here, however, it is necessary to “rewind the film” slightly and remember about the ill-fated lipoprotein (a), which is found in every 6th person in Russia and also causes heart attacks and strokes. It is precisely this that largely works against people with genetically determined atherosclerosis.

– But you said that it is rarely diagnosed…

— In principle, analysis of its content is not so expensive. In any large laboratory network, together with blood sampling it costs about 1,500 rubles.

The problem is different: the low awareness of both doctors and patients that it is the cause of atherosclerosis and it must be determined at least once in a lifetime. Another thing is that in most even very good clinics it is not included in the kit for express check-up of the body. Must be ordered separately. At the same time, just last year and only in our clinic, when examining 30 thousand people for lipoprotein (a), 8 thousand cases of high levels were identified.

“Bad” and “good” alcohol

— How is atherosclerosis related to such bad habits as smoking and drinking alcohol?

— Smoking with atherosclerosis is clearly evil! However, not only with him.

With alcohol everything is more complicated. That is, if atherosclerosis is combined, for example, with diseases of the gastrointestinal tract or diabetes, then absolutely not! But if a person, apart from atherosclerosis, is not sick with anything, a glass of dry wine at dinner will not harm him.

The fact is that moderate doses of alcohol increase the level of “good” cholesterol in the body. In this case, alcohol can be partly considered harmless. Naturally, as with any medicine, an overdose should never be allowed.

Learn to heal

— Among your many scientific and administrative regalia there is this: Chairman of the Academic Council of MEDSI. What kind of organ is this?

— The Academic Council was formed by us in 2009, and we recently celebrated its 15th anniversary. This is a unique project, and for this reason. Our centers represent 35 medical specialties: surgeons, orthopedists, dentists, gynecologists, rheumatologists, neurologists and many others. The work of each of them is aimed at carrying out prevention or treating a specific person, and he, the person, is alone. So, the Scientific Council was created so that doctors of different specialties could imagine what was happening “on the shop floor” among their colleagues. After all, the volume of medical information is enormous; God forbid that you keep up with the news in your area of ​​healthcare. At the same time, at regularly held meetings of the Academic Council, the best specialists share with colleagues news about what is happening in their fields of knowledge in the country and in the world. This increases not only general erudition, but also professional knowledge, which is very important. In addition, ideas often arise at the intersection of different specialties.