How prevention is changing the fight against the leading cause of death in Russia

The network of vascular centers established in RUSSIA has proven its effectiveness in saving lives. Today, the state prioritizes managing risk factors and increasing patient adherence to treatment.

September 29th marks World Heart Day— cardiovascular HEALTH directly determines life quality and life expectancy. In Russia, the prevention, diagnosis, and treatment of heart and vascular diseases are a central focus of the national project "Long and Active Life."

By 2025, a large-scale infrastructure will have been created in the country: more than 640 regional vascular centers and primary vascular departments are equipped with modern equipment. Over 2.4 million patients who have undergone myocardial infarction, coronary artery bypass grafting, or coronary artery stenting have received free medications . According to Sergei Boytsov, General DIRECTOR of the Chazov National Medical Research Center of Cardiology and Chief Cardiologist of the Russian Ministry of Health, the program has proven its effectiveness: "It is especially important that therapy begins in the hospital, ensuring a seamless transition to outpatient medication administration."

Lifelong medication is provided for patients with heart failure and atrial fibrillation. As Sergei Boytsov emphasizes, studies show a twofold reduction in the risk of complications within a year in patients receiving this medication.therapy . Over five years, mortality in Russians from circulatory diseases has decreased by 15%, from coronary heart disease by 26%, and from myocardial infarction by 17%. "This confirms the system's effectiveness, despite the fact that the program's launch coincided with the covid-19 pandemic," the cardiologist notes.

Rescue Circuit: Infrastructure and Technology

The development of care for patients with cardiovascular diseases has gone through several stages. As Sergei Boytsov notes, 15 years ago, primary vascular departments predominated in the country, while regional centers capable of performing percutaneous coronary interventions were fewer.

A turning point came with the launch of the federal project "Combating Cardiovascular Diseases." "The project allowed us to completely re-equip all specialized structures, and more and more primary vascular departments were equipped with angiography systems," notes Sergei Boytsov. "But most importantly, the number of regional vascular centers increased by 45%. This created the conditions for direct hospitalization of heart attack patients to specialized centers, where coronary blood flow can be quickly restored and the myocardium preserved.

At the same time, revolutionary changes have occurred in medical technology. As Sergei Boytsov emphasizes, interventional methods now compete with open surgeries. For example, minimally invasive heart valve replacement technology, through blood vessels and without incising the chest, has removed age restrictions for surgical treatment. "Now, age 80–90 is no longer a barrier to surgical intervention," the expert is convinced.

Experts emphasize that the effectiveness of medical care in cardiovascular emergencies directly depends on the speed with which it is sought. To recognize the signs of an acute cerebrovascular accident—a stroke, for example—there's a simple rule called "HIT," where "H" stands for a smile, "D" for movement, "A" for articulation, and "R" for the immediate decision to call an ambulance. "Healthcare has very little time to provide assistance. Therefore, noticing changes in facial expression, movement, and speech in a loved one and recognizing these signs of a stroke  is the first step to saving their life," says Oleg Shtegman, Chairman of the Krasnoyarsk Regional Branch of the Russian Society of Cardiology and Department HEAD at Krasnoyarsk State Medical University.

Today, more and more citizens are aware of the early signs of cardiovascular events. This work is being carried out through federal and regional media outlets and through information provided during preventive examinations and medical checkups. According to Sergei Boytsov, while a few years ago only 10-15% of heart attack patients sought prompt help, today this figure has risen to 35%.

Prevention Outline: A Culture of Health

Experts note that the emergency care infrastructure has been created and proven effective. Now comes the task of building a preventive healthcare system aimed at reducing the incidence of acute conditions. The focus of the national project "Long and Active Life" is shifting to creating a preventive system that integrates primary and secondary measures.

According to the Ministry of Health, 40% of the country's adult population suffers from hypertension. After age 50, the prevalence of the disease increases sharply, reaching 90% among those over 80. Screening has become the cornerstone of primary prevention, notes Sergei Boytsov: "More than 80 million adults undergo preventive examinations and screenings annually, with very high effectiveness."

Public initiatives play a vital role in fostering a culture of health. As Leo Bokeria, President of the Nation's Health League, President of the Bakulev National Medical Research Center for Cardiovascular Surgery, and Academician of the Russian Academy of Sciences, notes, the "10,000 Steps to Life" and "Walking Man" projects, along with the creation of smart health routes, have spread across the country. Moreover, "they are based on the most natural and ancient health technology—walking." "When a person embarks on a health route with their family, they strengthen their heart and create a new culture—the habit of being active," Bokeria emphasizes. "This widespread participation transforms prevention from a slogan into a real force that changes people's lives."

Secondary prevention concerns people with a confirmed diagnosis. Low treatment adherence remains a serious problem here. Research shows that detailed information about the disease, trust in the DOCTOR, and support from loved ones are essential for maintaining patient motivation, says Sergey Boytsov. He also notes that advances in pharmacology are helping: combination medications combining two or three components in a single tablet and extended-release formulations (15 days to six months) significantly simplify therapy. Particular attention is paid to achieving target clinical indicators. "It's not just taking medications that's important, but monitoring their effectiveness," emphasizes Sergey Boytsov.

Hidden Risks: New Medical Targets

Modern medicine is also paying attention to less-studied markers. One such promising area of ​​research is lipoprotein (a), an independent genetic factor whose role in cardiology is being actively studied.

Lipoprotein (a), first described in 1963, is of particular interest to science, explains Elena Reznik, Head of the Department of Internal Medicine Propaedeutics No. 2 at the Institute of Cardiology and Mathematics at Pirogov University: "Modern research confirms its role in the development of atherosclerosis and thrombosis, and its atherogenicity significantly exceeds that of traditional LDL cholesterol." The relevance of the problem is underscored by the fact that elevated Lp(a) levels are found in approximately 20% of the population, the expert emphasizes. Particular attention is paid to patients with acute coronary syndrome and aortic stenosis, among whom the prevalence of this pathology is particularly high.

Active work is currently underway to integrate new diagnostic capabilities into clinical practice. As Elena Reznik notes, the primary focus is on raising awareness among the medical community and developing laboratory diagnostics. The development of targeted therapy, for which clinical trials are already underway, appears to be a promising area.

The modern approach to cardiovascular prevention is gradually expanding, incorporating new biomarkers for a more personalized approach to risk assessment and patient health management.

Educational Front: Doctors and Patients

Expanding understanding of cardiovascular risk factors requires fundamentally new approaches to medical education and public awareness.

Today, educational programs are required to be based on clinical guidelines approved by the Russian Ministry of Health, which largely focus on primary and secondary disease prevention, notes Oleg Shtegman. He says they all emphasize the need for active patient involvement in health processes: "They must become active participants in their own treatment."

Modern educational standards already include the necessary competencies. "The curricula of all specialties include competencies for promoting a healthy lifestyle and conducting public health education," emphasizes Oleg Shtegman. According to him, health management begins with behavior modification—eating habits, physical activity, and leisure activities. Then comes self-monitoring of key health parameters. And only after that comes screening for hidden health problems (medical examinations) and professional medical support.

Particular attention is paid to training. According to the expert, the university has been offering a program in "Preventive Medicine" for three years now, reflecting the growing need for specialists in this field. "Health implies a state of psychological balance. Many people need psychological support, and this has been proven in the context of cardiovascular risks," notes Oleg Shtegman.

Strategy 2030: integration and personalization

The fight against cardiovascular disease requires the combined efforts of all healthcare system stakeholders, notes Sergei Boytsov. An effective system of collaboration has been established between leading medical institutions, including the National Medical Research Center for Therapy and Preventive Medicine, the Chazov National Medical Research Center of Cardiology, and the Almazov National Medical Research Center.

Key development areas through 2030 will include increasing patient adherence to treatment, introducing screening for new risk factors, and developing personalized approaches to disease prevention and patient care.

Particular attention is being paid to creating a comprehensive health support system. As Leo Bokeria notes, it is necessary to "take heart care beyond the doctor's office and make it part of everyday life, like brushing your teeth or ventilating your room." This entails developing a health-promoting infrastructure, regular educational campaigns, and engaging volunteers and healthy lifestyle instructors.

The success of the national project "Long and Active Life" will be determined not only by the development of medical infrastructure but also by the willingness of each person to take an active role in their own health, experts say. Modern medicine, as Sergei Boytsov notes, "eliminates age barriers and allows us to provide care to a greater number of patients," but the ultimate outcome depends on the combined efforts of doctors, the healthcare system, and the patients themselves.