Age-related changes in the cardiovascular system. Prevention of diseases of the cardiovascular system. Decreased contractility of the heart muscle

Essay

Topic: Caring for elderly and senile patients with diseases of the cardiovascular system

Completed by a student

Gr. D-106

Eshutkina Elizaveta Vladimirovna

Checked by the teacher: Vashkevich V.A.

Gomel 2016

Introduction

Age-related human development consists of the interaction of two main processes: aging and vitality. Aging is a universal endogenous destructive process, manifested in an increased likelihood of death. Vitaukt (lat. vita - life, auctum - increase) is a process that stabilizes vitality and increases life expectancy. Although not a disease, aging creates the prerequisites for the development of age-related pathology. The aging process is a continuous gradual transition from stage to stage: optimal state of health - the presence of risk factors for the development of diseases - the appearance of signs of pathology - loss of ability to work - death. The rate of aging can be expressed quantitatively using indicators reflecting a decrease in vitality and an increase in the damageability of the body. One of these parameters is age. Age is the duration of existence of an organism from birth to the present moment. The current modern age standards were adopted by the WHO Regional Office for Europe in 1963.

Age – years:

· Young age - 18-29

· Mature age - 30-44

· Average age - 45-59

· Old age - 60-74

· Senile age - 75-89

· Centenarians - 90 and older

Pathological changes characteristic of elderly and senile people begin to appear from the age of 40-50.

Just as in other age groups, the main goals of treatment in the elderly are to improve the quality of life and increase life expectancy.
What is important to know when prescribing treatment for older people?
1. Features of the course of diseases in old age (other symptoms, multimorbidity).
2. Features of metabolism in the elderly, affecting the pharmacokinetics and pharmacodynamics of drugs.
3. Features of drug administration.
4. Features of monitoring the effectiveness and safety of treatment.
Rational management of an elderly patient presupposes the mandatory achievement of mutual understanding and agreement in the triad “patient - nurse -

doctor". The degree to which the patient complies with medical recommendations is indicated by

in the medical literature the term “compliance” is used. Old age itself does not cause insufficient compliance, since the correct approach fully ensures the achievement of the latter - the use of verbal and written instructions, reducing the number of prescribed medications, preference for long-acting dosage forms and combination drugs, etc.

Anatomical and physiological changes in the cardiac vascular system in old age

The features of cardiovascular diseases in elderly and senile age are determined, like diseases of other organs and systems, by volutive processes in the body, but primarily by sclerotic damage to both blood vessels and the heart.
When the aorta, coronary, cerebral and renal arteries become sclerotic, their elasticity decreases; compaction of the vascular wall leads to a constant increase in peripheral resistance.
Tortuosity and aneurysmal dilatation of capillaries and arterioles occur, their fibrosis and hyaline degeneration develop, which leads to obliteration of the vessels of the capillary network, worsening transmembrane exchange.
The blood supply to the main organs becomes not entirely adequate.
As a result of coronary circulatory insufficiency, dystrophy develops
muscle fibers, their atrophy and replacement with connective tissue. Atherosclerotic cardiosclerosis is formed, leading to heart failure and heart rhythm disturbances.
Due to sclerosis of the myocardium, its contractility decreases, and dilatation of the heart cavities develops.
“Senile heart” (age-related changes in the heart muscle) is one of the main factors in the development of heart failure due to changes in neurohumoral regulation and prolonged myocardial hypoxia.
In old age, the blood coagulation system is activated, functional insufficiency of anticoagulant mechanisms develops, and blood rheology worsens.
In old and senile age, a number of hemodynamic features are formed: mainly systolic blood pressure increases, venous pressure, cardiac output, and later cardiac output decrease, etc.
Most often, in elderly and senile people, systolic blood pressure increases (more than 140 mm Hg) and so-called isolated systolic arterial hypertension develops. With age, the walls of large vessels lose their elasticity, atherosclerotic plaques appear, and organic changes develop in small vessels. As a result, cerebral, renal and muscle blood flow decreases.

To a large extent characterize the nature and pace of human aging. As a person ages, significant changes in the cardiovascular system occur.

Elastic arteries (aorta, coronary, renal, cerebral arteries) and the arterial wall change significantly due to compaction of the inner lining, deposition of calcium salts and lipids in the middle lining, atrophy of the muscle layer, and decreased elasticity.

This leads to thickening of the arterial walls and a constant increase in peripheral vascular resistance, an increase in systolic blood pressure, and an increase in the load on the ventricular myocardium; the blood supply to the organs becomes less than adequate.

In old and senile age, a number of hemodynamic features are formed: systolic blood pressure increases mainly arterial pressure), venous pressure, cardiac output, and later cardiac output decrease. As a person ages, systolic blood pressure can increase up to 60-80 years, diastolic blood pressure - only up to 50 years.

In men, the increase in blood pressure with age is often gradual, but in men, especially after menopause, it is more dramatic. Reduced aortic elasticity is an independent predictor of cardiovascular mortality.

In the arteries, endothelial dysfunction is noted, its production of vasodilator factors decreases, and the ability to produce vasoconstrictor factors is retained.

Tortuosity and aneurysmal dilatation of capillaries and arterioles, their fibrosis, and hyaline degeneration develop, which leads to obliteration of the vessels of the capillary network, worsening transmembrane metabolism, and insufficiency of blood supply to the main organs, especially the heart.

Veins also change as a result of sclerosis of the walls and valves, atrophy of the muscle layer. The volume of venous vessels increases.

As a result of coronary circulatory insufficiency, dystrophy of myocardial muscle fibers, their atrophy and replacement with connective tissue develops. There is degeneration of collagen, which is the main structural component.

Collagen becomes more rigid, therefore the extensibility and contractility of the myocardium decreases. Cardiomyocytes die and are replaced with connective tissue, which progresses with age.

Developing sclerosis of the heart muscle in the elderly contributes to a decrease in its contractility and expansion of the cavities of the heart. Atherosclerotic cardiosclerosis is formed, leading to heart failure and heart rhythm disturbances.

A “senile heart” is formed, which is one of the main factors in the development of heart failure due to changes in neurohumoral regulation and prolonged myocardial hypoxia.

Aortic stenosis with calcification is most often observed in old age.

In the sinus node, the number of pacemaker cells, the number of fibers in the left bundle branch and Purkinje fibers decreases, they are replaced by connective tissue.

A shift in the electrolyte balance in the muscle cells of the myocardium aggravates the decrease in its contractility, helps reduce excitability, and this causes a high frequency of arrhythmias in old age, increasing the tendency to develop bradycardia, weakness of the sinus node, and various heart blocks. With aging, systole lengthens and diastole shortens.

Structural and functional changes in the body, hormonal and metabolic disorders form the features of the clinical picture of cardiovascular diseases in elderly and senile people. With age, the neurohumoral regulation of microcirculation changes, the sensitivity of capillaries to adrenaline and norepinephrine increases.

Effect on the cardiovascular system of the autonomic nervous system weakens with age, but sensitivity to catecholamines, angiotensin and other hormones increases.

In old age, the blood coagulation system is activated , functional insufficiency of anticoagulant mechanisms develops, the concentration of fibrinogen and antihemophilic globulin increases, the aggregation properties of platelets increase - this contributes to thrombus formation, which plays a significant role in the pathogenesis

Aging of the cardiovascular system

Cardiovascular disease is the leading cause of death in older people. Coronary atherosclerosis, with and without clinical manifestations, occurs in most elderly people. Information about the important role of lipid profile abnormalities in the genesis of these changes is given above in the “Lipid profile” section.
A wide range of laboratory tests are used almost exclusively to monitor the pathological consequences of atherosclerotic lesions of the cardiovascular system (for example, enzyme testing to diagnose and determine the prognosis of myocardial infarction). Age-related changes in these indicators have certain patterns that must be taken into account when diagnosing diseases.
CK activity in women is 15-20% lower than in men in all age groups. Moreover, after 60 years, in women, CK activity decreases by 2% (in parallel with a decrease in bone mass, total body weight and physical activity), and in men by 7% (due to a decrease in muscle mass and CK activity in the myocardium). An even more pronounced decrease in CK activity is noted after 90 years, while CK-MB activity decreases so much that it cannot be detected.
With age, men and women experience a slight increase in LDH activity (in persons over 60 years of age it is increased by 10%). The spectrum of LDH isoenzymes changes somewhat due to a decrease in the LDH5 isoenzyme. AST activity changes slightly with age, as shown in Fig. 12-13 [Lapin A., 2003].

In old age, expansion of the cavities of the heart is often noted, and the contractility of the heart muscle decreases. In general, age-related changes in the cardiovascular system reduce its functional and adaptive capabilities.

By the age of 60-70, the weight of the heart gradually increases due to left ventricular hypertrophy, and then decreases slightly. In the ventricles, the upper part expands and the lower part narrows, the arterial cones lengthen. Elastic fibers grow in the connective tissue stroma of the heart, more so in the atria than in the ventricles. The endocardium thickens, and adipose tissue develops under the epicardium. In the myocardium, a decrease in the striation of muscle fibers is observed, and the size of the nuclei increases. There are two points of view regarding age-related changes in valve leaflets. Some believe that even at 70-80 years old, the collagen fibers of the valves change little; others note compaction and thickening of the collagen fibers, which leads to coarsening of the valves, their calcification and disruption of closure. The aging process gradually leads to atrophy of the papillary muscles, and therefore the atrioventricular valves appear to be directly attached by tendon threads to the compacted endocardium (Fig. 36). This unusual attachment of the valves causes, to a certain extent, their movement following the contraction of the heart, which does not happen in young people. With old age, there is a thickening of the connective tissue layer separating the atrioventricular bundle from the myocardium of the interventricular septum. In addition, polymorphic changes in Purkinje fibers (their diameter, number and size of nuclei, transverse striations of the fibers) are observed in the conduction system of the heart.

With age, cardiac colloid, which represents metabolically inert glycoprotein complexes, is deposited in the tissues of the heart. In hypertrophied hearts these deposits are more significant. Consequently, the formation of cardiac colloid depends not only on age, but also on the level of functional load of the heart. An indicator of heart aging is also the appearance of the aging pigment - lipofuscin - in the cells.
During the aging process, not only the central nervous control over the activity of the heart weakens, but also intracardiac reflexes. These changes are due to the fact that serious disturbances occur in the nerve cells located in the heart - the size, number and thickness of the processes change, and degenerated neurons appear. Changes in the chemical mechanisms of information transmission play a major role in these shifts. In the ganglia it is carried out with the participation of the mediator acetylcholine. In old age, its synthesis in the ganglia of the heart decreases. As a result of all these changes, the throughput and lability of the nerve ganglia decreases, they are tuned to lower transmission rhythms
information.
Changes in the arteries of the heart with age are characterized by coarsening of the fibrous stroma of their walls. The vessels become tortuous. Dilation of the subendocardial arteries was also noted.
Aging leads to restriction of coronary circulation and the development of heart failure. In old age, the processes of energy generation in the cell are limited; with increased function, underoxidized metabolic products accumulate in it faster, the concentration of hydrogen ions changes, the content of high-energy phosphorus compounds decreases, and hypoxia develops. Consequently, not only changes in blood supply, but also changes in metabolism can contribute to the development of coronary insufficiency in old age. In old age, the power of the anticoagulation system of the blood decreases, which contributes to the formation of blood clots, blockage of blood vessels, and the occurrence of heart attacks and strokes.
In the mechanism of coronary insufficiency, the role of a shift in neurohumoral regulation is important. Thus, in old age the content of the posterior lobe hormone increases
pituitary gland - vasopressin. Under physiological conditions in young people, vasopressin in the blood has a primarily antidiuretic effect. In old and senile age, the sensitivity of blood vessels to vasopressin increases, which creates the preconditions for a pronounced effect of vasopressin on the cardiovascular system. Its effect causes significant spasm of the heart vessels.
The smooth muscle cells of the vascular walls contain excitatory and inhibitory receptors. With old age, the number of excitatory receptors increases, and this also contributes to vasospasm. The combination of increased sensitivity of the cardiovascular system to vasopressin and its high content with an increased number of excitatory receptors creates the prerequisites for the development of arterial hypertension and coronary insufficiency.
Shifts in the blood supply to the heart become so significant that they do not even meet the reduced oxygen needs of the tissues. Myocardial infarction often causes sudden death. Disruption of heart activity is facilitated by age-related changes in cell membranes, their lipid layer, and ion channels. The rapid entry of sodium and calcium ions into the cell and the loss of potassium ions lead to gross disturbances in the rhythmic and contractile function of the heart, disruption of electromechanical coupling, cardiac arrest, and human death (Fig. 37).
The structure of blood vessels continuously changes throughout a person's life. The development of blood vessels under the influence of functional load ends at approximately 30 years of age. Subsequently, physiological growth of connective tissue occurs in the arterial wall, which leads to their compaction. In elastic arteries this process is more pronounced than in other arteries. In the main substance of the inner and middle shells, acidic sulfated mucopolysaccharides accumulate, which are associated with wave formation. After 60-70 years, focal thickenings of collagen fibers are observed in the inner lining of all arteries, as a result of which in large arteries the inner lining approaches the size of the middle lining. In small and medium-sized arteries, the inner lining grows weaker. The internal elastic membrane gradually becomes thinner and splits with age. The muscle cells of the tunica media atrophy. Elastic fibers undergo granular disintegration and fragmentation, while collagen fibers proliferate. At the same time, calcareous deposits appear in the inner and middle membranes of older people, which progress with age. In the outer shell, in persons over 70-80 years of age, longitudinally lying bundles of smooth muscle cells appear.
Currently, several signs of arterial aging are identified: 1) an increase in the capacity of the arterial bed due to the tortuosity of the vessels; 2) intimal hypertrophy, covering all its components (in the coronary arteries of the heart, the ratio of the inner shell to the middle one increases from 3:4 at 40 years to 5:6 at 50 years and 1:1 at subsequent ages), while hyperplastic processes in the intima are combined with destructive ones; 3) changes in the structure and location of endothelial cells - tile-like layering of cells on top of each other with the formation of gaps between them and partial degeneration; 4) a decrease in the number of fibroblasts and mast cells (in the adventitia of the abdominal aorta, the number of the latter decreases from 2000 per 1 mm3 of tissue at 20-40 years to 1364 at 60-80 years); 5) uneven increase in collagen content in some areas of the wall (newly formed atherosclerotic plaques contain 50% more collagen than intima); the length and diameter of collagen fibers increase.
The walls of blood vessels up to 50-60 years of life, as a rule, are moderately spasmodic; after 65-70 years, their lumen expands.
Age-related changes in veins are similar to those in arteries, but there are some differences. When there is a small number of muscle elements in the wall during aging, the perivascular connective tissue thickens. Diffuse or localized intimal thickening is observed, usually at the base of the valves or the confluence of veins. The internal elastic membrane gradually thins and straightens. Changes in the wall, along with disturbances in the outflow of blood, lead to deformation of the veins and the formation of varicose veins.
The lymphatic vessels of many organs (liver, intestines, testicle, ovary, lungs, prostate gland, etc.) in old age become covered with numerous varicose swellings and protrusions of various sizes and shapes. In places of protrusions, muscle elements in the vessel wall are sometimes absent, and the connective tissue membrane of the vessel comes into contact with the endothelium. In the wall of large lymphatic trunks and the thoracic duct in people over 35 years of age, the number of collagen fibers in the inner lining increases. This process progresses significantly towards the age of 60-70. At the same time, the number of muscle cells and elastic fibers decreases.
The capillary bed of the lymphatic system in elderly and senile age is gradually reduced, reducing the resorption surface of the endothelium and reducing the absorption of proteins, water, crystalloids, bacteria, foreign particles, etc. from tissues. This is manifested by rarefaction of the loops of lymphatic capillaries. Thus, 1 mm2 of the gastric mucosa on the lesser curvature contains in adulthood from 50 to 100 interglandular sinuses, in old age there are 20-30 of them, in old people and long-livers - only 15-25. Along the course of the lymphatic capillaries, sharp expansions are replaced by narrowings, until the internal lumen disappears.
During the aging process, the number and size of lymph nodes change. Thus, in old age the number of axillary tissues is almost halved.
nodes, inguinal nodes become smaller; the shape of the nodes from round, bean-shaped or oval turns into segmental or ribbon-like, and their sizes increase.
In the parietal lymph nodes, connective tissue often grows, and the lymphoid tissue is pushed to the periphery of the node, towards the capsule. In the visceral nodes, on the contrary, in old age and senility, compared with the mature period, the content of connective tissue decreases. The area of ​​the cortex also decreases, while the area of ​​the medulla increases.
A sign of aging of the lymph nodes is the limited replacement of parenchymal adipose tissue due to the conversion of some reticular cells into adipose cells. The cellular composition of the lymph nodes also changes: the number of macrophages, small lymphocytes and plasma cells increases. Lymphopoiesis decreases and lymph flow slows down, which ultimately leads to thinning of the pulpal cords and the cortical layer of the lymph nodes and expansion of the intermediate and portal sinuses.
In the mechanism of senile transformations of organs, the condition of the vascular bed plays a huge role. In old age, pathology of the cardiovascular system is widespread, which to this day is the real scourge of humanity, enemy number one. With aging, disturbances occur in various parts of the self-regulation of the cardiovascular system, creating the prerequisites for the development of pathology. There is an undeniable connection between arterial hypertension and the development of atherosclerosis, coronary insufficiency, and cerebrovascular accident. In patients with hypertension, myocardial infarction occurs much more often than in people with normal blood pressure. The main symptom of arterial hypertension is an increase in blood pressure.
Blood pressure is a difficult variable to regulate. It depends on cardiac output, on IOC - the amount of blood ejected by the left ventricle of the heart per minute, and on vascular tone, the gross indicator of which is the so-called TPR - total peripheral resistance. With age, blood pressure increases on its own, but does not reach the values ​​that characterize the development of arterial hypertension.
Hemodynamically, arterial hypertension in elderly and old people differs significantly from the development of this pathology in young people. In old age, “outflow hypertension” most often develops - an increase in blood pressure associated with an increase in cardiac output. However, with natural aging, cardiac output decreases.
With aging, oxygen starvation increases, and this leads to a compensatory increase in blood pressure. However, age-related changes in the capillary wall and cells prevent the absorption of oxygen. Moreover, the increase in pressure itself can damage the vascular wall. Thus, an adaptive shift has arisen (increase in blood pressure), and the signal to achieve an adaptive effect (elimination of oxygen starvation) does not come from the tissues. Thus, the adaptive can turn into pathological.
In old age, the concentration of the neuropeptide, substance P, in the blood decreases. It has a pronounced vasodilating property. An increase in vasopressin and a decrease in the concentration of substance P also contribute to the occurrence of hypertension.
The problem of the relationship between aging and atherosclerosis is particularly acute. Atherosclerosis and its manifestations are one of the main causes of death in elderly and old people. Studies conducted in the USA and a number of European countries using the same design revealed lipid deposits in the intima of the aorta in 100% of both sexes starting from the age of 10. At 10-19 years of age, fibrous plaques are found in the abdominal aorta in 16%. In men aged 10-19
years, lipid stains of the inner lining of the aorta occupy 9.9%, in women - 17.1%. The total area of ​​atherosclerotic changes in the coronary arteries in men increases from 2-3% of the intimal surface at the age of 10-19 years to 60-62% at the age of 80-89 years. All this emphasizes the validity of A.M.’s statement. Wichert that the center of gravity of modern research on atherosclerosis in humans should be transferred to the study of childhood and adolescence, since with developed atherosclerosis, that is, at 40-50 and even 30-40 years, it is difficult to identify what is leading at the stage of its occurrence , confined to the early periods of human life.

Some changes in the heart and blood vessels typically occur with age, but many other changes occur that are common age-related factors that can lead to heart disease if left untreated.

The heart has two sides - the atria. The right atrium pumps blood to the lungs to take in oxygen and get rid of carbon dioxide. The left atrium delivers oxygen-rich blood to the body.

Blood flows from the heart through arteries, which branch and become smaller and smaller as they travel through the tissues. In tissues, they become small capillaries.

Capillaries are where the blood gives oxygen and nutrients to the tissues and receives carbon dioxide and waste products back from the tissues. The vessels then begin to come together into large veins, which return blood to the heart.

Age-related changes in the heart

The heart has a natural pacing system that controls the heartbeat. Some of the pathways in this system may develop fibrous tissue and fatty deposits (cholesterol). The heart muscle loses some of its cells.

These changes can cause your heart rate to slow.

A slight increase in the size of the heart, especially the left ventricle, is not uncommon. The wall of the heart thickens, so the amount of blood the chamber can hold may actually decrease despite the overall size of the heart increasing. The heart may fill with blood more slowly.

Cardiac changes usually cause changes in the ECG. The ECG of a normal, healthy elderly person will be slightly different from the ECG of a healthy young adult. Rhythm abnormalities (arrhythmias), such as atrial fibrillation, are more common in older people. They may be caused by heart disease.

Normal changes in the heart also relate to the accumulation of the “aging pigment” lipofuscin in it. The heart muscle cells degenerate slightly. The valves inside the heart that control the direction of blood flow thicken and become stiffer. Heart murmurs are caused by stiffness of the valves quite often in old age.

Age-related changes in blood vessels

Receptors called baroreceptors monitor blood pressure and make changes to help the body keep blood pressure essentially the same when a person changes position or pace of activity. Baroreceptors become less sensitive with aging. This may explain why many older people suffer from orthostatic hypotension, a condition in which blood pressure drops when a person moves from lying or sitting to standing. This leads to dizziness because blood flow to the brain is reduced.

The walls of the capillaries thicken slightly. This may result in slightly slower rates of metabolism and waste.

The main artery of the heart (aorta) becomes thicker, stiffer, and less flexible. This is probably due to changes in the connective tissue of the walls of blood vessels. This raises blood pressure and causes the heart to pump harder, which can cause the heart muscle to thicken (hypertrophy). Other arteries also thicken and become stiffer. In general, most older people experience a mild increase in blood pressure.

Age-related changes in blood

The blood itself changes slightly with age. Normal aging leads to a decrease in the total amount of water in the body. As part of this, the fluid participating in the blood flow is reduced, so the blood volume is slightly reduced.

The number of red blood cells in the blood (and, accordingly, hemoglobin and hematocrit) decreases. This contributes to rapid fatigue. Most white blood cells remain the same, although some white blood cells responsible for immunity (lymphocytes) decrease in number, reducing their ability to fight bacteria. This reduces the body's ability to resist infection.

Impact of age-related changes

Under normal circumstances, the heart continues to supply sufficient blood to all parts of the body. However, aging of the heart may slightly reduce the ability to tolerate increased stress, since age-related changes have reduced the ability to pump additional blood into the heart, thus reducing the reserve functions of the heart.

Some factors that can increase the workload of the heart:

Some medications
- Emotional stress
- Extreme physical activity
- Disease
- Infections
- Injuries

Angina (chest pain caused by a temporary decrease in blood flow to the heart muscle), shortness of breath on exertion, and heart attacks can lead to coronary artery disease.

Various types of abnormal heart rhythms (arrhythmia) may occur.

Anemia is also possible due to malnutrition, chronic infections, loss of blood from the gastrointestinal tract, or complications of other diseases or side effects of various medications.

Atherosclerosis (hardening of the arteries) is a very common phenomenon. Fatty deposits (cholesterol plaques) inside blood vessels cause them to narrow and can completely block the blood vessels.

Heart failure is also very common among older people. In people over 75 years of age, congestive heart failure is 10 times more common than in younger adults.

Coronary heart disease is quite common, very often resulting from atherosclerosis.

Diseases of the heart and blood vessels are also quite common in older people. Common disorders include high blood pressure and orthostatic hypotension.

Heart valve diseases are quite common. Aortic stenosis, or narrowing of the aortic valve, is the most common valve disease in old age.

A transient ischemic attack (TIA) or stroke can occur if blood flow to the brain is disrupted.

Other heart and blood vessel problems include the following:

Blood clots
- Deep vein thrombosis
- Thrombophlebitis
- Peripheral vascular disease, resulting in intermittent pain in the legs when walking (claudication)
- Varicose veins

Prevention of age-related changes in the cardiovascular system

You can help your circulatory system (heart and blood vessels). Cardiovascular disease has risk factors that you should monitor and try to reduce:

High blood pressure,
- cholesterol level,
- diabetes,
- obesity
- smoking.

Eat heart-healthy foods that are low in saturated fat and cholesterol, and control your weight. Follow your doctor's recommendations for treating high blood pressure, high cholesterol, or diabetes. Reduce your tobacco consumption or quit smoking altogether.

Exercise can help prevent obesity, and it helps people with diabetes control their blood sugar levels. Exercise can help you maintain your abilities for as long as possible and reduce stress.

Regular examinations and examinations of your heart are necessary:

Check your blood pressure. If you have diabetes, heart disease, kidney disease, or other medical conditions, your blood pressure should be checked more closely.
- If your cholesterol level is normal, you should have it checked every 5 years or more often. If you have diabetes, heart disease, kidney disease, or other medical conditions, your cholesterol levels should be checked more closely.
- Moderate exercise is one of the best things you can do to keep your heart and the rest of your body healthy for as long as possible. Check with your healthcare provider before starting a new exercise program.
- Exercise moderately and within your capabilities, but do it regularly.
- People who eat less fat and smoke less tend to have fewer blood pressure problems and less heart disease than smokers who eat fatty foods.

Question: What advice can you give to people who want to lose weight?

Answer: Hello, Ksenia Sergeevna!

Question: We constantly talk about moderation. I don't think people know what moderation is. You can eat foods that you really like, but eat a little less of them. It is not at all necessary to abandon them completely. Don't even think about giving them up! It’s better to try to diversify your favorite dishes with others that are no less tasty and healthy.

Answer: Hello, Alexandra!

Question: I became a nutritionist not because I love studying nutrition, but because I love food. Ironically, while I was writing the article about stomach shrinkage, my own stomach was expanding. I gained 9 kilograms! My cholesterol level was 238! I realized that I was not following my own recommendations. I got a wake-up call after checking my cholesterol levels. Within a month I had lost 5 kilos and my cholesterol had dropped to 168. Eating a healthy bowl of oatmeal every morning was key. I added a handful of almonds, pistachios, walnuts, pecans, as well as some cherries, raspberries, and pomegranate to the oatmeal. Every day I ate this healing food. In addition, I ate three pieces of oily fish a week. I also did physical activity for half an hour every day. What is very important is that I did not give up any of my favorite dishes. In fact, on the day I was going to check my cholesterol levels again, I stopped by a friend of mine who had prepared a lunch of pork chops and various sauces. I ate one chop and realized it might not be a good idea on the day I was getting my cholesterol checked. But the best part was that my cholesterol levels dropped by 70 points. Imagine what my cholesterol level would be like if I didn't eat the pork chop first!

Answer: Good day! The concept of estrogen replacement therapy is based on this. The only difficulty is the side effects of this concept, which potentially increase women's risk of heart disease. There are estrogen-rich foods that can help keep your skin nice and soft. Soy is a good source of these substances. Beans and legumes mainly contain large amounts of phyto-estrogens. Flax is also a source of these substances. The main thing is that these products should be consumed throughout your life, and not wait until you are 50 years old. Start eating these foods from childhood, but in moderation. Many people believe that the more soy or other foods they eat, the healthier they will be. In Japanese culture, for example, soy is not a staple food. A handful of green soybeans and a small amount of tofu will be enough. You don't have to eat a whole kilogram of tofu. A lot doesn't mean it's useful.

Question: How much do genetic data influence the aging process? Is there anything you can do to control your genes?