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УДК: 616-084
CLINICAL AND EPIDEMIOLOGICAL FEATURES OF LONG-LIVED PATIENTS
WITH ISCHEMIC HEART DISEASE AND STRATEGIES FOR IMPROVING
DIAGNOSIS AND PREVENTION
Rakhmatova Dilbar Bahriddinovna
Bukhara State Medical Institute Department of Internal Diseases in Family Medicine
dilbar_raxmatova09@bsmi.uz
Resume:
Aging is an important risk factor for coronary heart disease (CHD) because the
likelihood of cardiovascular disease increases with age. Increasing life expectancy,
especially among the elderly, is associated with an increased incidence of CHD. The main
risk factors include heredity, climatic conditions, as well as high cholesterol, diabetes
mellitus, smoking and overweight. Long-term survivors often have chronic diseases,
weakened immune system and digestive system disorders. Research on the epidemiology
and prevention of IBS in the elderly remains a poorly reported topic.
Key words:
diabetes mellitus, smoking, overweight, stress, cholesterol, hyperlipidemia,
angina pectoris.
Introduction
:Most researchers agree that aging is a significant risk factor for the
development of ischemic heart disease (IHD), as the likelihood of cardiovascular conditions
increases with age. The growing life expectancy, particularly among elderly individuals, has
been associated with a higher incidence of IHD. The main risk factors include heredity,
climatic conditions, high cholesterol levels, diabetes mellitus, smoking, and excess div
weight. Long-lived individuals often suffer from chronic diseases, weakened immune
systems, and impaired digestive function. This underscores the need for a more in-depth
investigation of the clinical and epidemiological characteristics of IHD and the optimization
of methods for early diagnosis, prognosis, and prevention in older age groups.
Objective of the Study:
To determine the prevalence of obesity, arterial hypertension, and
small intestinal bacterial overgrowth syndrome (SIBO) among patients with low
cardiovascular risk according to the SCORE scale.
Materials and Methods:
The study included patients without signs of atherosclerosis,
classified as having low cardiovascular risk based on the SCORE scale. Abdominal obesity
was defined according to the IDF 2023 criteria. All participants underwent a comprehensive
clinical examination, including lipid profile analysis and glycemic level assessment. SIBO
was diagnosed using the hydrogen breath test with lactulose.
Results:
Recent studies emphasize the significant role of both internal and external risk
factors, as well as climate-geophysical and atmospheric processes, in the development of
ischemic heart disease (IHD). Older adults and long-lived individuals exhibit specific
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physiological characteristics: they are more prone to chronic diseases, weakened immune
function, reduced metabolic rate, and digestive system disturbances. Common health issues
among long-livers include immune suppression, cardiovascular and neurological disorders,
and impairments in digestion and sleep. The most prevalent cardiovascular diseases in this
population are hyperlipidemia, angina pectoris, myocardial infarction, hypertension, and
stroke. Major risk factors for the development of IHD include high cholesterol, diabetes
mellitus, smoking, excess div weight, and stress. Despite the increasing number of long-
livers, the epidemiology and prevention of IHD in this group remain insufficiently studied
and underreported. Ongoing preventive and therapeutic interventions for cardiovascular
diseases have contributed to changes in the age structure of the population.
According to forecasts, by 2030 the proportion of individuals above working age in the
Russian Federation will increase to 29.1% of the total population. Consequently, the
prevalence of ischemic heart disease (IHD) is expected to rise. In this context, one of the
most important areas of focus becomes the assessment of the contribution of risk factors
(RFs) to IHD morbidity and mortality among the elderly population. A distinct feature of
this age group is the simultaneous presence of multiple RFs, which tend to amplify each
other’s effects. Nevertheless, the prevalence of arterial hypertension and obesity increases
with age, whereas the proportion of smokers and individuals with hypercholesterolemia
tends to decline. Additionally, the correlation between certain RFs and mortality weakens
with age, which is attributed to the “survivor effect”—the early mortality of individuals with
a poor prognosis. These specific features of IHD progression in the elderly highlight the
necessity of developing an integrated methodological approach to the organization of
medical care. [1]
The study included 45 patients (mean age 91 ± 9 years; BMI 27 ± 5 kg/m²; 47% women).
The mean lipid profile values were: total cholesterol (TC) 5.4 (1) mmol/L, LDL cholesterol
3.8 (1) mmol/L, HDL cholesterol 0.98 (0.3) mmol/L, triglycerides (TG) 2.5 (0.5) mmol/L,
and glycemia 5.3 (0.2) mmol/L. Abdominal obesity was observed in 27 patients (60%),
among whom 11 (41%) were overweight and 12 (44%) were obese. The mean waist
circumference (WC) in the group with abdominal obesity was 91.5 (7) cm for women and
103.8 (9) cm for men. Small intestinal bacterial overgrowth (SIBO) was diagnosed in 13
patients (29%), 7 of whom also had signs of abdominal obesity. Stage 1–2 arterial
hypertension was identified in 45% of participants. Correlation analysis revealed that the
presence of SIBO was associated with elevated high-sensitivity C-reactive protein (hsCRP)
levels (r = 0.3; p < 0.05), while abdominal obesity was significantly associated with arterial
hypertension (r = 0.6; p < 0.05), myocardial hypertrophy (r = 0.5; p < 0.05), dyslipidemia (r
= 0.4; p < 0.05), and elevated hsCRP levels (r = 0.4; p < 0.05).
Most researchers agree that aging can be considered a significant risk factor, as there is a
direct correlation between the incidence of ischemic heart disease (IHD) and the age of the
population. The observed increase in life expectancy is largely attributed to a decline in
mortality rates among older age groups, primarily from IHD [2]. There are more than a
hundred theories explaining the causes of aging, with heredity and environmental factors
being the most widely accepted. The hereditary theory posits that aging is an intrinsic
property of the organism: over time, the biological processes of regression — growth,
development, maturity, aging, and death — are inevitable outcomes. In recent years, the
observed increase in life expectancy and aging of the population — including in Uzbekistan
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— has been accompanied by a rise in cardiovascular diseases, particularly a growing
prevalence of IHD. As a result, the study of the modern clinical and epidemiological
characteristics of IHD, as well as the development of effective approaches for early
diagnosis, prediction, and prevention in elderly populations, has become increasingly
relevant.
Recent studies emphasize the significant role of internal and external risk factors,
including climatic, geophysical, and atmospheric processes, in the development of ischemic
heart disease (IHD). Elderly individuals and long-livers exhibit specific physiological
characteristics: they are prone to chronic diseases, a decline in immune system function,
reduced metabolic rate, and alterations in digestive system function [3].
In other words, the main health issues among long-livers include weakened immune
function, diseases of the cardiovascular and central nervous systems, digestive disorders, and
sleep
disturbances.
The most common cardiovascular conditions affecting long-livers are hyperlipidemia,
angina pectoris, myocardial infarction, hypertension, and cerebral infarction. These
conditions are characterized by high prevalence, significant disability rates, substantial
healthcare costs, and a notable decrease in quality of life. Key risk factors for the
development of IHD in long-lived individuals include elevated cholesterol levels, diabetes
mellitus, smoking, overweight, and stress.
Despite the steadily growing population of long-livers, the epidemiology and prevention
of ischemic heart disease (IHD) in these groups remains a relatively underexplored and
underreported area of study. Prevention of IHD is typically categorized into primary and
secondary
prevention
strategies
[3].
Primary prevention
aims to prevent the development of atherosclerosis and IHD by
eliminating
or
mitigating
modifiable
risk
factors.
The main reversible risk factors include smoking, arterial hypertension, and hyperlipidemia
(elevated cholesterol levels).
Conclusion
.The group classified as having low cardiovascular risk according to the SCORE
scale is heterogeneous. Abdominal obesity and its associated markers of inflammation and
atherogenesis are significant indicators of this heterogeneity. The identification of non-
traditional risk factors among asymptomatic patients highlights a higher-than-expected risk
of cardiovascular disease within this population.
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