Dr. Penka Kamenova is a graduate of the English High School and completed her medical studies at the Medical University of Pleven. She has been the head of the Cardiology Department at the University Hospital “Kaneff” for the past 5 years.
Dr. Kamenova, is the number of Bulgarians suffering from cardiovascular diseases increasing, or is the trend stable?
Bulgaria was the country in the European Union with the highest mortality rate in 2017 – 1631 deaths per 100,000 people. Diseases of the circulatory system and cancer are the two main causes of death in the EU, with respiratory diseases ranked third, according to Eurostat data.
Following Bulgaria, Romania (1488), Latvia (1485), Hungary (1470), and Lithuania (1418) had the highest mortality rates. At the other end of the scale, the countries with the lowest mortality rates in the EU are France (838 deaths per 100,000 people), followed by Spain (844), Italy (875), and Luxembourg (911). Analysis by the statistical office shows that the main cause of death in all EU member states is diseases of the circulatory system, except for Denmark, Ireland, France, and the Netherlands, where cancer is the leading cause. The highest proportion of deaths caused by circulatory system diseases is observed in Bulgaria (66%), and the lowest in Denmark (23%). The highest proportion of cancer-related deaths is in Slovenia (32%), while the lowest is in Bulgaria (16%).
Does the average Bulgarian know how to protect their heart, and what is Bulgaria’s position in the treatment and prevention of cardiovascular diseases?
Yes and no. Behavior varies widely depending on age groups, regions, education, and especially the awareness of people regarding the importance of prevention.
Is there any positive trend? Over the past years, there has been a decrease in mortality from ischemic heart disease. Is this due to better treatment or other factors?
Diseases of the circulatory organs are the leading cause of death in developed countries. For every two out of three deaths, the cause is a cardiovascular disease. In the last 20 years, this number has halved. This is also the trend in Bulgaria. Changes in lifestyle, medication control of risk factors, new treatment methods—especially interventional techniques and the implantation of devices to prevent sudden cardiac death—contribute to reducing cardiovascular mortality. However, in comparison to other EU countries, Bulgaria’s figures remain high.
What are the symptoms of a heart attack that everyone should be aware of and take action if they appear?
Heart attack symptoms can have many “masks,” and a heart attack can even occur without symptoms or resemble a “cold.” The most typical complaints are first and foremost a typical pain with a heavy feeling across a wide area behind the sternum, which intensifies when lying down. Secondly, vegetative symptoms such as sweating, shortness of breath, and often a sense of fear. When such complaints occur, especially in people with risk factors, immediate action is necessary. Time is the most important factor in saving the heart muscle. Any delay puts the sufferer at risk of sudden death or the subsequent development of heart failure and a reduced quality of life. In the first minutes and hours of symptoms, timely action is vital – figuratively speaking, we must either save the drowning person or cut the rope of the hanging one. The quickest way to get appropriate help is to call 112. The patient should be taken to the nearest hospital with an intensive cardiology department. In the last 10-12 years, a network of interventional treatment centers has been established in Bulgaria, including one at UMHAT “Kaneff” and any town can reach such a center within 90 minutes. In this regard, we perform better than many other developed European and non-European countries.
Is there a recipe against heart attacks?
I would really like to answer with a definitive “yes.” There are measures that can drastically reduce the likelihood of a heart attack. The recipe is Prevention. There are three types of prevention: primordial prevention, which prevents the emergence of risk factors; primary prevention, which addresses risk factors to prevent the onset of disease; and secondary prevention, which aims to slow the progression of the disease and prevent recurrences. Risk factors can be divided into two groups: modifiable and non-modifiable (e.g., gender, age). Fortunately, the majority of risk factors are modifiable, meaning we can actively influence them and reduce their impact on the development of cardiovascular diseases. This includes factors like hypertension, high cholesterol, smoking, diabetes, chronic kidney disease, obesity, and reduced physical activity. These can be managed through non-medical approaches such as diet, exercise, quitting smoking and alcohol, weight reduction, and also with medications to control blood pressure, bad cholesterol, and diabetes. According to European prevention guidelines, every person over 40 years old should undergo cardiovascular risk assessment and develop a strategy for preventing cardiovascular diseases, with periodic reassessment of this risk.
What rules should patients follow after having a heart attack to ensure a long and healthy life?
After a myocardial infarction, patients undergo secondary prevention. The patient’s life after a heart attack largely depends on the treatment provided during the acute phase. If treatment is timely and adequate, the damage to the heart muscle is minimal, the heart muscle functions normally, and there is no risk of heart failure, acute arrhythmias, or sudden cardiac death. However, if treatment is delayed and part of the heart muscle is nonfunctional, the patient may experience heart failure, which needs to be properly treated. Measures that patients should follow include two groups: those that improve quality of life and those that prolong life. It is crucial to maintain blood pressure and bad cholesterol at target levels, maintain normal body weight, engage in daily physical activity, manage diabetes and kidney function, and avoid smoking and excessive alcohol consumption.
How does diet affect heart health, and is its role underestimated from an early age?
Diet and maintaining normal body weight are key risk factors not only for cardiovascular diseases but also for many other conditions, as well as for general and cardiovascular mortality. For example, countries with the lowest cardiovascular and overall mortality rates in Europe and the longest life expectancy are those where the Mediterranean diet is widespread, such as Italy, Spain, and Greece.
In general, adhering to a diet rich in fiber, excluding animal fats, offal, especially processed fats, red meat, refined sugar, and fructose, and including vegetables, preferably raw, are key to reducing the risk. The quantity of food should prevent obesity and metabolic syndrome. Physical activity, such as at least 30 minutes of walking outdoors every day, should be an indispensable measure.
As we approach the autumn-winter period, what are your recommendations for patients with health problems? Does the cold provoke instability in patients with coronary artery disease?
For reasons not fully explained, acute coronary syndromes are more frequent in the autumn-winter season. Hospitalizations for worsening heart failure also increase. There is a proven correlation between acute respiratory infections, including the flu, and acute coronary syndromes. Blood pressure control also worsens during this period. Despite these statistics, fear should not prevent proper behavior, and preventive measures must be applied. With the new global threat of the COVID-19 pandemic, it seems that all other considerations have taken a back seat. It is very important to follow the recommended measures and consult a doctor immediately if symptoms appear.
Can we say that right now we have two problems, roughly speaking, the coronavirus and fear?
Definitely yes. Fear of infection has led people to avoid visiting healthcare facilities, to self-medicate, and, to some extent, it has had positive effects—statistics show a decrease in morbidity from other respiratory infections and a reduction in overall mortality for the first six months of 2020. But there is another statistic—patients are not seeking medical help in time, arriving at the hospital in an advanced stage of the disease when sometimes nothing can be done. While the number of acute heart attacks has decreased, the frequency of surviving heart attacks and late presentations with complications has increased.
Has there been a decrease in patients seeking qualified help during the pandemic due to fear? What would you say to them?
Definitely yes. While following the recommendations to prevent COVID-19, we must not neglect the traditional recommendations for preventing cardiovascular diseases. COVID-19 infection has the highest morbidity and mortality in patients with cardiovascular diseases and diabetes. In other words, timely treatment and prevention of these chronic conditions ensures a better outcome and easier recovery from COVID-19. Of course, all recommendations for infection prevention must be strictly followed, both in healthcare institutions and outside them.
What is the attitude of patients toward preventive check-ups?
It varies depending on many factors. I believe that in recent years, more and more people are appreciating the benefits of prevention, and preventive check-ups are becoming more common.
Do you undergo preventive check-ups? Do you self-examine or trust your colleagues?
Yes. For diseases outside my expertise, of course, I rely on my colleagues.