Cardiovascular diseases are the leading cause of death globally; they cause more deaths than all other diseases together and cover most low- and middle-income countries. Within the non-communicable diseases, cardiovascular diseases, with malignant diseases, are the cause of almost three-quarters of deaths in the European Region. The estimates show that at least 80% of all heart disease, stroke and diabetes type 2 can be prevented.
Each year cardiovascular disease is the cause of 17.9 million cases of premature death, and by 2030 it is expected that 23.6 million people will die of these diseases. This projected numbers from the World Health Organization (WHO), are expected the CVD to remain the leading cause of death worldwide.
The most common risk factors for cardiovascular diseases are: high blood pressure, cholesterol, obesity, unhealthy diet, stress, smoking, low physical activity and elevated blood sugar. A significant number of deaths attributed to smoking or tobacco, which increases the risk of death from coronary heart disease and cerebrovascular disease for 2-3 times. The risk increases with age and is higher in women than in men.
SITUATION IN NORTH MACEDONIA
In North Macedonia in 2018 from diseases of the circulatory system died 10632 people with a mortality rate of 512.1 per 100,000 inhabitants, of which 5710 were men and 5462 were women. Diseases of the circulatory system accounted for 53.9% of total mortality.
Chart 1. Structure according to cause of death in N.Macedonia in 2018
Source: State Statistical Office, 2018
The rate of mortality from circulatory diseases in Macedonia in the period 2010-2015 is still growing. In 2010 the mortality rate amounted to 538.6, and in 2015 – 576.7 per 100,000 population.
Chart 2: Mortality from circulatory diseases in N.Macedonia, 2010-2018
The specific rate by age from circulatory diseases among the population over 65 is significantly higher than the specific rate of mortality among the population of 0-64 years.
Chart 3: Mortality from circulatory diseases in N.Macedonia by age, 2010-2018
Mortality from ischemic heart disease was significantly higher among the population over 65 years compared to mortality among the population of 64 years.
Chart 4: Mortality from ischemic heart disease in N.Macedonia by age, 2010-2018
The rate of mortality from cerebrovascular diseases over the age of 65 in 2018 amounted to 821.8 per 100,000, and the age of 64 years is 18.7% ooo, of which is evident that mortality is significantly higher.
Chart 5: Mortality from cerebrovascular diseases in N. Macedonia by age, 2010-2018
In the period 2010-2015, mortality from circulatory disease is slightly higher among women than men.
Chart 6: Mortality from circulatory diseases in N.Macedonia by sex, 2010-2018
The death rate from ischemic heart disease in the period 2010-2018 was higher in men (Chart 7), while the rate of mortality from cerebrovascular disease was higher among women (Chart 8).
Chart 7: Mortality from ischemic heart disease in N.Macedonia, by sex 2010-2018
Chart 8: Mortality from cerebrovascular diseases in N.Macedonia by sex, 2010-2018
In the period 2010-2018, acute myocardial infarction participated with about 95% of ischemic heart disease and cerebral infarction and stroke, unmarked as bleeding or infarction by about 89% in cerebrovascular diseases.
According to the HFA database of WHO, in 2015 the mortality rate from diseases of the circulatory system per 100 000 population ranged from 122.0 In Spain, 152,0 in Italy, 188.0 in Greece, 191.0 in Germany, 376.0 in Hungary, 467.0 in Romania, 576.7 in North Macedonia, 635.0 in Kyrgyzstan etc.
PREVENTION AND CONTROL
Having possibility that 80% of heart diseases can be prevented, the Republic of North Macedonia is implementing measures based on the evidence in order to prevent risk factors such as tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol, timely recognition of CVD, improved treatment of secondary and tertiary level, strengthening staff, equipment, reconstruction of old and construction of new hospital facilities and other measures. The main objective is to address the growing burden of people with cardiovascular disease and reduce disability and mortality from these diseases.
PREVENTION IN PRIMARY HEALTH CARE
In recent years the country gives special importance of health promotion and disease prevention in primary care. Implementation of preventive measures and activities in order to improve health status of the population is one of the legal obligations of each physician preventive health care, and each selected (family) doctor. In this sense, the Institute for Public Health and the 10 Centers for public health, and Health centers are actively working on the implementation of campaigns, education in schools, health facilities, and other areas, production and distribution of health educational materials, organizing shares for free preventive examinations primarily in rural areas, in order to raise awareness among citizens to look after their own health.
A part of the funds that the Health Insurance Fund (HIF), pay the doctors selected for implementation of preventive measures and activities. HIF defines preventive measures and activities as preventive purposes implemented on the insured in order to prevent diseases and are intended for those who infrequent (rare) visit a doctor. Selected GPs conducted fourteen preventive purposes. Target 11 of them is:
-Preventive measures and activities for early detection of chronic diseases (CVE – cardiovascular evaluation) in the population aged 25 to 65 years for both sexes.
To implement the target 11, there are tables that contain the following features / characteristics: gender, age, tobacco use, body height, height of systolic blood pressure, laboratory findings, previous heart attack, previous stroke, hypertrophy of left ventricular determined with EKG and the presence of diabetes. For each set of features / parameters (which are also risk factors), certain additional points are collected and obtaine a total score (SCORE). Once obtained total score (SCORE), can determine the level of risk of cardiovascular disease.
With the introduction of a systematic approach in selected general practitioners in PHC for timely detection of potential risk factors and their removal could significantly prevent the occurrence of emergency cardiovascular events (heart attack or stroke), and thus the occurrence of premature death among the population .