Prevention and modern treatment are the weapons of cardiologists in the fight against cardiovascular disease

Every year on 29 September we celebrate World Heart Day. The motto in 2024 is “Act with Heart”, a call expressed in a petition that focuses political and public attention on improving access to prevention, diagnosis and treatment of cardiovascular disease. They claim over 20.5 million lives a year and are the undisputed number 1 killer, leading the black statistics ahead of all forms of cancer and chronic respiratory diseases combined. On this occasion, we talk to Assoc. Prof. Dobri Hazarbasanov – one of the leading cardiologists in the country, head of the cardiology department at the high-tech hospital complex ‘Heart and Brain’ in Burgas.

According to the World Heart Federation, 80% of premature deaths due to cardiovascular disease can be prevented. What are the steps?

Over the past 50 years, thanks to large randomized and epidemiological studies, it has been established which treatments improve the survival of patients with cardiovascular disease (CVD). Their effective implementation in North American and Western European countries has led to a significant reduction in CVD mortality. Lifestyle changes are key: increased physical activity, smoking cessation and limiting intake of carbohydrates and saturated animal fats. A huge role is also played by the effective organisation of emergency medical care, intensive cardiac care units, patients’ access to modern diagnostic and therapeutic methods: echocardiography, cardiac catheterisation, coronary angiography and percutaneous coronary intervention (PCI), coronary by-pass surgery, implantation of pacemakers and defibrillators. This is an established standard of medical management that, together with effective medical therapy, has led to a fourfold reduction in CVD mortality in the United States over 40 years. Of course, this is possible when therapy is truly administered according to medical standards and recommendations and all patients have access to it. This includes: beta-blockers, PCIs, thrombolytics, statins, ACE inhibitors, widespread use of aspirin for secondary prevention in acute myocardial infarctions, effective control of arterial hypertension, SGLT-2 blockers, MRA antagonists, mechanical thrombectomy in acute ischemic stroke.

The Bulgarian Heart Institute has been working for 15 years to improve access to specialised treatment for CVD.

Yes, this is our long-term goal – 15 years ago a structure of centres was established, available 7 days a week, 24 hours a day, for the treatment of Acute Myocardial Infarction/MI/, centres for endo-vascular therapy of peripheral arterial disease. Since 2 years, high-tech hospital complexes ‘Heart and Brain’ in Pleven and Burgas for treatment of acute stroke with thrombolysis and mechanical thrombectomy are functioning. Patients have permanent access to specialists: cardiologist, cardiac surgeon, vascular surgeon, neurologist and neurosurgeon and outreach examinations in small settlements.

As every year, the Bulgarian Cardiology Institute will celebrate September 29 with a number of activities in the cities of Burgas, Pleven, Yambol, Varna, Veliko Tarnovo, Shumen.

How do modern diagnostic methods change the approach to treatment?

The application of the latest as well as established modern methods in the diagnosis of CVD is a condition without which effective treatment cannot be carried out. This is based on the work of our multidisciplinary teams with the latest generation of imaging and diagnostic equipment for interventional cardiology, vascular surgery, and endovascular interventions, neurointerventions (mechanical thrombectomy), electrophysiology, performing coronary and valvular cardiac surgery with classical and endoscopic access and hybrid approach for revascularization, transcatheter valve interventions (TAVI) – all in one place.

The leading cardiac surgeon from ‘Heart and Brain’ Burgas, Assoc. Prof Kornovski, is an expert in valve and coronary surgery at the European Heart Association and STS and his team works in collaboration with Thierry Carrel from Switzerland. I myself have worked as a proctor for TAVI implantations in the UK, Morocco, RSM, Lebanon, Cyprus, Romania, Ukraine, Iran and Bulgaria, and over the years have gained experience in interventional correction of paraprosthetic regurgitation in collaboration with Eric Eeckhout from Switzerland.

What are the most common complaints of your patients, what do they seek you for most often?

The most frequent reason why patients seek us are the manifestations of heart failure: shortness of breath, fatigue, arrhythmias. All cardiovascular diseases eventually lead to heart failure, which is the most significant pandemic in the last 20 years.

Symptoms of acute myocardial infarction are prolonged chest pain – we work daily and long-term to better inform patients, including on the Bulgarian Cardiology Institute website, and make patients aware of the symptoms, approaches, diagnoses and treatments of certain cardiovascular diseases. Over the years we have organised and successfully implemented numerous campaigns to raise awareness, prevention and control of CVD.

Symptoms of acute stroke are sudden onset of paralysis of limbs or impairment in speech, vision and/or consciousness, and we also prepare information materials on these symptoms.

In recent years, cardiologists have been sounding the alarm that cardiovascular disease is getting younger. What has been your experience?

This trend is observed all over the world. Reduced physical activity and the consumption of large amounts of high-calorie food is leading to an epidemic of overweight and obesity, which in turn is leading to the premature development of type 2 diabetes, arterial hypertension, dyslipidaemias associated with obesity – this is also a pronounced trend in children, which is particularly worrying.