By Dr. Cristhian Vallejo
Cardiovascular disease ranks first in mortality and morbidity around the world. Older patients are more susceptible to developing cardiovascular diseases because age plays a key role in the functionality of the body.
Older people are defined as a person aged 65 years or older. In 2019, a study from the American Heart Association reported that 78% of patients aged 60 to 80 years old were affected by cardiovascular diseases. The most frequent risk factors were hypertension, diabetes mellitus, obesity, smoking and age. These factors are highly associated with atherosclerosis and cardiovascular disease.
In Ecuador, especially in the coastal region, there are a number of diseases that affect the cardiovascular system, in fact, Manabí is the province with the most cases of diabetes mellitus in Ecuador.
In most cases, cardiovascular diseases are associated with a sedentary lifestyle. On the other hand, due to poor nutrition, people have become accustomed to eating at an unhealthy pace and consuming excessive amounts of salt and sugar.
Hypertension
Chronic disease, such as high blood pressure, is one of the major risk factors that we often look for because it can cause endothelial damage to the blood vessels. When blood pressure is measured at 140/90 or higher, it is considered high blood pressure.
Diabetes Mellitus (DM)
Diabetes mellitus is a silent and multifactorial condition. In 2020, the World Health Organization (WHO) reported that an average of 422 million adults have been diagnosed with diabetes, an increase from previous years. The most frequent form is Type 2 Diabetes Mellitus (T2DM).
Chronic hyperglycemia is associated with other metabolic changes related to DM and predisposes patients to several possible injuries, which could cause life-threatening complications.
Obesity
Obesity is a global health issue and patients with obesity are at major risk for developing cardiovascular disease, diabetes mellitus, gastrointestinal disorders and respiratory problems.
Obesity is measured by Body Mass Index (BMI). BMI is calculated by dividing your body weight by the square root of your height. It is measured in kg/m². A healthy weight as defined by the BMI scale is 18.5 – 24.9 kg/m2.
Smoking
Smoking is another risk factor for cardiovascular diseases, lung diseases, and cancer. It is one of the major causes of mortality and morbidity, every year thousands of people die because of smoking.
How can you prevent cardiovascular disease?
Diet
Mediterranean diets
Dietary Approaches to Stop hypertension (DASH)
Vegetarian diets
Exercise
30 min/day or 150 min/week of moderate to intense exercise is recommended. Physical exercise in older patients helps with cardiovascular risk and general quality of life.
Types of physical activities:
Walking
Aerobics
Balance
Strengthening
Flexibility
Influence on Cardiovascular risk:
Improves blood pressure control
Decrease risk of coronary and peripheral artery disease
Improves cardiac output
Improves symptoms (angina pectoris, palpitations, exertional dyspnea)
Improves walking distance
Lowers BMI
Glycemic control
Influence on the general quality of life:
Improves cognitive function
Improves sleep quality
Decreases pain and improves function in osteoarthritis
Hypertension control
Goal 130/80 mm/hg or fewer
Lifestyle + pharmacotherapy
Diabetes management
Goal HbA1c of -7% if it can be achieved without hypoglycaemia
Consider SGLT2 inhibitor and GLP1-RA for CVD prevention
Cholesterol
High dose or maximally tolerated statin for LDL reduction of +=50%
Goal LDL -1.81 mmol/l per AHA/ACC guidelines
Ways to stop smoking
Counseling
Pharmacotherapy
Routine check-ins with your general practitioner
Conclusion
In conclusion, cardiovascular diseases are a major reason for disability or mortality among older people. Therefore, it is important to make the necessary changes to prevent these diseases. One could consider making a schedule of daily activities, which includes physical activities for at least 30 minutes a day. Dietary changes could also be made such as avoiding excessive consumption of salt, sugar, and highly seasoned foods. A typical meal should include fruit, protein, carbohydrates, and vegetables. Additionally, by reducing body mass index, we contribute to a significant reduction in cardiovascular risk and may prevent a disease that can affect our quality of life. Lastly, it is important to carry out routine medical check-ups with your trusted doctor so that he can guide you through treatment plans, advice or evaluations.
*The information provided in this article is for educational purposes only and is NOT medical advice. Please contact your doctor or physician for qualified medical advice, diagnosis, and treatment specific to you and your needs.
Ecuador is a developing country, and because of this it is a country that is constantly looking for changes, improvements, and updates to its laws. No country has perfect laws, but at least in Ecuador it is evident that we are dedicated to improving. Ecuador has ranked as the second most popular country for North American retirees according to the latest edition of International Living magazine. This recognition is beginning to signal to local authorities that
being a destination country for retirees brings with it many benefits, but also many challenges, especially regarding immigration.
Since 2008, Ecuador has presented itself to the world as a country with open borders and free mobility. At the same time though, it has been adapting to the reality that we have been experiencing in recent years. This is why in 2017, for the first time, Ecuador published a Human Mobility Law that regulated all types of visas and gave a complete description of the migratory requirements for each type.
After two years of the pandemic there is no doubt that human mobility has changed, and Ecuador has not been blind to these changes. In the last five years Ecuador has had five important changes to immigration regulations and more than 50 internal resolutions granted by the Ministry of Foreign Affairs of Ecuador. In the region, Ecuador is considered one of the countries with a relatively simple and efficient immigration system, but at the same time, it is hard for all applicants to keep up with the changes.
On February 18, the regulations for the Organic Law on Human Mobility were updated again, which brought some interesting changes such as the temporary residence visa for self-employed workers (services) and the digital nomad visa. The latter being an invitation to those people who can do their work from home, so that they can come live in Ecuador.
Although sudden changes to the immigration laws in Ecuador can be deterring to North American expats, we can say with full confidence that the Ecuadorian government, even with limited resources, is always prioritizing the increase and retention of this community in our country. It is with the utmost importance that the government both prioritizes the invitation of North American expats, while also complying with internal security protocols which ensure the safety of all.
Below you will find a description and the requirements for each of the visas that are most popular within the North American expatriate community: