Prof. Dr. Borislav Georgiev is the chief assistant at the National Cardiology Hospital in Sofia. He specializes in cardiology at the Cardiology Clinic under Prof. H. Kuhn in Bielefeld, Germany. The main areas of interest in his work are related to electrocardiology, treatment of hypertension, prevention of cardiovascular diseases, epidemiology, drug therapy, etc.
Member of the Society of Cardiologists in Bulgaria (DKB), the European Society of Cardiology, the International Council of Electrocardiology, as well as the New York Academy of Sciences.
He was a member of the board of the international organization "Neart Friends Around the World". He has participated in several working groups of the American Heart Association. His biography was published in 1998 in the book "Five Hundred Leaders of Influence" by the American Biographical Institute, and in 1999 in the book "The First Five Hundred at the New Millennium" by the International Biographical Center in Cambridge.
Prof. Dr. Borislav Georgiev is the editor-in-chief of the "Nauka Cardiology" magazine and the chairman of the "Academy of Cardiology" Foundation. Participates in editorial boards of some Bulgarian scientific journals. He participates annually as a lecturer at Bulgarian and international scientific forums with a cardiology focus.
Has published abstracts in leading journals. For his scientific developments, he was awarded a young scientist award at the XX International Congress of Electrocardiology.
For the third year in a row, a Scientific-Practical Conference on problems in the approach to the therapy of the elderly was held in our country in February. Are there specialists in geriatrics in our country who can take care of Bulgarian patients in old age?
What are the goals of the treatment of the elderly and why it differs from other age groups, we talk to Prof. Dr. Georgiev, cardiologist.
Prof. Georgiev, what are the main problems with aging and longevity from your point of view as a specialist?
- Aging is inevitable. In aging, there is a progressive decline or loss of physiological functions at the molecular, cellular, and whole-organism levels, resulting in increased susceptibility to disease and death.
This is the result of both environmental and genetic factors caused by DNA damage and genetic dysregulation.
Normal aging is associated with physiological and structural changes in organs and systems. Centenarians are on the rise globally.
Do we age the same way?
- There are different types of aging and distinctions must be made between chronological aging and other forms, namely biological, social and psychological. Chronological aging refers to how old a person is. Biological aging is the physical condition of aging. Social aging is how one should respond socially. The different types can occur singly or in combination.
Prof. Dr. Borislav Georgiev
Do genes determine life span?
- Many studies are being done today as to why more people are living to be 80, 90 or 100 years old. Genes may not be entirely responsible for this. There are other conditions, such as epigenetic factors, environmental and lifestyle factors, the latter extending longevity in all phases of human development.
A proper understanding of normal age-related changes and their significance is necessary to develop appropriate corrective and treatment strategies.
Is there a difference between these changes occurring with age and diseases of old age?
- Changes associated with aging must be distinguished from age-related diseases. Aging-related changes can adversely affect he alth and functionality (requiring therapeutic strategies), predispose to disease (need for adult risk assessment), and interact with disease, resulting in altered disease presentation, response to treatment and the results.
People over 65 are the fastest growing age group not only in the United States but also in Europe. According to UN forecasts, in some developed countries in 20 years they will make up about a third of the total adult population. And experts point out, there is only one way out: to make the elderly he althy and active. Is this possible to achieve and how?
- It is possible with the help of he alth strategiesFirst, prevention should be developed in the elderly and old people. It is also, as in young people, related to the control of risk factors and screening for early detection of the diseases of old age. It is also very important to conduct rehabilitation programs - stimulation of motor activity and walking (especially for the elderly).
To achieve such longevity in good he alth, which diseases require a more specific and individualized approach to the elderly?
- Diseases in old people are treated in the same way as in young people. But, in old people we observe polymorbidity (they have several diseases) and therefore there should be a complex and individual approach to treatment.
This is particularly important in the evaluation of drug interactions, as well as for drug dosing according to altered metabolic processes in the elderly.
What are the latest recommendations in the treatment of arterial hypertension and diabetes mellitus at this age?
- The hypertension recommendations of recent years are not much different for the elderly. If we start therapy over the age of 80, it is done at an arterial pressure above 160/90 mmHg.
And in the course of treatment, the pressure should be lowered below 140/80 mmHg, but only if it is well tolerated (no orthostatism, no staggering or memory changes). If the achieved pressure is not well tolerated, it should be maintained higher.
In addition, many drugs are dosed according to kidney function. And, if it is greatly reduced, doctors should administer reduced doses or change the drug, which is contraindicated in suppressed renal function (for example, a thiazide diuretic is replaced by a rimkov).
What advice can you give to an elderly patient after a heart attack so that he can recover faster and more fully?
- To take the prescribed medicine and to move. Don't lie down. And visit your doctor more often
Exercise, losing weight, reducing the consumption of s alt and heavy foods reduce the risk of cardiovascular diseases by 10-15%. Unfortunately, the Bulgarian is not taught to protect his heart - education in a he althy lifestyle starts from early childhood.
Has your attitude to cholesterol changed?
- Mine hasn't changed, but many people don't pay much attention to cholesterol. It is controlled by diet and medication (not supplements). The best statin for the elderly is atorvastatin. The others are applied according to kidney function.
Most elderly people have a “bouquet of diseases” take medicine by the handful? You mentioned the so-called polymorbidity. Medicines, in turn, have their side effects - the more medicines, the more side effects. A vicious circle ensues. Is there a way out of this situation?
- In this situation, the individualized approach is applied - drugs are prescribed that can affect several diseases or drugs are not administered that would worsen one of the diseases. But this is true for all cases of polymorbidity (and at a young age).
The longevity industry is actively developing worldwide today. Modern biotechnologies provide new approaches to solving the problems of aging, leading to an increase in the quality of life at every age. Are there promising and new developments in the direction of "eternal youth"?
- Eternal youth is movement, drinking water, treating all diseases, limiting all supplements and herbs (which can negatively affect medications) and seeing a doctor more often.
According to one of the main theories, aging is a chronic inflammatory process. And one of the most promising drugs for eternal youth are those that counteract inflammatory processes. Do you share this opinion? Is old age a disease?
- Old age is not a disease. The inflammation is valid for both young and old, according to the disease present. Antioxidants have not proven effective in the elderly (and in the young as well). There is no medicine for eternal youth!
Does man have a slow suicide program? Do we carry within us the "seeds of death"?
- This is cell death. There are cells that reproduce and cells that do not. Now they are working on the subject of stem cells (everyone has them inside and they help a lot). It is important not to stimulate cell death - for example, by smoking and smoking cigarettes, by consuming harmful foods (very fatty and high-calorie). There are genes for longevity, but they are not everything. There are many other factors that reduce life expectancy.
You mentioned that there are longevity genes. Are there statistics on how many centenarians there are in Bulgaria?
- Two years ago, when we discussed them from the point of view of the search for a gene that has not yet been discovered, there were more than 10 in Bulgaria. There is currently a great deal of discussion going on and looking for the reason for longevity. And she, most likely, is not one. It is researched on a global level whether there is a genetic predisposition.
Now we have new therapies called gene therapies. If we find any possibility of gene modification, these therapies can be thought of to extend people's lives.
Other problems are related to the hormonal system, to hormonal aging. All this is discussed at our conferences, but there should be a speci alty, a whole field of medicine, which is fully engaged in the diagnosis and therapy of diseases in the elderly.
We are going slowly and slowly, because first of all - doctors have to get used to the fact that the senile organism is not the same as the old one - that is, it is not an aged young organism, but a changed physiological organism. And from there, it should be well known.
Do we already have specialists who are dedicated to the diagnosis and treatment of the elderly in our country?
- We don't have geriatricians and gerontologists. This speci alty existed before in our country. There was also an institute of geriatrics and gerontology. People around the world continue to deal with geriatrics and gerontology, but unfortunately in Bulgaria the specialists in this field have slowly and gradually decreased
This speci alty is not recognized, supposedly there was no interest in it. The he alth care system is structured in such a way that it is not aimed at old age, but at nosologies, and from there a vacuum has gradually been created in the field of geriatrics and gerontology - that is, the science of diseases in people over 80 years old.
Now this activity is in the hands of GPs and many specialists who treat the elderly. Therefore, doctors need to know the problems of aging and know how to diagnose and treat diseases in the elderly. Our aim is to provide the comfort of life in he alth.
What do you put in the concept of "comfort of life in he alth" for elderly patients?
- We talk about a good quality of life because there are diseases that are characteristic of old age and which, if we do not treat them, may worsen the quality of life of the person.
Therefore, one of our goals is not only to extend life, because it already has an average duration of over 80 years, but also for the patient to live a quality life - i.e., we can afford a slightly higher blood pressure pressure than it is in the young person, but the patient should not be deafened, for example.
Don't forget your medicines, don't forget your house… We discussed these things and will continue to do so every year. The conference is large and multi-faceted. Every medical field is relevant to geriatrics.
