Heart disease prevention methods

Currently, the core logic of heart disease prevention recognized in the field of global evidence-based medicine is "based on stratified risk assessment, lifestyle adjustment as the core, and supplementary drug intervention when necessary." There is no universal method that applies to everyone.

Last week I met a 32-year-old Internet executive at the cardiology clinic. His annual physical examination report was all "normal". Except for his BMI being a little too high, there was almost no problem. He recently had chest tightness for a week straight before he came for a check-up. After a coronary CT scan, 30% of his coronary artery was blocked. He himself was confused, saying that he would normally run two kilometers if he thought about it, so why did something go wrong? I looked through the lifestyle habits questionnaire he filled out: he slept an average of 4 hours a day, drank 3 glasses of ice cream a day, took out a lot of oil and salt every day, and the two kilometers he occasionally ran couldn't make up for the holes he usually made.

There are a lot of arguments on the Internet about how exercise can protect your heart. Some people say that you need to run five kilometers at high intensity every day to be effective. Some people say that taking a walk after a meal is enough. In fact, both sides have evidence-based basis. The recommendation of the American Heart Association, which has been adhered to for almost ten years, is to get 150 minutes of moderate-intensity exercise every week, such as brisk walking, cycling, swimming, and your heart rate reaches 60%-70% of (220-your age). You don’t have to be so exhausted that you can’t breathe. ； However, a new study released by the European Society of Cardiology last year also stated that for office workers who have been sedentary all year round, high-intensity intervals of about 10 minutes each time (such as running briskly for 30 seconds and walking slowly for 1 minute) are more effective in protecting the heart than walking slowly for an hour every day. But this does not mean that everyone should increase the intensity. For people with basic high blood pressure and chest tightness when they usually move, practicing blindly can easily induce aortic dissection, which is not worth the gain. I also treated a 28-year-old fitness coach last year. He applied liposuction and strength training for two hours a day for a month in order to compete. In the end, he was admitted to the CCU with fulminant myocarditis. After being rescued, he did not dare to exercise strenuously for six months. He was originally trying to protect his heart, but instead it damaged his heart. Who can you tell me about this?

There are more misunderstandings about eating. Don’t listen to the health promotion accounts that say you shouldn’t touch a bite of fat. I have a 68-year-old old patient who couldn’t live without braised pork in the past. Even after he was diagnosed with 20% coronary artery stenosis, he didn’t stop eating it. So he changed it to eating it once a week, two pieces each time, with half a catty of green leafy vegetables. Now three years later, his blood lipids are more stable than many young people who eat boiled vegetables every day. There is also a lot of controversy over saturated fats in the academic world. It used to be said that all saturated fats damage blood vessels. Now more and more studies have found that the natural saturated fats in grass-fed butter and fat meat are not the same as the trans fatty acids in processed pastries and fried chicken. There is no need to completely fast, but people with excessive triglycerides should really eat less. To be honest, if you don't eat hot pot and barbecue for the rest of your life, you won't be able to hold on. Instead, you will be prone to overeating due to depression. It is better to control the frequency and walk an extra 3,000 steps every time you eat, which is worse than anything else. I also love to eat skewers, and the frequency is limited to twice a month. I will definitely take a detour for half an hour the next day after eating. My blood lipids have always been stable within the normal range. There is no need to force myself to become an ascetic, but instead put a burden on my heart due to anxiety.

Many people tend to ignore the impact of emotions on the heart. Two years ago, I met a 52-year-old aunt who eats and exercises as regularly as a robot. Her blood lipids, blood pressure, and blood sugar are all normal, but she always has inexplicable chest tightness. After a long period of investigation, she finally found out that it was coronary artery spasm by doing an angiogram. After asking, I found out that she quarreled with her husband every day. After each quarrel, she felt chest tightness for a long time, and sometimes it still hurt. This thing is like the plastic water pipes in your home. The pipes are originally fine, but if you turn the switch and pull the pipe every day without any trouble, it will burst in a short time. The same goes for the heart. Long-term anxiety, anger, and stress will cause the blood vessels to contract and spasm repeatedly, which is more harmful to the blood vessels than high blood lipids. So don’t always force yourself to be perfect in everything. Occasionally fishing for fish, losing your temper, or complaining to your friends will actually be good for your heart.

As for the question that people ask most about whether to take medication for prevention, the most controversial one now is aspirin. Previously, the U.S. Preventive Services Task Force (USPSTF) said that high-risk people aged 40 to 70 can eat small doses to prevent myocardial infarction. Last year, the latest guidelines changed directly, saying that people who have no clear coronary artery stenosis and no history of myocardial infarction and cerebral infarction should not eat indiscriminately, which may increase the risk of gastrointestinal bleeding. There are other health products such as Coenzyme Q10 and deep-sea fish oil. You can say that they are completely useless. Some studies have shown that Coenzyme Q10 can help relieve muscle pain in people who take statins for a long time. You can say that they are useful. Normal healthy people cannot prevent heart disease by taking them. Don’t waste your money.

To put it bluntly, there is really no one-size-fits-all method to prevent heart disease. Whether you are a 996 office worker who sits in an office every day, or a worker who does manual labor every day, a high-risk group with a family genetic history, or a young person with no usual problems, the appropriate method will definitely be different. Don't believe the nonsense on the Internet about "three actions to avoid heart disease" and "eat this kind of food to prevent myocardial infarction". You should really take precautions. Go to the hospital for a comprehensive cardiovascular risk assessment first, and then adjust according to your own situation. It is much more reliable than following the messy health accounts.