heart disease prevention medicine

There is no universal "miracle drug for preventing heart disease" that is suitable for all healthy people. The current clinically recognized prevention logic of heart disease drugs is to target people with different cardiovascular risk levels, combined with lifestyle adjustments, and targeted use of drugs to control high-risk factors. Any product that claims that "everyone can prevent heart disease" is either exaggerated propaganda or a stolen concept.

When I was doing a free clinic in the community last week, most of the aunties and uncles who came around were asking the same question: If I take coenzyme Q10/deep sea fish oil/notoginseng powder every day, will I not get myocardial infarction? The one who was particularly impressed was Aunt Zhang. She took a cloth bag and poured out half a bottle of Coenzyme Q10 given in the health class. She said that Lao Li next door had not had a heart attack after taking it for three years, and she had to take it every day. In fact, this does not mean that this kind of health products are completely useless. For example, high-purity EPA fish oil. Current evidence-based medicine has indeed confirmed that for people with triglycerides ≥5.6mmol/L, it can help lower blood lipids and reduce pancreatitis and cardiovascular risks. ； Coenzyme Q10 can also effectively alleviate the adverse reactions of patients who suffer from muscle soreness after taking statins for a long time. But if you are a healthy person with a balanced diet and normal indicators, eating these is really not much different from eating more deep-sea fish or eggs. Of course, some colleagues in the nutrition department believe that young people now eat takeaways that are heavy in oil and salt every day, and their intake of Omega 3 is generally insufficient. There is no harm in taking a small dose of ordinary fish oil, but the premise is that you do not regard it as a "medicine", let alone stop the anti-hypertensive and lipid-lowering drugs prescribed by the doctor. Oh, by the way, I met a young man a while ago who bought all the high-purity fish oil for pets and said that the oil for humans had additives. I really couldn’t laugh or cry.

What is more troublesome than the indiscriminate consumption of health products is the abuse of prescription drugs. Last month, a 30-year-old programmer came to the outpatient clinic. He was overweight, had critical blood lipids, and had no family history. He saw a blogger saying that statins are "cardiovascular miracle drugs," so he bought them and took them for three months. When he came for a follow-up check, his transaminase was twice as high as the normal value, so he was asked to stop immediately. First of all, it must be made clear that if you have been diagnosed with coronary heart disease, myocardial infarction, or have missed a stent or bridge, then aspirin, statins, and beta-blockers are drugs recognized by global guidelines and must be taken as directed by doctors for a long time. These are the true "secondary prevention drugs for heart disease" and can reduce the risk of another myocardial infarction by more than 30%. This is not controversial.

But if you don’t have heart disease yet, but you just have a few high-risk factors, such as high blood pressure, hyperlipidemia, and smoking, should you take these medicines in advance? This is very controversial. Take aspirin, for example. Ten years ago, European and American guidelines recommended that people with a 10-year cardiovascular risk of more than 10% take it regularly. New studies in recent years have found that the risk of gastrointestinal bleeding in this group of people may have offset the cardiovascular benefits. So now the latest guidelines have lowered the recommendation level very low. Domestic expert consensus is more cautious. Generally, only people aged 40-70, with a 10-year cardiovascular risk of more than 10%, and no history of gastrointestinal ulcers or bleeding are recommended to take aspirin in small doses. I have been practicing cardiology for so many years, and I have seen too many people who go to extremes. They either don't believe in any medicine, saying that "the medicine is only 30% poisonous." They would rather take tens of thousands of yuan of "Vascular Scavenger" health supplements than take a few yuan of statins. In the end, they came to the emergency department when their blood vessels were 80% blocked. ； Or he was so anxious that his blood lipids were found to be 0.1 higher during a physical examination, so he took all the preventive medicines he could find, and eventually suffered liver and kidney damage.

In fact, heart disease preventive medicine is like a fire extinguisher at home. If your home has a pile of flammable and explosive materials (you already have coronary heart disease, and the three highs have been poorly controlled for many years), then you must not only equip it with a fire extinguisher, but also install a smoke alarm (regular review)； But if your house is clean and you only occasionally forget to turn off the mosquito coils (you just occasionally stay up late, have a slightly higher weight, and have critical indicators), you don’t need to put three fire extinguishers in every room. Putting out the mosquito coils first (adjusting your schedule, controlling your diet) is better than anything else.

Oh, by the way, people have been asking a lot about the "hyperglycemic injections" (GLP-1 receptor agonists) that can help lose weight recently, as well as the antihyperglycemic drugs of the antidiabetic class. Studies have indeed proven that they can reduce the risk of cardiovascular disease in high-risk people with diabetes. Many people wonder if they can be used as preventive drugs. There is a lot of quarrel in the academic circles right now. One group believes that this type of drug has few side effects and can reduce cardiovascular risks even when used by healthy people. It may become a new choice for primary prevention in the future. ； The other group believes that the long-term benefits for healthy people are unclear, and many people will suffer from nausea, vomiting, and thyroid abnormalities after taking them. There is no need to take risks for uncertain benefits. Currently, there is no clinical recommendation for healthy people to use these drugs to prevent heart disease.

In the final analysis, there is really no universal answer to whether or not to take preventive medicine for heart disease and which kind to take. Don’t just follow the trend and stock up on what your neighbors say is good, and don’t prescribe medicine for yourself based on half-baked popular science on the Internet. Take the time to go to a cardiology department for a simple cardiovascular risk assessment. The doctor will give you the most suitable plan based on your indicators, family history, and living habits. This is more reliable than just blindly eating ten bottles of health products.