What medicines should be taken to prevent heart disease?

There is no universal preventive drug for heart disease that is suitable for everyone. Whether and which kind of drug should be used depends entirely on the individual's risk stratification of cardiovascular disease. Lifestyle intervention is enough for low-risk groups and does not require medication at all. Only medium- and high-risk groups need targeted medication after a doctor's assessment.

When I went to the outpatient clinic last week, I met two patients who were particularly representative: a 29-year-old young man from an Internet company. He had no other underlying diseases except for slightly high low-density lipoprotein and staying up late all year round. There was no history of premature cardiovascular disease in his family. The calculated risk of ASCVD (atherosclerotic cardiovascular disease) in ten years was less than 3%. I directly asked him to quit milk tea and make time to run three or four times a week. He would be rechecked in 3 months. He didn’t even prescribe half a pill.； Another 58-year-old Zhou had smoked for 30 years and had a history of high blood pressure for 12 years. Last year’s physical examination showed that the carotid artery had 50% stenosis. I directly prescribed him atorvastatin and low-dose aspirin, and repeatedly told him not to stop taking the medicine without permission.

Speaking of which, we have to mention aspirin, which is the most frequently asked question. A few years ago, it was regarded by many people as a "panacea for daily blood vessel protection." In recent years, after the guidelines were updated, many people said that it has serious side effects and should not be used at all. In fact, both opinions are too extreme. The current consensus in the industry is that only people with a ten-year ASCVD risk of ≥10% and no peptic ulcer or bleeding tendency are suitable for primary prevention with low-dose aspirin. If you are a low-risk group, you will be prone to gastric bleeding and abnormal gum bleeding after taking it, which is totally not worth the gain.

Of course, aspirin is not the only medicine that can be used to prevent heart disease. For people with high blood pressure, long-term stabilization of blood pressure below 130/80mmHg is the best prevention. Commonly used drugs such as pilin, satan, and dipine, as long as they are taken according to the doctor's instructions, have far less side effects than the damage caused to blood vessels by long-term high blood pressure.； If the blood lipids are not up to standard, especially if the low-density lipoprotein is higher than the target value, statins are the first choice basic medication. If you are indeed intolerant to statins, there are other options such as ezetimibe and PCSK9 inhibitors, which have undergone decades of large-scale clinical verification and are very safe. If you are a patient with atrial fibrillation, taking anticoagulants as directed by your doctor to prevent thrombosis is also the key to preventing myocardial infarction.

During my usual consultations, patients always ask whether Panax notoginseng, Salvia miltiorrhiza, and Coenzyme Q10 can be used to prevent heart disease on a daily basis. I usually tell the truth that there is currently insufficient large-scale clinical evidence to prove that these can reduce the risk of heart disease in healthy people. For example, Coenzyme Q10 currently has two different views. One group believes that it has a certain protective effect on cardiomyocytes, while the other group believes that daily supplementation of healthy people has no clear benefit. Now it is clinically used more to relieve muscle soreness caused by taking statins, or to assist in the treatment of myocarditis. Ordinary people do not need to spend a lot of money on daily supplements. ； As for Chinese herbal medicine, if you really want to treat it, you have to find a regular Chinese medicine doctor to diagnose the syndrome. Don't buy it yourself and eat it, which will put extra burden on the liver and kidneys.

In fact, blood vessels are just like the tap water pipes at home. Pay attention not to pour oil into them (eating high in oil and sugar) or throw away debris (smoking and drinking alcohol). If you clear them regularly (exercise regularly), there is a high probability that they will not be clogged. Use strong dredgers (take medicine) if they are not needed. Only people who have already blocked most of their pipes or whose pipes are of poor quality need medication to assist in maintenance. If there is any "preventive medicine for heart disease" that is suitable for everyone, it would be to quit smoking, limit alcohol intake, have a regular schedule, and get 150 minutes of moderate-intensity exercise every week. If you do these, it will be more effective than any expensive health supplements you take.