heart disease prevention medicine

There is no "miracle drug" that will permanently prevent heart disease once you take it. However, there are several types of drugs that have been clinically proven for decades and can significantly reduce the probability of serious heart attacks such as myocardial infarction and heart failure for specific risk groups. All drugs must be used as needed after risk assessment by professional doctors. Taking them on your own may harm your health.

Not long ago, I met a 48-year-old Uncle Zhang at a community free clinic. He works long distances as a logistics worker. His physical examination showed that his low-density lipoprotein was 3.8mmol/L and his blood pressure was stuck at the critical value. The community doctor suggested that he take half a statin to control his blood lipids. He turned around and left, saying, "It's medicine that's 30% poison." Then he went to a health food store and spent more than 3,000 yuan to buy a soft capsule called "pure natural heart disease preventer." Don't tell me, there are quite a few people who hold this idea. As the most widely used cardiovascular preventive drug, statins have been confirmed by numerous studies to lower blood lipids and stabilize plaques. For people who have been diagnosed with coronary heart disease or have multiple high-risk factors, long-term consumption can reduce the risk of myocardial infarction by more than 30%. Of course, this does not mean that you must take statins if you have high blood lipids. There are indeed different opinions in the academic circles: for low-risk people who do not have risk factors such as high blood pressure, diabetes, smoking, and family history, but whose low density is slightly higher than the normal value, they can first give them a 3-6 month lifestyle adjustment period, and there is no need to rush to take medicine. The benefits of taking statins rashly for this group of people may not be worth the risk of side effects.

When it comes to the pitfalls of self-medication, aspirin is definitely the hardest hit area. Two years ago, I received a 62-year-old aunt in the emergency department who was vomiting blood. When I asked her, I found out that she had heard from neighbors that taking aspirin could prevent heart disease. She did not go to the hospital for any evaluation. She bought aspirin and ate one tablet every day. After half a year of taking it, she developed gastric ulcer bleeding. But you can’t say that aspirin is a scourge. For patients who have been diagnosed with coronary heart disease, have had a stent removed, or have had a myocardial infarction, aspirin is an essential drug clearly recommended by the guidelines. The benefits of long-term use far outweigh the risk of bleeding. ； But if ordinary people who have never had heart disease want to use it for prevention, domestic and foreign guidelines have now narrowed the scope of application. Only people who have a high risk of cardiovascular disease and a low risk of bleeding after a doctor's assessment are recommended to take it.

In the past two years, there has been an Internet celebrity "fat-lowering injection", whose scientific name is PCSK9 inhibitor. Many businesses promote it as a "heart disease prevention vaccine", saying that one injection will last for half a year, and you will not be afraid of anything you eat. Last month, I treated a 32-year-old young man with familial hypercholesterolemia. The low density was above 5mmol/L all year round. He took the maximum dose of statin plus ezetimibe and it only dropped to 3.2. Later, he was given this lipid-lowering injection. After three months of review, it dropped to the standard line of 1.8. The effect is indeed effective. But I also want to pour cold water on it. This drug is currently recommended for people who are statin intolerant or who have been diagnosed with extremely high-risk cardiovascular disease. Ordinary people who only occasionally eat hot pot and have slightly high blood lipids really don’t have to spend thousands of dollars to get this injection, let alone the idea that they can eat Heisser. This is purely a lie.

Some people must ask, are the deep-sea fish oil and coenzyme Q10 that are so popular on the Internet considered heart disease preventive drugs? Objectively speaking, at present, only high-purity medical Omega-3 fatty acids have been proven to have certain cardiovascular benefits for people with severely elevated triglycerides. The fish oil sold in ordinary health food stores with a concentration of only about 30% is basically just to make up for loneliness, and may also consume excess saturated fat. As for Coenzyme Q10, it is mostly used to relieve the side effects of muscle soreness that some people experience after taking statins. It has no clear role in preventing heart disease. Of course, if you are not short of money and want to take some, there is no harm in taking it, but don't expect it to replace regular preventive drugs. There are also different opinions in this academic field. Some studies in the field of nutrition believe that long-term supplementation of high-purity Omega-3, vitamin D and other nutrients can reduce the risk of cardiovascular disease. However, mainstream cardiovascular clinical guidelines have not listed them as routine preventive drugs. Everyone can choose according to their needs, and do not blindly follow the trend.

I have been working in the cardiovascular department for almost eleven years, and I have seen too many people go to extremes: either they regard preventive drugs as a gold medal to avoid death, and then continue to smoke and stay up late to eat hot pot after taking them, or they regard drugs as a scourge and refuse to take them even though the risks are very high. To be honest, the number one preventive medicine for heart disease in my mind has never been the ones sold in pharmacies. It is the extra two stops you walk after get off work every day, the half a spoonful of salt you skip when cooking, the consciousness you put down your phone after staying up until 12 o'clock, and the cigarette you finally quit smoking after more than ten years.

The Uncle Zhang I mentioned at the beginning was later persuaded by me not to buy those health care products. He quit smoking when he went back and tried to stop and take two steps every day when running long distances. He deliberately asked for less salt and less oil at home when eating. After three months for a review, the low density was directly reduced to 2.9, which is completely within the standard and he did not take any medicine at all. Now he says to everyone he meets that there is no universal preventive medicine. The best medicine lies in his own life.