What are the preventive drugs for heart disease?

At present, the main categories of heart disease prevention drugs that have been clinically proven to be effective by evidence-based medicine include statins, antiplatelet drugs, β-blockers, and ACEI/ARB drugs. However, all drugs have a strict scope of application and cannot be bought and taken regularly by ordinary people to prevent diseases.

I met a 39-year-old programmer at the outpatient clinic last week. His physical examination showed that his low-density lipoprotein was 4.2mmol/L. He was overweight and had a family history of coronary heart disease. After a risk assessment, he was classified as a high-risk group. We prescribed him atorvastatin for primary prevention, which means early intervention before he has coronary heart disease to prevent plaque from growing and blocking blood vessels. For patients who have already had a myocardial infarction and received a stent, most of these drugs need to be taken for a long time, which is secondary prevention to avoid recurrence of the disease.

For example, aspirin, which everyone often hears about, has been quite controversial in primary prevention in recent years. In the past few years, the European and American guidelines had a relatively wide scope of application. Later, it was found that the risk of bleeding was higher than the benefit for low-risk groups. Now the standards have been tightened. The current consensus among domestic academic circles is that it only It is recommended to use low-dose aspirin for prevention only for people who have a ten-year risk of cardiovascular disease exceeding 10% and who do not have high-risk factors for bleeding. If you only stay up late occasionally and do not have high blood pressure or family history, don’t follow the trend. It is really easy to cause gastrointestinal bleeding.

In fact, the logic of the action of these drugs is easy to understand. Statins are like scavengers in blood vessels, specifically "sweeping" out excess low-density lipoprotein to prevent it from depositing on the blood vessel walls and growing into plaques.； Beta blockers are equivalent to putting a soft brake on the heart, slowing down the heart rate that beats too fast and reducing the oxygen consumption of the heart. Patients with coronary heart disease can significantly reduce the risk of myocardial infarction by taking them. ； ACEI/ARB are the antihypertensive drugs that everyone often hears about as "Privacy" and "Satan". They were originally used to control blood pressure, but later it was discovered that they can also improve vascular endothelial function. Patients with hypertension and diabetes take it to protect their heart better than other antihypertensive drugs alone.

Speaking of this, some people must be curious, so do the coenzyme Q10, salvia pills, and deep-sea fish oil sold on the market count? These are currently auxiliary products. There are not enough large-scale studies to prove that they can directly reduce the risk of heart disease. If you always feel a little chest tightness and fatigue, it is okay to take some to relieve the symptoms. If you point to them to prevent heart disease, then it is putting the cart before the horse.

Oh, by the way, all preventive medicines must be fully evaluated by a doctor before they can be prescribed. I met an aunt before. She heard from an old sister that taking aspirin can prevent myocardial infarction. She bought it and took it for half a year. As a result, she was hospitalized for gastric bleeding. She has had gastric ulcers for many years and is not suitable for taking aspirin. This is the lesson of taking medicine randomly. After all, medicines are divided into three parts, and what is suitable for others may not be suitable for you.