Heart disease prevention medicine

There is no universal miracle drug for preventing heart disease that is suitable for all healthy people. All drugs with clear preventive benefits must be combined with individual cardiovascular disease risk stratification and used after evaluation by professional doctors. Taking so-called "preventive drugs" on your own may bring fatal risks.

When I went out to the clinic last week, I met a pretty typical patient: a 42-year-old Internet programmer. The physical examination report showed no other problems except that the low-density lipoprotein was just stuck at the critical value of 3.4mmol/L and the blood pressure occasionally reached 135/85mmHg. When I sat down, the first thing I said was, "Doctor, please prescribe me some of the best heart disease preventive drugs. My colleague just had a myocardial infarction last week. I'm afraid something will happen to me too." I encounter similar problems almost every day, especially in the spring and autumn when cardiovascular diseases are at high incidence. Aunts in their 70s and young people in their 30s are all looking for this kind of panacea that can "sit back and relax after taking it."

When it comes to preventive drugs for heart disease, the first thing that many people think of is aspirin. In the past few years, the saying that "an aspirin a day can prevent myocardial infarction" was spread all over the street, but now the consensus has changed: here we need to clarify two concepts, whether you want to do primary prevention or secondary prevention - secondary prevention refers to patients who have been diagnosed with coronary heart disease, myocardial infarction, and cerebral infarction. As long as there are no contraindications, aspirin must be taken. There is no controversy in the industry; but if you have not suffered from these diseases, it belongs to the category of primary prevention. The industry is still very noisy about whether you should take it. European and American guidelines in recent years have generally raised the threshold very high, requiring that the 10-year risk of ASCVD (atherosclerotic cardiovascular disease) exceeds 10% and that there is no history of gastric ulcer or bleeding before it is recommended. Some experienced domestic experts will be relatively lenient. Be relaxed, if you have a clear family history of premature myocardial infarction (my father had a myocardial infarction before the age of 55, and my mother had a myocardial infarction before the age of 65), or the carotid artery has exceeded 50% stenosis, you can consider taking it in small doses even if the risk has just reached 7%, but it is definitely not something that everyone can use as a health medicine. Last year, I took in a 61-year-old man. I heard that the old man said aspirin can prevent heart disease. I went to the drugstore to buy aspirin and take it every day. After taking it for three months, he developed black stools. When he was found to have gastric bleeding, hemoglobin was only 7g, and he almost needed a blood transfusion.

The other most frequently asked question is statins. Many people think that they only lower blood lipids. In fact, their role in stabilizing plaques and preventing blood vessel rupture and blockage is the core of preventing myocardial infarction. But the controversy over whether it should be eaten or not is not small: the American ACC Guidelines in 2013 set the threshold at 7.5% for a 10-year risk before recommending it, but the 2021 European Guidelines recommend it only when the 10-year risk is stuck at 10%. The domestic guidelines are somewhere in between, and additional reference items such as "whether there are carotid plaques and family history" are added. I met a 50-year-old aunt a while ago, with an LDL of 3.5 and no other underlying diseases. She watched a short video and bought an imported powerful statin and took it for half a year. When she came for a review, she said that her muscles ached all over her body. When she checked for creatine kinase, it exceeded three times. She quickly stopped taking the medicine and adjusted for three months before she recovered. Her situation could have been adjusted by exercise and diet first, and she did not need to take medicine at all. She suffered for half a year in vain.

As for the "natural preventive medicines" such as coenzyme Q10, deep-sea fish oil, and nattokinase that are popular in WeChat Moments and short videos, to be honest, the current evidence-based evidence cannot support the role of "healthy people in preventing heart disease." The American Heart Association has clearly stated that only patients diagnosed with heart failure may benefit from supplementing Coenzyme Q10. Healthy people will pay an IQ tax if they take it. High-purity prescription-grade Omega3 fish oil has a certain effect on patients with particularly high triglycerides. However, the effective content of the health product fish oil you buy that costs one or two hundred yuan a bottle may not even be one-tenth. At most, it is a psychological comfort. I once had a patient who spent more than 3,000 yuan a month on an imported "heart health package". He refused to take statins because his blood lipids were high. He thought it would have side effects. However, last year, a coronary CTA was performed and it was found that the blood vessel was 60% blocked. He regretted it very much.

In fact, after all is said and done, the cheapest and most effective preventive medicine for heart disease is not placed in a pharmacy at all, but is held in your own hands. Let me give you an example that impressed me deeply: Ten years ago, I managed two patients of the same age. They were both 50 years old, both had a family history of high blood pressure, and were both overweight. One of them felt that he was young anyway, smoked and drank as much as he wanted, and ate braised pork every meal. He said that he would just take preventive medicine in the future. As a result, When he was 52 years old, he was sent here for acute myocardial infarction and two stents were placed; the other one quit smoking when he returned home, walked for an hour after dinner every day, and used half the salt and oil in cooking. Now he is 60 years old and has been checked again. His blood pressure and blood lipids are normal. There is no plaque in the carotid artery, and he does not even take antihypertensive drugs. To use an inappropriate metaphor, the heart is like the car you drive. Taking medicine is to add cleaning additives to the engine, but if you step on the accelerator every day, fill up with low-quality gasoline, and never maintain it, it will be useless no matter how much additives you add.

I usually joke with patients that if you really want to find preventive drugs without a prescription, just focus on three indicators: whether the resting heart rate is around 70 beats per minute, the waist circumference should not exceed 90cm for men and 85cm for women, and the blood pressure should be stable below 130/80mmHg for a long time. If these three standards are met, it will be more effective than blindly taking three or four health products. If you are really worried that you are at risk, go to the hospital for a specialized cardiovascular risk assessment. Tell the doctor your blood sugar, blood lipids, smoking history, and family history, and let the doctor help you decide whether to take medicine and what medicine to use. Don’t just buy medicine after blindly searching for some popular science.

After all, your heart is your own. There is never any magic medicine that will last forever. Preventive medicine that is suitable for others may be poison when put on you. You need to understand this common sense.