Heart disease prevention medication

Generally healthy people do not need to regularly take heart disease prevention drugs. Currently, the only prescription drug for primary prevention of coronary heart disease (i.e., reducing the risk of the first attack when not sick), which has the most evidence-based evidence in the world and is mentioned by multiple guideline consensuses, is low-dose aspirin. It is only recommended for people aged 40-70 years old, with a 10-year risk of cardiovascular disease ≥10%, and no high risk of bleeding. The core method for preventing heart disease for everyone else is lifestyle intervention, and taking medicine blindly may bring risks.

Last week I met a 62-year-old Uncle Zhang in the outpatient clinic. There was nothing wrong with him during the physical examination except for slightly higher blood lipids. I heard an old neighbor downstairs say that "taking aspirin as you get older can prevent myocardial infarction." I have seen too many similar situations in the past few years. Either I took prescription medicines and had side effects, or I saved half a box of "heart-protecting health products" to eat. I spent a lot of money, but my heart was not protected, and other problems came to me first.

Let’s talk about a basic concept first. The preventive medication we are talking about today refers specifically to the primary prevention medication used by people who have not yet been diagnosed with cardiovascular diseases such as coronary heart disease, myocardial infarction, and cerebral infarction. If they have already had the disease, it belongs to secondary prevention. You should take aspirin, statins and other medicines as prescribed by your doctor. Don’t stop randomly. This is not within the scope of today’s discussion.

When it comes to the preventive use of aspirin, there has actually been controversy in the academic community, and guideline preferences vary widely in different regions. In 2021, the U.S. Preventive Services Task Force directly withdrew its recommendation for primary prevention aspirin for people over 60 years old. The reason is that the risk of bleeding in this age group is increased, and the benefits of taking the medicine are not worth the risks; European guidelines are more cautious, and only those who are assessed to be extremely high-risk will consider recommending them; our country's guidelines are more in line with the physical constitution of the Chinese people, and people aged 40 to 70 years old First, make a 10-year cardiovascular disease risk score. If it exceeds 10%, and you have no history of peptic ulcers, bleeding, or taking other anticoagulants, it will be recommended to take 75-100 mg of low-dose aspirin, and the bleeding risk must be regularly assessed. It does not mean that you cannot stop taking it for a lifetime. If the risk decreases after a few years, or the bleeding risk becomes high, you can stop at any time.

Some people must ask, if you can’t just take prescription drugs, then it’s okay if I take some deep-sea fish oil and coenzyme Q10, right? Not really sure. Let’s talk about Coenzyme Q10 first. The current clinical evidence only supports the consumption of Coenzyme Q10 by two types of people: one is for patients who already have cardiomyopathy to help improve heart function, and the other is for people who suffer from muscle soreness as a side effect of taking statins. Supplementation can relieve symptoms. As for whether healthy people can take Coenzyme Q10. There is currently no authoritative guideline in the world that gives definite recommendations for preventing heart disease. At most, some nutritionists or doctors of traditional Chinese medicine will recommend that people who often stay up late and have particularly high myocardial oxygen consumption take appropriate supplements. This is something that "doesn't do much harm if you eat it, but don't expect to prevent disease."

Deep-sea fish oil is even more controversial. A few years ago, there were studies saying that high-purity Omega-3 can reduce the risk of cardiovascular disease. Large-sample studies in recent years have overturned this conclusion. Now the mainstream view is that if you rarely eat fish, your blood lipids will The triglycerides are particularly high, so you can properly supplement with high-purity fish oil. If you want to rely on the low-purity fish oil bought in ordinary health food stores to prevent heart disease, it is basically a waste of money. The content of unsaturated fatty acids is not much, but there are a lot of additives. If you eat too much, you may gain weight. Some people also ask whether Salvia miltiorrhiza tablets and Panax notoginseng powder can be eaten. There is indeed a view in the field of domestic traditional Chinese medicine that people with blood stasis and constitution can improve circulation and reduce the risk of disease if taken appropriately. However, due to the lack of large-scale evidence-based medical evidence, mainstream Western medicine guidelines have not included routine recommendations. If you really want to try it, go to a doctor at a regular traditional Chinese medicine hospital to diagnose the syndrome, and don’t buy blindly following short videos. In the past few years, I have encountered patients who suffered liver damage from eating Sanwu Panax notoginseng powder.

Oh, by the way, many people ask whether statins can be used for prevention. This needs to be made clear. If you have been diagnosed with hyperlipidemia, diabetes, or already have atherosclerotic plaques, you must take statins. The benefits far outweigh the extremely low risk of side effects. However, if you are a completely healthy person and your blood lipids are within the normal range, if you want to rely on taking statins to prevent heart disease, the academic community is currently very divided. Some studies say that it can slightly reduce the risk of disease, while others say that it is of no use. Instead, it may increase the probability of blood sugar elevation and muscle pain. Therefore, there are currently no guidelines recommending that healthy people regularly take statins for prevention.

To be honest, I have seen too many people overcomplicate the prevention of heart disease, and always feel that they have to eat something to be practical. In fact, protecting the heart is like maintaining an old bicycle at home. Don’t do it too hard, avoid getting exposed to the rain (smoking less, drinking less and staying up late), pumping gas and oil regularly (exercise regularly and eat healthily), it is much more effective than pouring messy imported additives on the chain when you have nothing to do. In the past two months, there was a 29-year-old Internet guy who often stayed up until two or three o'clock. His electrocardiogram during physical examination showed some T-wave changes. He was so scared that he bought five or six heart-protecting health products and took them for two months. When he came for a review, I told him that he was suffering from myocardial ischemia due to staying up all night. I changed my schedule and took 20 minutes a day to go downstairs and run twice. It was much more effective than the health products that cost thousands of dollars. He went back and did it for a month, and the electrocardiogram was all normal again.

Finally, there is no neat summary, but a reminder: If you really need to evaluate whether you should take preventive medicines, go to the hospital and find a cardiologist to get a risk score. Don’t follow your neighbors or short videos to blindly buy medicines. If you are not sick and take medicines, but you have something wrong, the probability of getting sick is really much higher than if you don’t take medicines.