Heart disease prevention medication

For people who have been diagnosed with coronary heart disease, myocardial infarction, cerebral infarction or coronary artery stenosis exceeding 50% (secondary prevention group), statin + aspirin is recognized as a necessary medication if there are no contraindications.； The general population who are not sick, even if they have risk factors such as high blood pressure and high blood lipids, should not take preventive medicines casually. Whether and what to use must be determined by a cardiologist after a risk stratification assessment. Health products and internet celebrity heart-protecting medicines spread on the Internet basically have no clear preventive effect.

Last week, I met a 32-year-old Internet programmer in the clinic. He is 1.75 meters tall and almost 180 pounds. He has never had high blood pressure in 3 years. He had never had a regular treatment for high blood pressure. After browsing a short video, he saw a message saying "take aspirin to prevent myocardial infarction."

Let’s talk about the non-controversial part first: If you have had a myocardial infarction, missed a stent, or have been diagnosed with coronary heart disease if a coronary CT shows a stenosis of more than 50%, or even had an ischemic cerebral infarction before, then don’t hesitate. As long as there are no contraindications such as gastric bleeding or severe liver function abnormalities, you must take statins and aspirin as directed by your doctor for a long time. I have met many patients who thought, "I don't have any symptoms, so what medicine should I take?", or they stopped secretly because they were afraid that statins would damage the liver or aspirin would damage the stomach. A while ago, there was a 52-year-old uncle who stopped the medicine on his own two years after the stent was inserted. He went to climb a mountain and was sent to the emergency room for acute myocardial infarction. When he was recanalized, he found that the original stent position was blocked by 90% again, and he suffered even more than the first time. Of course, it does not mean that everything will be fine after taking it. Check blood lipids, liver function, and occult blood in the stool every 3 to 6 months. Adjust the dosage according to the indicators to stabilize the low-density lipoprotein at 1.8mmol/L or even lower. Only then can we really take prevention seriously.

The most controversial issue is whether people who have not yet been diagnosed with heart disease should take preventive drugs, which is what academic circles call "primary prevention." A few years ago, European and American guidelines also said that aspirin was recommended when the 10-year risk of cardiovascular disease exceeded 10%. New research in the past two years has raised the threshold to 20%, and also excluded people with a high risk of bleeding. Our Chinese guidelines are more cautious. After all, the gastric mucosa of Chinese people is generally more sensitive than that of Europeans and Americans, and the infection rate of Helicobacter pylori is also high. The risk of bleeding from blindly taking aspirin is much higher than that of Westerners. Therefore, in clinical practice, only those patients who have several risk factors at the same time (such as high blood pressure + diabetes + smoking + high blood lipids), and whose calculated 10-year risk exceeds 20%, and who have no history of gastric ulcers or bleeding, will be advised to take a small dose. My former classmate’s father had high blood pressure at the age of 58, but other blood sugars and blood lipids were normal. He didn’t smoke, and the risk in 10 years was only 8%. He was tricked by the community health class into taking aspirin for a year, and the physical examination showed positive for occult blood in the stool. He stopped taking the medicine and adjusted his stomach. There was no need to take that sin.

Many people also ask about Internet celebrity heart-protecting health products, such as coenzyme Q10, deep-sea fish oil, and nattokinase. Can they replace drugs for prevention? Seriously, don’t expect too much from these things. Coenzyme Q10 can only be used by people who have muscle soreness as a side effect of taking statins. Coenzyme Q10 can relieve discomfort. There is simply insufficient evidence that healthy people can prevent heart disease when taking it. ； High-purity medical prescription fish oil can indeed help lower triglycerides, but the effective content of the health-care fish oil you buy that costs one or two hundred yuan a bottle may be less than 10%. At most, it is just a supplement of unsaturated fatty acids, but it cannot achieve the preventive effect at all. ； As for Danshen Dropping Pills and Suxiao Jiuxin Pills, they are for emergency use by patients with coronary heart disease. If people are not sick, taking them every day may irritate the stomach, which is not worth the loss.

I have been in clinical practice for almost 10 years, and I have seen quite a few people who go to extremes: either they insist on not taking medicine when they clearly should, and only regret it when they get sick.； Either you just take a bunch of medicines and health supplements without any problems, and only come to the hospital when problems arise. When it comes to the prevention of heart disease, taking medicine always comes second to lifestyle adjustments - if you stay up late every day, eat heavy oil and salt every day, and smoke cigarettes all the time, no matter how many preventive medicines you take, it will be useless. If you are really worried that you are at risk, go to the cardiology department of a regular hospital, draw blood to check blood lipids, blood sugar, and do an electrocardiogram, and let the doctor assess your risk. It will be more useful than watching 100 short videos or listening to the experiences of 10 neighbors.