Heart disease prevention tools

The current core prevention logic of heart disease confirmed by global evidence-based medicine is essentially "stratified intervention + lifestyle priority + precise management and control of high-risk groups." There is no universal solution that applies to everyone. All "heart-protecting tips" that are divorced from individual foundations are basically IQ taxes.

I met 58-year-old Uncle Zhang at a community free clinic last week. He has been smoking for 30 years, at least two packs a day, and his blood pressure has been hovering at 150/95 all year round. He thought he could eat and sleep without any problems. However, after a coronary CT scan, it was found that the blood vessel had been blocked by 32%, and he would most likely need a stent in two to three years. Many people’s impression of heart disease prevention is to “eat less oil and exercise more”, but it’s really not that simple. Last year, I treated a 32-year-old Internet operation and maintenance man. He ran 5 kilometers at night every day, ate light meals for three meals, and had a body fat rate of only 17%. The physical examination showed that he had cardiac hypertrophy. After questioning, I found out that he stayed up until 3 a.m. every day to go to bed. His high pressure had been 140 for more than half a year and he didn't take it seriously. The heart is like a water pump that has been used at home for more than ten years. Even if you wipe the outer casing every day, if it is kept spinning and overloaded every day, the internal parts will still be worn out.

Let’s talk about the most familiar dietary adjustments first. The DASH diet currently recommended by the mainstream means limiting salt (no more than 5g per day, which is about the amount of a beer cap), eating more whole grains, fresh fruits and vegetables, white meat and high-quality soy products, and less refined sugar and trans fat. This has been confirmed by follow-up of hundreds of thousands of samples over decades, and can reduce the risk of cardiovascular disease by about 20%. Interestingly, in recent years, supporters of the ketogenic diet and the original diet have also put forward different views, saying that as long as you strictly abstain from refined sugar, even if you eat more saturated fat (such as butter and fatty meat), it will not increase blood lipids, but can reduce vascular inflammation. However, there is currently no large sample follow-up data of more than 10 years to confirm this conclusion, so there is no need for the general population to take this risk. People who are obese and insulin resistant can try it under the joint guidance of nutrition departments and cardiologists, and don’t mess around on their own.

Many people's understanding of exercise is also prone to extremes. They either don't move at all and slump on the sofa until midnight after get off work, scrolling on their mobile phones, or they work hard all of a sudden and suddenly go climbing a mountain or running a half marathon on the weekend, which can easily induce acute myocardial infarction. The advice I usually give to patients is very practical. You don’t have to stick to the target of 150 minutes of moderate-intensity exercise per week. Take one less bus stop after get off work and walk for 20 minutes. Don’t just lie down when you get home. Stand and watch two episodes. Moving is better than not moving. The key is regularity. Don’t fish for three days and dry the net for two days. By the way, people with high blood pressure must not go out for morning exercises at 5 or 6 in the morning. When the cold air stimulates vasoconstriction and blood pressure, it is easy to cause problems. It is good to go out for a walk at 3 or 4 in the afternoon.

If you have high blood pressure, diabetes, or high blood lipids, or if your immediate family members have a family history of early onset heart disease before the age of 55, don’t just rely on your lifestyle. Here I have to talk about the most controversial statins. A search on the Internet is full of posts saying that statins damage the liver and muscles. Many people are resistant when they see doctors prescribing statins. To be honest, the incidence of adverse reactions of statins is really very low. Only about 1% of people will suffer from elevated transaminases and muscle soreness, and most of them can recover after stopping the drug. For people who have already developed coronary atherosclerosis or whose low-density lipoprotein cholesterol exceeds 4.9, the benefits of taking statins far outweigh the risks, and can reduce the risk of myocardial infarction by more than 30%. But if your density is only slightly high and there are no other high-risk factors, you can adjust your lifestyle for 3 months before rechecking. If it drops down, you don’t need to take medicine at all. Oh, yes, there is also aspirin. It is no longer recommended for ordinary healthy people to take aspirin to prevent heart disease. Only people who have been diagnosed with coronary heart disease or cerebral infarction need to take it for a long time. If you eat it blindly, it may easily induce gastric bleeding.

Many people like to buy various heart-protecting health products, such as coenzyme Q10, deep-sea fish oil, and nattokinase, which are said to clean blood vessels. Let me put it this way, if you have a balanced diet and are not deficient in nutrients, these things are basically useless. Even high-purity fish oil that does have the effect of lowering triglycerides is only an auxiliary medication and cannot replace statins and lifestyle adjustments. Buying that for a few hundred yuan a bottle is really not as cost-effective as buying two more pounds of fresh fish.

In fact, there really aren’t that many fancy ways to prevent heart disease. Don’t stay up late every day, eat barbecue every day, smoke all the time, and then expect that taking a health supplement can protect your heart. That’s impossible. It's better to have your blood pressure, blood lipids, and blood sugar checked every year. If there are any problems, get them checked as soon as possible.