Heart disease prevention and treatment

The core of prevention is long-term stable control of metabolic indicators and avoidance of controllable risk triggers. There is no once-and-for-all "heart-protecting trick"; treatment requires an individualized plan based on the specific classification and severity of the disease, and there is no "universal cure" that applies to everyone.

Last Wednesday when my clinic was about to get off work, a 38-year-old young man came in. He was wearing a wrinkled plaid shirt, his hair was greasy, and he was sweating while holding his left chest. When I asked, I found out that he was a back-end developer for an Internet company. He stayed up for 12 consecutive days and nights working on a project, drinking at least 4 glasses of ice cream every day. Last year, the physical examination showed that his low-density lipoprotein was 4.2mmol/L. The doctor asked him to take medicine to control it. He felt that he was young and could handle it, and he didn't even go for a reexamination. As a result, after the coronary CTA was performed, 70% of the anterior descending artery was blocked. Fortunately, he was not in the stage of myocardial infarction. He was prescribed statins and aspirin first, and ordered him to immediately suspend the project at hand and adjust his schedule. Don’t think this is an exception. In the past two years, the number of patients with coronary heart disease aged 30-40 in my outpatient clinic has increased by at least 30% compared to five years ago. Many people’s understanding of heart disease is still at the stage of “senile disease”. In fact, the age of onset has already dropped a lot.

Many people have a very big misunderstanding about prevention: they think that as long as I exercise enough, I can do whatever I want. Last year, there was a retired teacher who walked 20,000 steps a day without hesitation. He told everyone he exercised enough that he would not get a heart attack. As a result, he drank all kinds of meat and drank two taels of white wine every day. During his last physical examination, when he took blood, there was a layer of milky white oil floating on the top. His triglycerides were so high that even the instrument could not detect it. His coronary arteries were blocked in two places, and he panicked. Interestingly, there are actually different voices in the academic community regarding the heart-protecting effect of exercise: the mainstream view affirms the benefits of 150 minutes of moderate-intensity aerobic exercise per week, but recent studies have shown that long-term excessive high-intensity exercise, such as running marathons all year round and high-intensity iron lifting for more than two hours a day, may actually increase the risk of atrial fibrillation and myocardial fibrosis. To put it bluntly, the saying "too much is not enough" is really appropriate when it comes to heart protection.

There is also the dietary question that people ask the most. Don’t believe the rumor that “eating onions and drinking red wine can soften blood vessels.” The resveratrol content in red wine is so low that it can be ignored. Drinking too much will increase blood pressure and increase the burden on the heart. There is no unified conclusion regarding the optimal heart-protecting diet plan: the traditional low-fat diet recommends reducing the intake of saturated fat and eating less fat meat and animal offal. Supporters of the Mediterranean diet and low-carb diet, which have become popular in recent years, believe that refined carbohydrates are the culprits in increasing triglycerides and inducing insulin resistance. As long as the intake of carbohydrates is controlled, eating saturated fat appropriately will not increase cardiovascular risks. As a clinician, I will not forcefully recommend a certain diet to patients. If you can stick to it for a long time and your blood lipids, blood sugar, and weight can be stabilized within the target range after eating it, it is a good diet that is suitable for you.

Don’t scare yourself if you are really diagnosed with a heart problem. Many people panic and look for remedies as soon as they see the words "myocardial ischemia" and "premature beats" in the electrocardiogram report. In fact, heart disease is a very large category, and the ways to deal with different problems vary greatly. For example, if it is just occasional atrial or ventricular premature syndrome, there are no symptoms of palpitation or chest tightness, and there is no structural heart disease, I usually ask the patient to go back and adjust his or her work and rest first. Don't drink coffee and milk tea, and stay up less late. Many people adjust and come back for a month to check for premature beats, and the premature beats are gone, and they don't need to take medicine at all. ; If the symptoms are obvious, you can also use a small dose of beta-blockers. Different doctors have different habits. Some doctors will prefer to use medication early to control symptoms, while others will recommend adjusting your lifestyle first. There is no absolute right or wrong. It depends on your own acceptance.

Controversy has always existed about the issue of stents that everyone is most concerned about: For example, should coronary artery stenosis be inserted when it is 70% narrowed? Mainstream guidelines recommend that surgery is needed only if there are clear symptoms of angina, or if the FFR (fractional flow reserve) test shows insufficient blood supply. If there are no symptoms and the blood supply is sufficient, even if the blood supply is narrowed to 75%, conservative treatment can be performed first. Last year, a 62-year-old aunt found out that her coronary artery stenosis was 75% during a physical examination. She went to several hospitals. Some said she had to put in a stent, and some said she could take medicine first. When she came to see me, she was almost insomnia with anxiety. I did an FFR test on her, and the result was 0.87. , fully meeting the blood supply demand of the myocardium, I prescribed statins and ezetimibe for her, and asked her to control her diet and avoid too intense square dancing. A follow-up examination six months later found that the stenosis had not progressed, and her blood lipids had dropped to 1.6mmol/L. She could usually go shopping and climb the third floor without gasping for breath.

The most common thing I say to patients in the clinic is, don’t think of heart disease as too scary, and don’t take it too seriously. Health supplements such as Coenzyme Q10 and deep-sea fish oil are fine if you have better economic conditions. Especially for those who suffer from muscle soreness after taking statins or have sequelae of myocarditis, taking Coenzyme Q10 can indeed relieve symptoms, but it absolutely cannot replace regular drugs for lowering blood pressure, lipids, and antiplatelets. Don’t listen to online bloggers who say that taking health supplements can stop Western medicine. There are really not a few people who end up with myocardial infarction. Oh, by the way, if any of your immediate family members had coronary heart disease before the age of 55, even if you are only in your 20s now, it is best to check your blood lipids and blood pressure once a year. Don’t regret it after something happens.

To put it bluntly, the heart is like an old appliance that has been used at home for more than ten years. If you handle it gently and check it regularly, you will have no problem at all after using it for seventy or eighty years. If something really goes wrong, fix it as soon as possible. Don’t wait until it is completely scrapped before you worry. It’s as simple as that.