Heart disease prevention measures

The core logic of heart disease prevention is not the "universal health list" popularly circulated on the Internet, but stratified intervention in controllable risk factors based on one's own risk - this is currently the most effective path recognized by academic circles and clinical front lines in the global cardiovascular field.

When I was at a community free clinic last year, I met many uncles and aunts asking me, asking me "Can eating Panax notoginseng powder every day prevent myocardial infarction", asking me "Can eating Panax notoginseng powder every day", and asked me "Will I have a heart attack sooner or later if I stay up until 2 o'clock every day?". Generally speaking, people who have no family history of heart disease, whose blood pressure, blood sugar, and blood lipids are all within the normal range, who do not smoke, and whose BMI does not exceed the standard, are considered low risk and basically do not need any additional special intervention; if there are one or two risk factors, such as occasionally high blood pressure, or parents with a family history of heart disease before the age of 55, they are considered medium risk and should take more care; those who have been diagnosed with high blood pressure, diabetes, or hyperlipidemia are considered high risk and must follow the doctor's plan.

Let’s talk about eating first. Don’t believe in the extreme statement that “you can’t touch even a morsel of fat.” An old man I managed heard rumors that he had been on a vegetarian diet for half a year, but his blood lipids had not dropped. He was also deficient in albumin and was shaking when he walked. The current academic consensus is that as long as the proportion of saturated fat is controlled within 10% of total calories, it is perfectly fine to eat braised pork ribs or hot pot once or twice a week. On the contrary, it is better than being greedy and eventually overeating. Oh, by the way, there is another controversial point here that has been going on for a long time: Should we give up coffee completely? Previous cohort studies in Europe and the United States have shown that drinking less than 3 cups of black coffee a day can reduce cardiovascular risk. A domestic follow-up study with a large sample in the past two years also came to a similar conclusion. However, if you have premature beats and feel flustered and sleep poorly after drinking coffee, then there is no need to join in the fun. Individual differences are always more important than big data conclusions.

A while ago, news spread that a fitness blogger died suddenly while running at night. Many people were too scared to move. In fact, on the contrary, sitting still for a long time is the invisible killer of cardiovascular disease. The currently recognized effective dose is 150 minutes of moderate-intensity exercise per week, which is to the extent that you can talk but cannot sing when walking briskly. Going downstairs after dinner and walking around the neighborhood for half an hour, or riding a bike and visiting the park on weekends all count. Unless you already have severe coronary stenosis, then a doctor will need to prescribe exercise. By the way, there is also an undecided research direction here: some scholars in the field of sports medicine have suggested that persevering in high-intensity endurance exercise all year round, such as running several marathons a year and spending a long time in the gym to train heavy weights, may slightly increase the risk of atrial fibrillation. Therefore, ordinary people really do not need to pursue "clock-in exercise". Moving is better than not moving. If you insist on running 5 kilometers and hurt your knees and insist on it, it will not be worth the gain.

As for the most frequently asked question, “Should we take aspirin in advance for prevention?”, this controversy has been quarreling in the academic community for almost ten years: European and American guidelines updated in 2019 do not recommend regular consumption by elderly people over 70 years old without underlying diseases, as the risk of bleeding far outweighs the benefits; domestic guidelines are currently more conservative, recommending that people over 60 years old with high risk People at high risk, such as those who have been diagnosed with diabetes and have high blood pressure, can only take it after a doctor assesses the risk of bleeding. Do not go to the drugstore to buy it and eat it blindly. I just treated an old man who suffered from stomach bleeding after taking aspirin last month. Originally, he only had mild high blood pressure and was not at the level where he needed to take it. He suffered for nothing.

What many people tend to overlook is the impact of mood and work and rest. When I was in the emergency room, I saw several cases of myocardial infarction due to being too excited to play mahjong, and a 28-year-old programmer who suffered an aortic dissection after working on a project for three days in a row. Factors that may seem "deficient" such as high stress, long-term anxiety, and high mood swings will actually continue to increase sympathetic nerve tension and put a little burden on the heart. There is no need to force yourself to "quit emotions". Occasionally emo and occasionally angry are normal, just don't stay in a tense state for a long time. For example, take half an hour every week to relax, even if you sit on the sofa and daze, petting a cat, it is better than spinning around.

In fact, to put it bluntly, heart disease prevention is never a militarized list that needs to be strictly implemented, and there is no magic medicine that "can 100% prevent myocardial infarction". It is just to know more about your physical condition, avoid pitfalls that you know will harm your body, and don't be too anxious about the rest. After all, even the doctors in our department occasionally stay up late to catch up on papers and are greedy for hot pot. As long as the overall situation is within control, being too tight will deviate from the original intention of prevention.