Heart disease prevention guide

Keep the three indicators of blood pressure, blood lipids, and blood sugar within the standard line for a long time, stay away from tobacco (including second-hand smoke, e-cigarettes), maintain light activities for more than 20 minutes at least three times a week, and do a targeted heart-related screening once a year after the age of 40. Most of the remaining 20% ​​is related to whether you always fall into the trap of "extreme health care" or "folk health care".

I was particularly impressed by the 32-year-old Internet operator who was just discharged from the hospital last month. He has no family history of heart disease, but he didn’t take it seriously when his blood lipids exceeded the limit during physical examinations for three consecutive years. He stayed up until 2 o’clock every day to change his plan. He became addicted to smoking and smoked half a pack of e-cigarettes a day. When he was working on a project last week, he suddenly had chest pain and broke out in a cold sweat. When he went to the emergency department for an angiogram, he found that his coronary artery had been blocked by 60%, and he almost needed a stent.

Many people think that as long as there are no symptoms, they don’t need to worry about the three high blood pressure. I have met too many patients whose blood pressure rose to 160 and they felt that they were “in good health and can handle it.” By the time chest pain occurs, the blood vessels have already been blocked. I would also like to mention here the controversial topic "whether to take antihypertensive and lipid-lowering drugs for a long time": those who advocate taking less medicine believe that long-term medication harms the liver and kidneys. The guidelines of the Western medicine system recommend that as long as the indicator exceeds the standard line and cannot be lowered through life intervention for 3 months, you must continue to take the medicine. In fact, both sides are reasonable. The core is that you have to monitor your indicators regularly. You can't insist on not eating, and you can't just eat and drink after taking medicine and think everything is fine. There is an old patient next to me who has taken antihypertensive drugs for ten years and measured his blood pressure on time every day. Now he is almost 80 and has no heart problems.

When it comes to hurting blood vessels, tobacco is definitely the number one "invisible killer". Don't believe in the marketing rhetoric of "low-tar cigarettes are healthier" and "e-cigarettes are harmless". A few years ago, a large-sample cohort study was conducted in Europe. The probability of vascular endothelial damage among people who smoke e-cigarettes is three times higher than that of non-smokers, which is almost the same as those who smoke regular cigarettes. Others say, "My old man has smoked all his life and lived to be 90." That's all an example. Go to the emergency care unit and see that nine out of ten patients with myocardial infarction under the age of 40 have a long-term smoking history. This probability is here. There is no need to gamble with your body on a small probability event. There used to be an old smoker who couldn't quit smoking, so he only smoked two or three cigarettes a day, thinking that he was fine. Last year, he was diagnosed with carotid artery plaque, and the doctor forced him to quit completely. He persisted and quit for half a year. This year, the plaque shrank a bit during the review, and the effect is more obvious than taking many health supplements.

Nowadays, there are a lot of opinions on the Internet about how to exercise to prevent heart disease. Some people say that you should walk 10,000 steps a day, some say that high-intensity interval training is effective, and some say that resting is the only way to protect the heart. In fact, our clinical practice never prescribes the same exercise prescription to everyone: if you ask an old man with bad knees to walk 10,000 steps a day, his knees will become useless if his heart is not trained well. ； Young people who never exercise usually run a half marathon, which may easily induce myocardial ischemia. The most appropriate exercise is actually something you can stick to for a long time. Even if you walk downstairs for 20 minutes after meals every day, or do stretching or Tai Chi at home, as long as your heart rate is 20-30 beats higher than when you are sitting, it will be useful if you stick to it. Not long ago, there was an aunt in her 50s. She used to have high blood lipids and was afraid to run or jump. She followed her husband to the park for a half-hour jog every day after meals. After walking for a year, her blood lipids dropped to the normal range this year.

Many people think that doing a routine electrocardiogram every year is equivalent to checking the heart. In fact, it is not true. A routine electrocardiogram can only detect abnormalities when you have a disease. For people with high blood pressure, diabetes or family history, it is best to do a carotid artery ultrasound every year to see if there are plaques. After the age of 45, do a coronary CTA every 2 years. If possible, check the high-sensitivity troponin. These indicators can detect abnormal signals in the heart 2-3 years in advance. By the time symptoms appear, they are often already very serious.

Oh, by the way, there are two questions that people ask a lot. Let me explain them clearly: One is whether drinking coffee will hurt the heart. Current research by the American Heart Association shows that 1-2 cups of black coffee a day can reduce the risk of cardiovascular disease. However, drinking it will aggravate the symptoms of people with premature beats and tachycardia, so there is no unified answer. If you feel your heartbeat is fast and uncomfortable after drinking it, don’t drink it. If you don’t feel it after drinking it, you can drink it. There is no need to force yourself to quit.； The other is "drinking red wine to soften blood vessels." This statement is more controversial. Some studies say that the resveratrol in red wine is effective, but you have to drink dozens of bottles a day to achieve the effective dose. On the contrary, alcohol intake itself will increase cardiovascular risks, so we generally do not recommend drinking red wine to protect the heart. If you really want to supplement resveratrol, eating more grapes is no better.

In fact, I have been a cardiologist for so many years, and I feel that the prevention of heart disease is really not that mysterious. To put it bluntly, don’t do it. Don’t stay up until three or four o’clock and still feel young, don’t smoke until you cough and still think it’s fine, don’t ignore a lot of high indicators and not go to see them. Oh, by the way, there is another point that many people ignore. Don’t hold your breath for a long time. Long-term anxiety, sulking, and excessive pressure will also increase the burden on the heart. Last year, there was a girl who worked overtime for three consecutive months and hid in a rental house crying every day. Finally, she was diagnosed with stress cardiomyopathy. Fortunately, she was discovered early.

After all, the heart has been beating for a lifetime. If you are kind to it, it will treat you well.