Heart disease prevention measures

The core prevention logic of heart disease is actually very simple - by controlling basic indicators such as blood pressure, blood sugar, and blood lipids, adjusting unhealthy lifestyles, and conducting targeted regular screenings, more than 80% of the risk of disease can be avoided. There are no secret remedies.

Last week I met a 42-year-old Internet programmer at a community free clinic. His blood pressure has been above 150/90mmHg for almost three years. He has never taken any medicine. He doesn’t go to bed until 2 o’clock every day. He eats two cups of iced American milk tea a day. Last week, he felt chest tightness and breathlessness, so he came for a checkup. After the coronary CT scan, two blood vessels were blocked by 30%. If it continues to progress, stents will be needed. He held the report sheet and asked me if I would not be able to do anything in the future. I felt there was no need to be so anxious. It would be much better for you to pay a little attention to many things than to fix the leaks after something went wrong.

Let’s talk about blood lipids. In the past few years, European and American guidelines have been promoting “the lower the LDL (low-density lipoprotein, also known as “bad cholesterol”), the better”, and even recommended that high-risk groups lower it to less than 1.4mmol/L. However, in China this year, we just The updated consensus on cardiovascular disease prevention and control mentions that it is enough for ordinary people to control LDL within 2.6mmol/L. People without underlying diseases do not need to blindly take statins in pursuit of extremely low values. Instead, they may have side effects of muscle soreness and abnormal liver function. The same goes for blood pressure. It does not mean that lower is better. For people over 65 years old, the systolic blood pressure can be lowered within 140mmHg. If the systolic blood pressure drops below 120, it will easily lead to insufficient blood supply to the brain. Oh, by the way, if you have been diagnosed with high blood pressure or diabetes, don't believe the rumors that "antihypertensive drugs are dependent" and "antihyperglycemic drugs damage the kidneys". Take the medicine when you need to, and controlling the indicators is the most important thing. I have met too many patients who ended up with myocardial infarction because they refused to take medicine. It is really a pity.

Many people think that to prevent heart disease, they have to eat boiled vegetables, run 5 kilometers every day, and live like an ascetic. This is really not the case. A while ago, there was a 68-year-old patient. He heard that vegetarianism can clear blood vessels. After half a year of vegetarianism, he did not even dare to touch eggs and milk. The last time he came for a review, his blood lipids did not drop much. His albumin dropped a lot and he felt dizzy when he walked. There is currently no conclusive conclusion in the academic circles that being vegetarian is better for heart health than eating moderate amounts of meat. On the contrary, some studies have shown that eating moderate amounts of deep-sea fish, lean beef, chicken breasts, and supplementing with high-quality protein can actually reduce the risk of heart failure. The core is actually to control the intake of trans fats, added sugars and sodium - the cup of full-sugar bubble milk tea you usually drink has more trans fat than the daily intake recommended by the WHO. The sodium content of pickled radishes, soy sauce meat, and processed ham at home is horrifyingly high, so don't eat it every day. It's perfectly fine to eat it once or twice a week to satisfy your cravings.

When it comes to exercise, the question I get asked the most is “What should I do if I sit in the office every day and don’t have time to exercise?” It really doesn’t mean you have to get a fitness card and run a marathon to be called exercise. You get off the subway two stops ahead of get off work and walk for 20 minutes, or do 10 minutes of stretching exercises along with the video during your lunch break. That’s enough for a total of 150 minutes of moderate-intensity activity every week, which means you can talk but not sing during exercise. That’s enough. In the past two years, studies have shown that high-intensity interval training (HIIT) is more effective in improving cardiac function. Some people have followed suit. As a result, people who have frequent premature beats have gone to the emergency room directly after training. So don’t blindly follow Internet celebrity exercises. The best is the one that suits you. If you feel flustered and chest tight for a long time after exercise, it means that the intensity is too high and you need to adjust it downwards.

There is also the matter of smoking. I have met too many old smokers who say, "I have been smoking for decades, but quitting now will cause problems more easily." This is not true. No matter how long you smoke, the risk of coronary heart disease can be reduced by 50% after 1 year of quitting. After 10 years of quitting, the risk is almost the same as that of a non-smoker. Oh, by the way, don’t think that e-cigarettes are “healthy alternatives.” A study published in the New England Journal of Medicine last year showed that aerosols from e-cigarettes can directly damage vascular endothelial cells, increase the risk of thrombosis, and are also high-risk factors for heart disease. As for alcohol, no matter how much you drink, it is not good for your blood vessels. If you really can't postpone the social activities, don't worry about the psychological burden if you drink a few sips less. Just don't drink it every day. You don't have to be so anxious that you can't sleep because of it. It will be bad for your heart.

Let’s talk about screening again. Last year, a 30-year-old girl came to see a doctor. She had an electrocardiogram done every year for physical examination at her workplace, and everything was normal. However, she had frequent chest pain recently and was found to have familial hypercholesterolemia. Her LDL was three times that of normal people, and her blood vessels already had obvious plaques. So don’t think that everything will be fine if the routine physical examination is normal. If you have high-risk factors such as family history of heart disease, obesity, staying up late for a long time, and smoking, it is best to have blood lipids and carotid artery ultrasound done every year after the age of 30 to see if there are early plaques in the blood vessels. After the age of 40, you can consider coronary CT screening. Of course, many experts say that it is unnecessary for ordinary people to undergo coronary CT examinations for radiation. This is indeed true. Ordinary people without any high-risk factors do not need to undergo excessive examinations to avoid unnecessary radiation exposure.

Speaking of which, I can't live a completely "healthy life". Sometimes I have to stay up until one or two o'clock to catch up on papers. I also like to eat butter hot pot on weekends to satisfy my cravings. But I will pay attention to going to bed early the next day after staying up late and eating lighter two or three days after eating hot pot. Every week Even if you go downstairs and play badminton for half an hour three nights, you won't deliberately force yourself to completely quit all "unhealthy" hobbies. After all, preventing heart disease does not require you to live a life without fun, but to minimize the risk as much as possible under the premise of being comfortable.

In fact, many people nowadays either take the prevention of heart disease too seriously, staying up late and drinking heavily, or they are too anxious and feel that they are going to have a myocardial infarction when they feel slightly uncomfortable. It is really unnecessary. The heart is more durable than you think. The occasional stay up late or eating hot pot will not cause problems all at once, but it is also more fragile than you think. Long-term bad habits accumulate, just like the scale in the water pipes accumulates thicker and thicker, and it may become blocked one day. More snacks are better than anything else.