What are the types of drugs for heart disease prevention

The drugs currently used clinically for the prevention of heart disease essentially revolve around the core of "reducing the formation of vascular plaques, stabilizing plaques, and avoiding blood vessel blockage." There is no so-called "universal preventive drug". All drugs must be stratified for cardiovascular risk first, and only those that should be used should be used. Taking inappropriate ones will have side effects.

Last week I met a 42-year-old freight driver in the clinic. He has a family history of hypertension. He has had high blood pressure for 6 years and has never taken any medicine. His low-density lipoprotein was found to be 3.9mmol/L, and his body mass index (BMI) is almost 29. After a risk assessment, the probability of myocardial infarction and cerebral infarction within ten years was more than 12%, making him a high-risk group. At that time, he was prescribed low-dose aspirin and medium-strength statins, which are currently the most commonly used primary and secondary prevention of heart disease.

When it comes to aspirin, many people are familiar with it. In the past few years, many people still had it at home. They thought that eating aspirin as you get older can prevent heart disease. In the past two years, the academic consensus has actually narrowed a lot - if you have been diagnosed with coronary heart disease, myocardial infarction or a stent, you must take it for a long time, but if you just have a little blood For people with high fat and low- to medium-risk risk assessment, eating indiscriminately can easily cause gastrointestinal bleeding and gum bleeding, which is not worth the gain. Currently, different clinical studies are still controversial on whether low-risk people should use aspirin. There is no unified conclusion. The core still depends on the individual risk-benefit ratio.

Statins, which are often paired with aspirin, have completely different logic of action. You can think of them as a "rust-removing stabilizer" for blood vessels. They mainly reduce the level of low-density lipoprotein, a "vascular garbage", and stabilize the soft plaque that has formed on the blood vessel wall to prevent it from breaking and forming a thrombus to block the blood vessel. Nowadays, many people say that statins damage the liver and kidneys. In fact, as long as they are taken under the guidance of a doctor and the liver function and muscle enzymes are regularly monitored, the incidence of side effects is very low. If you are intolerant to statins or your blood lipids still cannot drop to the target value after taking them, there are also PCSK9 inhibitors that have become popular in the past two years. One injection every six months can stabilize blood lipids, but the price is a bit higher and it is suitable for high-risk people.

In addition to these drugs that directly target blood clots and blood lipids, drugs to control underlying diseases are actually more important preventive measures. For example, for people with high blood pressure, if they take antihypertensive drugs for a long time to stabilize their blood pressure below 130/80mmHg, they can reduce the risk of coronary heart disease by more than 40%. Antihypertensive drugs such as Dipine, Sartan, and Prilim, as long as they are suitable for their physical constitution, have a very obvious protective effect on blood vessels. I followed up a 63-year-old aunt who was diagnosed with high blood pressure 20 years ago. She has been taking Sartan antihypertensive drugs regularly. Her carotid artery plaques are now lighter than many 50-year-old people, and she has never had chest tightness or pain.

There are also new hypoglycemic drugs that have become popular in recent years, such as GLP-1 receptor agonists and SGLT2 inhibitors. They were originally used to lower blood sugar in diabetics. Later, clinical studies found that they can also improve vascular endothelial function and reduce the risk of heart failure and myocardial infarction. Nowadays, many people without diabetes who are at high cardiovascular risk will prescribe such drugs after evaluation by doctors, which is equivalent to an extra layer of protection.

But I have to remind everyone that all preventive drugs are "icing on the cake". I met a patient two months ago who was diagnosed with coronary heart disease and drank heavily and ate fat every day. Even though he was taking double doses of statins, his blood lipids still did not fall to the target value. He was hospitalized once last month because of angina pectoris. If you really want to prevent heart disease, quit smoking, stay up less late, and eat less food high in oil and salt. This is more effective than taking any medicine. If you want to take medicine and what medicine to take, you must seek professional doctor evaluation. Don't just buy medicines after reading some popular science on your own.