Lecture content on heart disease prevention knowledge

There is no 100% prevention plan for heart disease. The most effective prevention logic is "life-cycle lifestyle adjustment + individualized risk screening." There is no standard diet or exercise formula suitable for everyone. Any prevention recommendations that are divorced from individual basic diseases, age, and genetic history are all nonsense.

I have been practicing in the cardiology department for 12 years, and last month I encountered two typical examples at a community free clinic: a 42-year-old Internet programmer whose triglycerides were twice as high during a physical examination. He came holding a thermos cup soaked in wolfberry and asked if he should take a statin immediately, and he didn’t even dare to eat more.； Another 67-year-old aunt, whose blood pressure had just reached the critical value of 140/90, was so panicked that she had her blood pressure checked eight times a day and even dared not go to the square dance downstairs. In fact, both of them made the same mistake: treating heart disease prevention as a unified standard answer, and either being overly anxious or using random methods.

Let me first tell you something that is still controversial in the industry, so that you will not become more and more confused after reading different popular science contents: it is about the control standards for bad cholesterol, that is, low-density lipoprotein (LDL-C). Our current domestic guidelines recommend that extremely high-risk groups (those who have had a myocardial infarction or have a stent installed) should reduce it to below 1.8mmol/L. Yes, but in recent years a number of cutting-edge studies in Europe and the United States have put forward the view that “lower is better” and even recommended lowering it to below 1.4mmol/L. However, many conservative scholars believe that if elderly people over 75 years old do not have clear coronary stenosis problems, lowering it too low may increase the risk of hemorrhagic stroke. There is no need to impose a hard value. So you really don’t need to use the online standards to argue with your own physical examination report. What level of control should you have? Ask the attending doctor for comment with your complete examination results, which is more useful than reading 10 popular science articles.

We usually say that prevention requires "keep your mouth shut and move forward", but it really doesn't mean that you should eat boiled vegetables every day and take 10,000 steps a day. I used to have an old patient who ate boiled vegetables for three months in order to lower his blood lipids after he retired. He lost ten pounds and felt wobbly when he walked. When he came for a follow-up examination, his blood lipids had indeed dropped a little, but his blood potassium was also low. Later, I adjusted him to eat lean pork belly once a week, no more than 2 taels each time, with half a catty of green leafy vegetables. I went to the park to play Tai Chi for half an hour every afternoon without forcing myself to walk 10,000 steps. I checked last month and found that his blood lipids were very stable and he was full of energy. Oh, by the way, don’t believe the saying that “a small amount of drinking softens blood vessels.” Most studies have now proven that even a small amount of drinking can cause cardiovascular damage. However, there are also small-scale epidemiological surveys that show that postmenopausal women who drink no more than 1 tael of red wine a day do have very slight cardiovascular benefits. However, this benefit is not worth it compared with the benefits of not drinking. If you can avoid drinking, try not to drink.

Speaking of this, someone must have asked, so I have a physical examination every year and there are no problems, so I don’t need to worry about it? Not really. I treated a 36-year-old man last year. His blood lipids and blood pressure were normal during the annual physical examination at work. He always stayed up late, and he had a history of familial hypercholesterolemia that he didn’t even know he had. When he was brought here due to a sudden myocardial infarction, his coronary arteries were 90% blocked. Our blood lipid standards for routine physical examinations are set for the general population. If you have a family history of premature cardiovascular disease (parents or siblings had myocardial infarction before the age of 55), long-term smoking, obesity and other high-risk factors, it is best to do an additional coronary calcium score screening, or find a doctor to do a 10-year ASCVD risk assessment, which can uncover many hidden risks.

There is another point that is often overlooked: emotions. Our blood vessels are like the rubber water pipes at home. If you twist and smash them every day, no matter how good the quality is, they will easily break. I met a 38-year-old woman last year who had no problems with her normal physical examination. After an argument with her husband, she suddenly suffered from chest pain and started sweating. She was sent here to be checked for stress cardiomyopathy, also known as "broken heart syndrome", which is acute damage to the heart caused by stimulation of the heart during violent mood swings. So don’t think that prevention means keeping your mouth shut and moving forward. Don’t get sulky and don’t put too much work pressure on yourself. This is also the most important part.

Oh, by the way, one last thing to mention about the pitfalls that everyone often steps into: Don’t just go for the so-called “blood-activating injection” to prevent myocardial infarction. Every autumn and winter, I meet a lot of uncles and aunts who come to the clinic and ask for infusions. It’s really unnecessary. The blood-activating ingredients that are injected will be metabolized in a few days, and may increase the risk of allergies and phlebitis. It is really not as effective as taking antihypertensive drugs on time and not stopping the drugs at will. Those deep-sea fish oils and coenzyme Q10 that are so popular also have auxiliary effects. If your blood lipids are normal, you don’t need to spend thousands to buy a bunch of them at home. If your blood lipids are really excessive, you still have to take statins when you should. Don’t take health care products as medicine.

What I’m talking about today is not to force everyone to follow strict rules. After all, everyone’s physical condition is different. If you are not sure, just take your physical examination report of the past six months to the cardiology clinic to find a doctor for an evaluation. It is much more reliable than searching for messy information on the Internet for a long time. Now if you have any questions, you can raise your hands and ask, and I will answer them one by one.