heart disease prevention medicine

There is currently no universal heart disease prevention drug that is suitable for all people. All drugs approved for the prevention of cardiovascular disease are only suitable for clear risk groups. Healthy people taking them without authorization may cause serious side effects, and the gain outweighs the loss.

Last week I met a 52-year-old Aunt Zhang in the cardiology clinic. She came in with a pale face and covered her face. When asked if it was gastric bleeding, after asking for medical history, she found out that she heard the sisters from the square dance team said, "If you take aspirin when you are over 50, you will not have a heart attack when you are old." Without doing any risk assessment, she went to the drugstore to buy enteric-coated aspirin and took it for half a year, which caused erosion of the gastric mucosa. This sounds outrageous, but it is actually very common. Many people’s understanding of “heart disease preventive drugs” is still at the stage of “it’s useful if you take them”, and they are completely unaware of how strict the boundaries for the use of this type of drugs are.

Take the most classic aspirin, for example. A few years ago, European and American guidelines recommended that people over 40 years old and with 1-2 cardiovascular risk factors routinely use it for primary prevention (that is, early intervention before the disease occurs). In the past two years, the guidelines have successively lowered the recommendation level. Now it is only recommended for people who have a 10-year cardiovascular event risk greater than 10% and who do not have a high risk of bleeding. This evaluation standard alone screens out most healthy middle-aged and elderly people. Not to mention that ordinary people are confused. When the National Cardiovascular Annual Conference was held two years ago, two veteran professors with 30 years of experience were arguing over this matter. One said that as long as there are soft plaques in the coronary arteries, they should take it. The other said that people with no symptoms and blood lipid levels reaching the target should first rely on lifestyle adjustments instead of just taking medication. In the end, they did not reach a unified conclusion. They could only say that individual differences are too great and there will never be a standard answer.

Let’s talk about statins, which are the most commonly prescribed drugs by doctors now. Controversies have never stopped. A search on the Internet all shows that "statins damage the liver and will cause myolysis". It is true that less than 1% of users will experience adverse reactions such as elevated liver enzymes and muscle soreness. However, for people who have been diagnosed with hyperlipidemia and coronary artery stenosis of more than 30%, the benefits of statins in stabilizing plaques and reducing the risk of myocardial infarction are far greater than the extremely low probability of side effects. On the other hand, if your blood lipid indicators are within the normal range and you have no family history of cardiovascular disease, it is completely unnecessary to simply rely on taking statins for "prevention", and you may even cause problems.

As for the "Internet celebrity preventive products" such as coenzyme Q10 and deep-sea fish oil that are currently popular on the Internet, to put it bluntly, they are auxiliary supplements and are not formal preventive drugs at all. Coenzyme Q10 was sold out during the COVID-19 crisis at the end of last year. I met a 23-year-old Internet worker who found no heart problems during the physical examination. He took three pills a day. He said he was afraid of developing myocarditis after working overtime. I told him that if you first change your habit of staying up until two o'clock every day, it would be more effective than taking ten bottles of Coenzyme Q10. At present, domestic and foreign guidelines do not list this type of supplement as a routine preventive drug for heart disease. Only patients who suffer from coenzyme Q10 deficiency after taking statins or already have cardiomyopathy need additional supplements. Healthy people take it as a psychological comfort at most, and spend a lot of money, but the actual effect is minimal.

There is another direction that is not widely discussed now, but has been debated in academic circles for several years: Can beta-blockers be used to prevent people who have no underlying diseases but have a high heart rate after staying up late for a long time? There are cohort studies showing that low-dose beta-blockers can reduce the risk of cardiovascular events in people with long-term sympathetic nerve excitation. Other studies say that these people will suffer from side effects such as fatigue, depression, and decreased sexual function after taking the medicine. The overall benefits are unclear, and it has not been recommended in the guidelines. Anyone who tells you that taking this can prevent heart disease in healthy people either does not understand or wants to make money from you.

To be honest, I have seen too many people trying to save trouble, thinking that taking a small pill can offset the effects of staying up late, drinking, and eating high-fat and high-salt meals. How can it be such a good thing? After so many years of hard work in clinical practice, I often tell patients that the most universal "heart disease preventive medicine" is not in the pharmacy at all. It is in the vegetables with less salt and sugar in your bowl, in the extra two kilometers you walk after get off work every day, and in the good sleep you get half an hour early every day. Of course, if you already have basic diseases such as high blood pressure, hyperlipidemia, and diabetes, don't insist on not taking medicine. See a doctor for a comprehensive risk assessment. Just follow the doctor's advice on what and how much you should eat. Never look for medicine on your own, and don't believe in any miracle preventive medicine.