A complete list of preventive measures for heart disease

According to public data from the World Health Organization, more than 80% of premature heart disease (i.e., heart disease that occurs before the age of 55 in men and women before the age of 65) can be completely avoided through scientific intervention. The core intervention logic does not need to rely on expensive drugs or special therapies. It only needs to cover the three core aspects of "daily habit adjustment, high-risk factor control, and regular screening." Personalized adaptation can be done based on personal physical conditions. There is no so-called "universal magic formula."

When I was following up in the cardiology department two years ago, I met a 42-year-old middle-level Internet worker. During the annual physical examination, except for a slightly higher low-density lipoprotein, the electrocardiogram and cardiac ultrasound were all normal. He usually took time to play badminton every week. As a result, he suffered a myocardial infarction after an all-nighter to catch up on a project. An angiogram was sent to him and showed that all three blood vessels were stenotic by more than 70%. Two stents were put in to save him. Later, when I chatted with him, I found out that he usually ate takeout and always felt that he would be fine if he was young and exercised. Staying up late at night was commonplace, and he didn't take the high blood lipids to his heart at all.

When many people talk about the prevention of heart disease, their first reaction is to "be vegetarian". In fact, this is the most controversial point now. In the past few decades, mainstream academic circles have been advocating low-fat diets, believing that reducing saturated fat intake can reduce the risk of heart disease. However, in recent years, supporters of ketogenic and low-carb diets have produced many small sample studies, proving that as long as metabolism is normal, appropriately increasing saturated fat intake and reducing refined carbohydrates can actually improve blood lipid indicators and reduce the risk of heart disease. Among the cardiac rehabilitation patients I come into contact with, there are two situations: There is a retired teacher who insists on eating a DASH diet (that is, eating more whole grains, fresh fruits and vegetables, high-quality lean protein, and less processed sugar, red meat, and high-sodium foods). In less than half a year, his low-density lipoprotein dropped by 22%, and he even reduced the amount of antihypertensive drugs. ； There is also a 28-year-old young man who blindly eats ketogenic food in order to lose weight. He eats bacon and butter every day. In three months, his triglycerides were three times the normal value. He was also found to have coronary calcification plaque. The current academic consensus is also very clear: no dietary structure is suitable for everyone. The core principles are to limit exposure to processed foods and refined sugars, do not consume more than 5g of salt per day, and do not go to extremes for a long time.

After talking about eating, let’s talk about exercise. Many people think that to prevent heart disease, they have to run five kilometers every day and do strength training. This is not true. Several patients I have come across who are recovering from myocardial infarction used to be part of the weekend sports party. They usually sit in the office and are too lazy to even get up to get water. On weekends, they run half marathons and climb mountains whenever they have free time. This puts a sudden burden on the heart. In fact, more and more studies now show that daily light activities, such as getting off the car two stops ahead of get off work and walking for 15 minutes, climbing the stairs for 10 minutes during lunch break, or even mopping the floor and watering plants at home, the combined effect of these activities is better than high-intensity exercise once or twice a week. Of course, there is also controversy here: Is HIIT (high-intensity interval training) good for the heart? For healthy people with no underlying heart disease and normal blood pressure, HIIT 1-2 times a week can indeed improve cardiopulmonary function. However, if you have problems with high blood pressure and myocardial hypertrophy, practicing HIIT blindly will increase the risk of aortic dissection and myocardial infarction. Last year, there was a fitness blogger in his 30s who practiced HIIT despite a cold. He suffered a sudden aortic dissection and was not saved. It was a pity.

There are many risk factors that people don’t even notice at ordinary times, which are more hidden than high blood pressure and high blood sugar. For example, many people think that snoring during sleep means they are sleeping soundly. In fact, if snoring suddenly stops for a few seconds, and then continues to gasp for air, this is sleep apnea. In the long run, the body will be in a state of hypoxia for a long time, and the damage to the vascular endothelium is more severe than high blood pressure all year round. I once had a 50-year-old patient whose blood pressure could not be lowered after taking three antihypertensive drugs. Later, he checked the sleep monitoring and found that he had severe sleep apnea. He was on a ventilator for half a year. Now he only takes one antihypertensive drug and his blood pressure can be stabilized within the normal range. There is also chronic stress. Some people always say that "anger can lead to heart disease." In fact, it is okay to get angry once in a while, but being in a state of high stress for a long time, such as 996 every day, long-term anxiety, and high cortisol levels will indeed accelerate the formation of blood vessel plaques. Of course, there is no need to prevent heart disease. If you are sick, quit your high-paying job and lie down. As long as you can find a suitable outlet, such as having a meal with friends every week to complain, or taking two hours every week to do something you like, you can offset most of the effects of stress. The views of the psychology and cardiovascular circles are consistent.

Many people think that a routine physical examination every year is enough, but this is not the case. Electrocardiograms and cardiac ultrasounds in routine physical examinations can only detect organic diseases that have already occurred, such as myocardial ischemia and cardiac structural abnormalities. If you want to detect early signs of vascular plaques in advance, if you have high-risk factors such as family history of heart disease, smoking, high blood pressure, and hyperlipidemia, it is best to have annual physical examinations after the age of 35. Add a carotid artery ultrasound and four blood lipid tests (focus on low-density lipoprotein LDL-C, which is best controlled below 2.6mmol/L for the general population and below 1.8 for high-risk groups). After the age of 40, you can do a coronary CTA scan every 2-3 years to see if there are any coronary calcification plaques. Of course, there are different opinions here: one group believes that low-risk groups do not need to undergo coronary CTA, but will consume unnecessary radiation, and are prone to excessive anxiety because of the detection of small plaques. The other group believes that early detection and early intervention can nip the risk in the bud. The current compromise plan is that low-risk groups do not need to undergo routine coronary CTA before the age of 50, and high-risk groups can appropriately increase the frequency of screening according to the situation.

Finally, let me mention a few questions that people often ask, such as whether coenzyme Q10 and fish oil are useful? If you are taking statins and have muscle soreness as a side effect, taking some coenzyme Q10 can indeed relieve it. However, if you are a healthy person, taking it will not have any additional heart-protecting effect. It is better to eat deep-sea fish twice a week. There is also smoking, including second-hand smoke, which is an undisputed high-risk factor for heart disease. Don't take the example of "my relative who has smoked for decades and lived to be 90 years old" as an example. The big data is there. The risk of heart attack in smokers is three times that of non-smokers. If you quit smoking for one year, the risk can be reduced by 50%. Why not?

In fact, after all, the prevention of heart disease is really not as complicated as everyone thinks, and there is no need to live like an ascetic. Occasionally eating a hot pot heavy in oil and salt, or staying up late to watch football occasionally. As long as it is not a long-term habit, there will be no big problems. After all, the essence of these preventive measures we take is to make ourselves live longer and more comfortably, instead of putting a lot of rules on ourselves and making ourselves anxious every day. That is really not worth the gain, right?