Heart disease prevention measures

The core logic of heart disease prevention has never been to apply a unified "health formula", but to implement layered prevention and control based on one's age, underlying diseases, and family history. Prioritizing the four top risk factors of smoking, hypertension, dyslipidemia, and diabetes that have been confirmed by the global medical community, and supplemented by lifestyle adjustments that suit individual circumstances, more than 80% of the risk of premature heart attacks can be avoided.

Last month when I was doing a cardiovascular screening in a community in the old city, I met 62-year-old Uncle Zhang. He held up his exercise record and told me that he had quit smoking for 10 years and walked 20,000 steps a day without touching pork. How could it be found that his coronary arteries were 30% blocked? I looked through his physical examination report and found out that he never stopped eating pickles with porridge, his sodium intake exceeded the standard by almost three times, and his blood pressure hovered at 145/95 all year round. If he didn’t feel dizzy, he didn’t need to take medicine, which was equivalent to ignoring the core risk factors. No matter how self-disciplined he exercised, he couldn’t make up for this hole. Many people have similar misunderstandings about heart protection as Uncle Zhang. They think that as long as they are "restrained" enough, they can completely avoid risks, but they ignore individual differences and the priority of core contradictions.

There is a lot of controversy online now about heart-protecting diets. One group says that a Mediterranean diet with more deep-sea fish and olive oil is the gold standard, while the other group claims that a pure vegetarian diet is the ceiling for heart-protecting. Both sides can produce a lot of research data to support it. Objectively speaking, the 2023 "Lancet" cohort study did show that the incidence of cardiovascular events among people who adhere to a Mediterranean diet is 25% lower than that of an ordinary diet. However, our department followed up 120 people who adhered to a pure vegetarian diet for more than one year last year. Nearly 30% had elevated homocysteine. For every 5 μmol/L increase in this indicator, the risk of myocardial infarction increased by 33%. In fact, there is no perfect diet template at all. People with high uric acid should not follow the trend and eat too much deep-sea fish. Elderly people with bad teeth do not need to chew raw vegetable salads. They are still nutritious when cooked. The core is to control the intake of oil, salt, and added sugar, and do not go to extremes.

Oh, by the way, I also have to mention the pitfalls of sports. There used to be a 28-year-old Internet programmer who read on the Internet that HIIT can burn fat and protect the heart. He stayed up until 10 o'clock every day after get off work and still practiced for 40 minutes. After practicing for the third time, he had chest pain and was sent to the emergency room. It was found that it was coronary spasm induced by sympathetic nerve excitement. There are indeed studies in the field of sports medicine that believe that high-intensity exercise 1-2 times a week can improve cardiopulmonary function, but the premise is that you have no underlying cardiovascular problems. If you usually get short of breath while climbing the third floor, or have been found to have coronary plaques, then low-intensity exercises such as slow walking and Tai Chi are safer. Don’t blindly follow the trends in exercise duration and intensity. If you can speak normally and not be out of breath when exercising, this intensity is just right.

Don’t think that your emotions, routine, etc. are trivial matters. Last year, I met a 35-year-old woman who had nothing wrong with her normal physical examination. After an argument with her husband, she immediately went to the doctor with chest pain. She was found to have "broken heart syndrome", which is actually myocardial damage caused by severe mood swings. There are also many young people who stay up late to catch up on projects, struggling to carry on even when their heartbeats are pounding. At that time, your vascular endothelium is quietly damaged. Don’t always think that you are young and can handle it. Cases of myocardial infarction in people in their 20s are really not uncommon nowadays.

Finally, many physical examination centers will not specifically remind you: Don’t just do an electrocardiogram for a physical examination for ordinary people. If you have a family history of heart disease, or smoke for many years, or have high blood pressure, it is best to add carotid artery ultrasound and blood lipids to see if there are early plaques. The low-density lipoprotein index in blood lipids is much more important than total cholesterol. If you belong to a high-risk cardiovascular group, this index must fall below 1.8mmol/L to be qualified. It does not mean that everything will be fine if it is within the reference value range.

In fact, protecting the heart is really not that complicated. You don’t have to worry about what you can’t eat and what you can’t touch every day. If you smoke one less cigarette and stay up one unnecessary night, it will be much more effective than taking hundreds of yuan of heart-protecting health care products. If you are not sure about your risk level, a 10-minute risk assessment with a cardiovascular specialist is much more reliable than blindly browsing online health posts.