What are the drugs for heart disease prevention?

At present, it is clear that clinically evidence-based drugs for the prevention of heart disease mainly focus on anti-platelet, regulating blood lipids, and controlling basic diseases. Not everyone needs to take them, and the risk of cardiovascular disease must be assessed first before making a decision.

Last week, I met a young man who works as an Internet operator in the outpatient clinic. He is 32 years old, overweight, and has had high LDL for two years. I searched online for a long time and wanted to take aspirin to prevent myocardial infarction. I calculated for him that the risk of the disease in 10 years was only 3%, and I directly persuaded him to go back. I didn’t even prescribe any medicine. I asked him to go back to control his weight and stop staying up late. He would just check his blood lipids again in half a year.

Speaking of which, aspirin is the most familiar heart-protecting drug. In the past few years, many people wanted to take some preventive medicine no matter what the situation. In recent years, there has been a lot of controversy. Low-risk groups may easily increase the risk of gastric bleeding and cerebral hemorrhage if they take it. There was a 62-year-old aunt who bought aspirin for half a year after listening to her elder sisters saying that it was good to take aspirin. As a result, she was hospitalized for gastric mucosal erosion and bleeding. In addition to a slight high blood pressure, her blood sugar and blood lipids were normal, and she had no family history. She was completely unable to meet the standards for taking aspirin. The current consensus in the academic community is also very clear. Only high-risk groups who have been diagnosed with coronary heart disease or myocardial infarction, or whose 10-year cardiovascular risk exceeds 10%, are recommended to use low-dose aspirin as a preventive measure. Before taking it, they must first check for problems such as peptic tract ulcers and bleeding tendencies.

Compared with the "tangle" of aspirin in primary prevention, the preventive effect of statins and lipid-lowering drugs is now more and more recognized. To put it bluntly, its function is to lower the "bad cholesterol" (low-density lipoprotein) in blood vessels and "reinforce" the soft plaque that has grown on the blood vessel wall to prevent it from easily breaking and falling to block the blood vessel. It is like laying a protective net on an easily collapsed soil slope, greatly reducing the risk of myocardial infarction. Many people are afraid that statins will damage the liver and muscles. In fact, the incidence rate of these adverse reactions is less than 1%. Regular review of indicators is enough. If you really encounter intolerance, there are also options such as ezetimibe and PCSK9 inhibitors, so you don’t have to stop eating due to choking.

In addition to these two categories, for people with underlying diseases, keeping the corresponding indicators under control is the best prevention in itself. For example, for those with high blood pressure, long-term use of antihypertensive drugs such as amlodipine and valsartan to stabilize blood pressure below 130/80mmHg can reduce the damage to the blood vessel wall caused by long-term high pressure impact and fundamentally reduce the probability of atherosclerosis. ； For those with diabetes, many of the new anti-diabetic drugs currently used, such as dapagliflozin and semaglutide, have clear cardiovascular benefits. While lowering blood sugar, they can also reduce the risk of heart disease. For patients who have already suffered from myocardial infarction or heart failure, doctors often prescribe beta-blockers such as metoprolol or prindroid drugs such as perindopril, in order to improve heart function and reduce the risk of recurrence and sudden death.

Of course, don’t think that you have to take medicines to prevent heart disease. People in their twenties and thirties who have no underlying diseases and have healthy lifestyles don’t need to take these medicines at all. If they quit smoking and stay up less late, and take time to move every week, they are more reliable than taking any “heart-protecting pills.” There is no need to spend a penny on those heart-protecting health care products that are touted as amazing.