What are the preventive drugs for heart disease?

First of all, we need to clarify a major premise - there is no "panacea" for heart disease prevention that is suitable for everyone. Whether or not to take medicine and what medicine to take are completely based on your own cardiovascular disease risk stratification. There is never a saying that "you have to take it when you reach your age". Last week when I was doing missionary work in the community, I met two aunts with completely opposite conditions. They are both 62 years old. Aunt Wang has a 10-year history of hypertension. Last year, she was found to have a 7mm hypoechoic plaque in the carotid artery and an LDL level of 4.2mmol/L. She was assessed to be in a high-risk group for cardiovascular disease. We asked her to take rosuvastatin combined with low-dose aspirin, and at the same time adjusted the antihypertensive medication to a dose that can stably control it at 130/80mmHg. ； Aunt Liu, who was traveling with us, had normal blood pressure, blood lipids and blood sugar, and she still insisted on square dancing. No one in her family had early heart disease, so we just asked her to go back and continue to maintain her current living habits. She didn’t need to take any preventive medicine, and she didn’t mess around with buying health care products.

If you often go to the cardiology department, you will find that statins are most commonly used for prevention. Their core function is to reduce bad cholesterol (low-density lipoprotein) to a safe threshold, especially for people who already have atherosclerotic plaques. If this indicator is controlled, the plaques will not be easy to rupture and grow, which can reduce the risk of myocardial infarction and cerebral infarction by more than 30%. However, there has always been a saying on the Internet that "statins damage the liver and muscles". This is not a rumor. It is true that a small number of people will experience elevated transaminases and muscle soreness after taking it. However, as long as the indicators are followed regularly, the dosage is adjusted or the type is changed, most people can tolerate it. There is really no need to stop taking the medicine privately after listening to others. I had an old patient who stopped taking statin privately less than a year ago. The originally stable plaque suddenly progressed and blocked 80% of the coronary arteries. Finally, a stent was placed to solve the problem.

There is also the most familiar aspirin. This drug has actually been controversial for several years. In the early years, there was indeed a saying that "middle-aged and elderly people take aspirin daily to prevent heart disease." But now the guidelines at home and abroad have changed - only people who have been diagnosed with cardiovascular diseases such as coronary heart disease and cerebral infarction can use it. It is recommended for secondary prevention, or for people who are assessed to be high-risk and have a low risk of bleeding. If you have gastric ulcers and are prone to bleeding, taking aspirin will easily cause gastrointestinal bleeding, which is not worth the gain. You must seek professional evaluation from a professional doctor, and you must not buy and eat it on your own.

In addition to the two categories that everyone has heard the most, many people actually ignore that antihypertensive drugs and hypoglycemic drugs themselves are the best preventive drugs for heart disease. Long-term high blood pressure and high blood sugar will slowly corrode the endothelium of blood vessels and provide opportunities for blood lipid deposition, just like the corroded walls of water pipes are more likely to attract dirt. Controlling blood pressure and blood sugar within the standard range for a long time is more effective than eating any number of health care products that "maintain blood vessels." If you are statin intolerant, or your blood lipids cannot be lowered to the target value, there are now lipid-lowering injections such as PCSK9 inhibitors. In the past, one injection cost more than a thousand, but now it only costs a few hundred with medical insurance, and many high-risk patients can afford it.

Of course, the basis of all drug prevention is lifestyle adjustment. If you stay up late every day, eat takeaways that are heavy in oil and salt, smoke and drink frequently, no matter how many drugs you take, you can't stop your blood vessels from deteriorating, right?