The latest comprehensive list of heart disease prevention methods

There is no universal "universal prevention formula". The truly effective prevention is to first clarify one's own risk stratification (low/medium/high risk), and then carry out targeted "controllable risk factor intervention + sustainable micro-adjustment of life + regular accurate screening". It is much more cost-effective than following the trend of taking Coenzyme Q10 and running 5 kilometers every day.

When I was following up in the cardiology department in the past few months, I saw too many people who went to extremes: a 42-year-old Internet operations director whose father had a myocardial infarction at the age of 48. His low-density lipoprotein has been above 3.9mmol/L for a long time. I heard others say that exercise can prevent heart disease. He ran 10 kilometers on an empty stomach every morning, drank three or four cups of coffee a day, and didn't touch any red meat. As a result, a physical examination and coronary CTA showed that the blood vessels were 30% blocked. When he got the report, he was completely confused, saying that I had obviously done all the "right" things, so how could there be problems?

In fact, he didn't understand that people with different risk levels have completely different prevention priorities. If you use methods for low-risk people and apply them to high-risk people, it will naturally be useless.

When it comes to risk stratification, it is actually easy to judge: those whose immediate family members have had coronary heart disease or myocardial infarction before the age of 55, those who themselves have high blood pressure, hyperlipidemia, or diabetes, those who smoke and drink all year round, and whose BMI exceeds 28, are all at medium to high risk. The rest, those whose daily indicators are all normal and have no family history, are considered low risk.

Let’s talk about the food issue that everyone is most concerned about first. There are actually two schools of thought in the academic circles.

In the past, traditional views required strict low-fat and low-salt diets, with no saturated fat, and abstain from all braised pork and cream cakes. However, a 10-year follow-up study just published in the New England Journal of Medicine this year showed that as long as the total proportion of saturated fat in the daily diet does not exceed 10%, eating braised pork 1-2 times a week and drinking a cup of full-fat milk tea will not increase the risk of heart disease at all. On the contrary, if people who are completely vegetarians do not consume enough high-quality protein, their myocardial energy supply will be insufficient, which is detrimental to heart health.

My own advice to patients is also very practical. You don’t need to be a complete ascetic. When cooking, use 1/3 less salt than before. Try to choose less salt for takeaways. Eat no more than 500g of red meat per week. Trans fats (non-dairy creamer in milk tea, crispy bread, etc.) Fried foods (including fried foods) should be eaten as little as possible. Just eat once or twice a month to satisfy your cravings. It can fully meet the prevention requirements. No one can stick to the plan that requires you to avoid hot pot or barbecue for the rest of your life. On the contrary, it will be more harmful to overeat until the end.

Let’s talk about sports, this is also the area where people are most likely to go to extremes.

I have seen people lying on the sofa every day scrolling on their mobile phones without even wanting to go downstairs. I have also seen middle-aged men who do high-intensity interval training four times a week and run three marathons a year. The latter's cardiac enzymes were high when he last came for a physical examination. If he continues to practice, he will be at risk of myocardial damage.

The latest guidelines do not actually require everyone to do aerobic exercise. Low-risk groups can do whatever they want, as long as the total exercise time per week is 150 minutes, whether it is walking, square dancing, rocking iron, or playing peek-a-boo with your children. Even if you walk for 20 minutes today and climb 10 floors tomorrow, it will be enough.

People who are at moderate risk should not engage in competitive sports that are too intense, such as running a full marathon, playing basketball, or climbing several kilometers of mountains. Try to choose medium-intensity sports, which means that you can still talk to people normally during exercise, and you are out of breath but not so breathless that you can't speak complete sentences. If you feel flustered and chest tight for a long time after exercise, stop quickly and don't force yourself.

For people who are at high risk or have been diagnosed with coronary heart disease, it is best to go to the hospital to do an exercise stress test first, and ask the doctor to give you a special exercise prescription. Follow the exercise and do not increase the amount blindly, otherwise you will be in danger.

Many people ask me whether they should take supplements or health products for prevention. Here I will tell you the latest consensus.

The first is Coenzyme Q10. There are currently two schools of thought in the academic community: One school believes that healthy people do not need to take supplements at all. Most of the dose you take will be excreted through metabolism, which is a pure waste of money.； The other group believes that people who have already suffered myocardial damage, or who have muscle soreness as a side effect of taking statins for a long time, can take appropriate supplements, which can indeed relieve discomfort. To sum up, healthy people should not buy blindly. If you have corresponding symptoms, just follow the doctor's advice.

There is also the much-hyped aspirin. In the past, many people thought that middle-aged and elderly people should take some to open blood vessels. The latest guidelines have made it clear: only people who have been diagnosed with coronary heart disease, cerebral infarction, or have had a stent need to take aspirin for a long time to prevent secondary attacks. Taking aspirin for healthy people will increase the risk of gastrointestinal bleeding and cerebral hemorrhage. Do not buy it blindly.

Oh, by the way, there is also screening, which is most easily overlooked by everyone. This is the most cost-effective prevention method.

Last week, a 38-year-old programmer came for a physical examination. He usually had no symptoms, except that his father had a myocardial infarction at the age of 50. I asked him to do a carotid artery ultrasound. The result was that there were already soft plaques. If the plaques were not discovered two or three years later, the rupture of the plaques would be a myocardial infarction.

The latest screening recommendations don’t need to be so complicated: low-risk people should check their blood pressure, blood lipids, blood sugar, and routine electrocardiogram every two years before the age of 40, and once a year after the age of 40.； Those at moderate risk should be checked every year after the age of 35, and carotid artery ultrasound should also be done to see if there are early plaques. ； For high-risk patients, it is best to have a coronary CTA or exercise stress test every 2-3 years. Early detection of soft plaques is better than anything else.

Finally, I would like to remind everyone, don’t believe in the folk remedies of “slapping the elbow socket to open blood vessels” or “drinking salvia tea to prevent myocardial infarction”. If you really have unexplained chest tightness, chest pain, shoulder pain, or toothache, especially if it worsens after exercise, go to the hospital quickly and don’t delay things by relying on folk remedies.

In fact, heart disease prevention is really not that complicated. There is no need to do so many bells and whistles. First, understand your risk level, change a few small habits that can last a lifetime, and have regular physical examinations. It is much more effective than spending tens of thousands of dollars on health care products and getting a fitness card that you never go to.