What are the preventive drugs for heart disease?

At present, there is no "universal preventive drug" for heart disease that is suitable for all healthy people in clinical practice. It is recognized that the main drugs that can be used for targeted prevention in high-risk groups are statins and lipid-lowering drugs, low-dose aspirin, plus disease control drugs for basic diseases such as hypertension and diabetes. All preventive drugs must be evaluated for cardiovascular risk first, and must not be taken on their own.

Last week, I met a 42-year-old salesperson in the clinic. He socializes and drinks all year round and smokes one and a half packs of cigarettes a day. His physical examination showed that his low-density lipoprotein was 3.9mmol/L. His carotid arteries have developed unstable soft spots. His 10-year cardiovascular risk assessment is 18%. He is a high-risk group with a high risk of myocardial infarction. , I prescribed him 10 mg of rosuvastatin, combined with 100 mg of enteric-coated aspirin every day. This is a typical primary prevention drug for heart disease - he has not had angina pectoris or myocardial infarction yet, and he has lowered his blood lipids in advance to inhibit platelet aggregation and avoid sudden rupture of plaques blocking the coronary arteries.

When it comes to aspirin, the academic circles have been divided in the past two years. In the past few years, the updated cardiovascular disease prevention guidelines in Europe and the United States directly deleted the routine aspirin prevention recommendations for low-risk groups with a 10-year cardiovascular risk of less than 10%. The core reason is that ordinary people are afraid that ordinary people will take medicine indiscriminately to increase the risk of bleeding. I took in a 58-year-old aunt last month. I heard from the square dancing sisters that she took aspirin to prevent myocardial infarction, so I bought it without consulting a doctor. Her blood pressure and blood lipids were all normal, and she had no family history of heart disease. Eight months later, she drank liquor with a friend and was hospitalized for stomach bleeding. Afterwards, a risk assessment showed that her risk of heart disease in 10 years was only 3%. There was no need to take this medicine, and she suffered in vain.

Many people come to me to prescribe "specific drugs to prevent heart disease." They always think that antihypertensive and antidiabetic drugs are for other diseases and are not considered heart prevention drugs. This is actually a big misunderstanding. For example, if you have long-term essential hypertension, if you insist on taking antihypertensive drugs such as amlodipine and valsartan to stabilize your blood pressure below 130/80mmHg, you will reduce the burden on the heart and prevent long-term high pressure from making the heart thick and causing plaque to grow on the blood vessel walls. This is more reliable than taking any number of health care products that claim to "protect the heart." The same goes for patients with type 2 diabetes. Stabilizing blood sugar within a reasonable range is reducing the probability of vascular disease, which is the best way to prevent heart disease.

Many patients also ask me whether Coenzyme Q10 and deep-sea fish oil can be used to prevent heart disease. To be honest, if you do not have myocardial damage or the adverse reactions of muscle soreness after taking statins, these are nutritional supplements and are not clinically recommended routine preventive drugs at all, so there is no need to spend a lot of money to buy them.

To be honest, many of the high-risk patients I come into contact with can quit smoking, control their diet high in oil and salt, and smoke three or four days a week and walk three to five kilometers. The preventive effect is better than taking half a statin. Don’t pin all your prevention hopes on taking medicines. Medicines have corresponding side effects, and the risks can be reduced by lifestyle adjustments. There is no need to take additional risks by taking medicines.