Heart disease preventive injections

As of 2024, there is no "preventive shot" that can 100% prevent all heart disease approved for sale globally. The "heart disease preventive shot" that ordinary people think of is essentially a layered prevention and control plan from lifestyle to clinical intervention.

Zhou, a 38-year-old middle-level Internet worker whom I met at the cardiology follow-up clinic last month, sat across from the consultation table holding last year's physical examination report. On the report, there was only an arrow indicating slightly elevated LDL, and everything else was normal. He felt that he was young and could handle it. He had a heart attack while staying up late for three consecutive months to catch up on a project, and had to put in two stents to save his life. The first thing he said when he saw the doctor was, "Doctor, are there any injections that can prevent heart disease?" I never want to suffer this again."

In fact, not just Lao Zhou, many patients have asked this question in the past two years. The "injections" everyone talks about mostly refer to the PCSK9 inhibitor lipid-lowering drugs that have become popular in the past two years. Long-acting injections once every two weeks or once every six months can reduce low-density lipoprotein to extremely low levels. Many high-risk patients can even reverse the progression of coronary plaques after taking them. Regarding the attitude towards this drug, the views in the cardiovascular field of Western medicine are also divided into two groups: one group believes that for extremely high-risk groups with familial hypercholesterolemia and myocardial infarction, this drug is indeed equivalent to a "semi-preventive shot" and can reduce the risk of recurrence by more than 50%. As long as economic conditions permit, it is worth taking it. ； The other group has repeatedly emphasized that it cannot be deified. The current clinical follow-up data is only about 10 years at most, and the potential side effects of long-term use are still unclear. For ordinary people with slightly higher blood lipids and no other underlying diseases, the cost-effectiveness of a few thousand injections is extremely low, and there is no need to rely on injections for prevention.

A nationally renowned veteran Chinese medicine practitioner I had consulted before had a completely different understanding of "preventive shots for heart disease". He often said that the "preventive shots" of traditional Chinese medicine are never inserted into the body, but are inserted into the living habits. He has a patient who has been followed up for 8 years. In 2015, it was found that his coronary artery was blocked by 40%. He was unwilling to take statin western medicine because of poor liver function, so he followed his advice and drank astragalus and salvia miltiorrhiza in place of tea every day. He also took Baduanjin for 20 minutes in the morning and evening. After 20 years of smoking, I quit eating braised pork every now and then once a month. Last year, my coronary CT scan showed that the plaque not only did not grow, but also shrank a bit, and the degree of blockage dropped to 25%. The effect is better than that of many patients who insist on taking lipid-lowering drugs.

Don't tell me, there is quite a quarrel about this topic on the Internet now. Some people think that with the development of technology, there must be a miracle drug that can be solved with one shot. They would rather spend tens of thousands of dollars on injections than bother to talk about it. Some people think that heart disease is hereditary, and it is useless to prevent it. You should get it anyway. I think both of these statements are extreme. The World Health Organization has already published data that 80% of premature coronary heart disease can be avoided through lifestyle intervention. If you really have high-risk factors, just take the medicine when you need it. There is no need to be afraid of side effects.

Not long ago, I met an aunt in her 50s. Her blood lipids during physical examination were only 0.2mmol/L higher than the normal value. She had no high blood pressure or diabetes, and no family history. She insisted on asking the doctor to prescribe PCSK9 inhibitors, saying that she needed to get "preventive shots" in advance. After persuading her for a long time, she was willing to adjust her diet and exercise for 3 months before rechecking. In fact, for the vast majority of ordinary people, our "vaccination" does not need to go to the hospital at all: don't drive if you can walk two more steps when you go out. When you come home from get off work and slump on the sofa to check your mobile phone, standing up and tiptoing to shake your legs is considered moving. Occasionally drink a cup of milk tea to relieve the pain. It doesn’t matter if you are greedy. Drinking water every day is definitely not enough. Don’t just look at the arrows for your annual physical examination of blood lipids. It is best to control the low-density lipoprotein of young people below 2.6mmol/L. If you have underlying diseases such as hypertension and diabetes, it must be lowered to below 1.8 to be safe. These little things may seem inconspicuous, but together they are the cheapest and most effective "vaccine".

A little girl in her 20s came for a physical examination before and asked me when I would be able to get a real preventive shot for heart disease. It would be best if one shot would last a lifetime, and she would no longer have to eat food and stay up late to worry about sudden death. I laughed at that time, how could such a good thing happen? The so-called "heart disease preventive injection" is, in the final analysis, never about the small tube of medicine given in the hospital. It is about the one hour less you stay up at night every day, the extra mouthful of green leafy vegetables you eat, the less anger you get during an argument, and the five hundred extra steps you walk after a meal. If you accumulate these little things every day, they are more effective than any magic needle.