How to rationalize the use of antiplatelet drugs to make coronary heart disease more and more “stable”?

Coronary artery atherosclerotic heart disease, or CHD for short, is the leading “killer” of the nation’s health, and its incidence has been trending younger in recent years. Antiplatelet drugs are one of the most commonly used drugs for patients with stable coronary heart disease, and their rational use is essential to prevent myocardial infarction and cardiovascular death. In the China Cardiovascular Disease Report 2011 published in 2012, it was pointed out that the mortality rate of cardiovascular disease in China has remained high in recent years, with the mortality rate of cardiovascular disease ranking first in 2010, significantly higher than that of tumors and other diseases, becoming the primary “killer” affecting the health of the nation. Coronary artery atherosclerotic heart disease, referred to as coronary heart disease, is the most common cardiovascular disease, China has become one of the world’s largest number of people suffering from coronary heart disease, and in recent years, the morbidity characteristics of coronary heart disease in China has shown a trend of youthfulness, in which the number of deaths due to coronary heart disease between the ages of 35-60 years old has increased significantly, so it is important to actively prevent and treat it. Academician Chen Keji has done a lot of work in the field of combined Chinese and Western medicine in the prevention and treatment of coronary heart disease for more than 50 years, and has achieved fruitful results. Academician Chen Keji said, “Coronary heart disease is a chronic non-communicable disease caused by the combination of poor lifestyle and genetic and environmental factors, once the patient wears the “hat” of coronary heart disease, we must be prepared for long-term “battle” with it. Once patients put on the “hat” of coronary heart disease, they should be prepared for a long-term “battle” with it. Although coronary intervention (PCI) has made great progress in the past decade, its main application area is the early intervention of acute coronary syndrome (ACS), especially acute myocardial infarction with ST-segment elevation, timely revascularization, saving ischemic myocardium and saving lives, while for a large number of patients with stable coronary artery disease (mainly including chronic stable exertional angina, old myocardial infarction), and patients with chronic myocardial infarction after successful hemodynamic reconstruction therapy, the treatment of coronary artery disease has been performed. For a large number of patients with stable coronary artery disease (mainly chronic stable exertional angina, old myocardial infarction and patients with stable disease after successful revascularization treatment), if the angina attack cannot be controlled based on improving lifestyle and reasonable medication, PCI therapy may help to relieve symptoms to a certain extent, but the indications should be strictly grasped and stents should not be abused. Academician Chen Keji further pointed out, “Although coronary heart disease is incurable, but through reasonable drug treatment and lifestyle improvement, let their coronary heart disease “stabilized”, but still with the disease can prolong the years, and can have a good quality of life, in the field of coronary heart disease therapeutics today, regardless of coronary intervention In today’s coronary therapeutics, regardless of the future development of coronary interventional technology, the cornerstone of lifestyle improvement and rational drug therapy is unshakable.” The main objectives of pharmacological treatment of stable coronary artery disease are twofold: first, to prevent myocardial infarction and sudden death and to improve the quality of life; second, to reduce the onset of angina symptoms and to improve the quality of life. Therefore, when selecting therapeutic drugs, prevention of myocardial infarction and death should be the first consideration. Evidence from numerous studies shows that antiplatelet therapy can effectively reduce the incidence of acute cardiovascular events, and can also significantly reduce the incidence of postoperative cardiovascular events in patients who have undergone hemodialysis. Therefore, drugs that inhibit platelet activation have become one of the mainstays of antithrombotic therapy in the prevention and treatment of coronary heart disease, and the clinical application of antiplatelet drugs has become a landmark event in the field of coronary therapeutics. At present, aspirin combined with clopidogrel are the two most commonly used antiplatelet agents in patients with clinically stable coronary artery disease, especially aspirin, which has become a routine drug for secondary prevention of coronary artery disease in patients without contraindications. The benefits are greater and the risk of bleeding is lower, but patients with a history of prior gastric bleeding and peptic ulcers should avoid aspirin in favor of clopidogrel therapy and should be careful with the use of gastric mucosal protective agents.” With the prolonged use of antiplatelet agents, there is a diversity of platelet reactions, generally divided into hyporesponsiveness, which is characterized by an increased risk of thrombosis, also known as “antiplatelet resistance”, and hyperresponsiveness, which is mainly characterized by an increased risk of bleeding. The former is characterized by an increased risk of thrombosis, also known as “antiplatelet resistance”, while the latter is mainly characterized by an increased risk of bleeding. Academician Ke-Ji Chen has discovered many anti-platelet agents from traditional Chinese medicine over the years, and has done important work in reducing cardiovascular events with the use of blood-stasis activating agents. Since the 1990s, Academician Chen has pioneered the study on the intervention of blood circulation and blood stasis in post-interventional restenosis of coronary artery disease in China, and the results showed that the combination of blood circulation and blood stasis agents with conventional medical treatment in Western medicine can significantly reduce the incidence of in-stent restenosis, recurrent angina and major cardiovascular events, providing a new way to prevent restenosis after PCI. Compounded Chinese medicines or herbal extracts with blood-activating effects such as refined coronary heart tablets, Le vein granules (Guanxin II group formula) and Chuanxiongzine have good therapeutic effects on stable coronary heart disease and exert good anti-platelet effects. Academician Chen Keji said, “Domestic doctors for the secondary prevention of coronary heart disease currently mostly use a combination of Chinese and Western medical treatment, due to concerns about aspirin-induced bleeding or aspirin resistance, making more people choose to combine the application of blood-activating and stasis-transforming Chinese medicine, which has proven to have good clinical effects. However, it is worth noting that proprietary Chinese medicines also require evidence-based use. But on the other hand, for the treatment of stable coronary artery disease, only proprietary Chinese medicines should not be chosen because of excessive concern about the side effects of western medicines, especially for those high-risk patients with combined hypertension, diabetes and dyslipidemia. The clinical application of blood-activating and blood-stasis-transforming herbal medicines should be done for something or nothing, and should not be disregarded and a cure for all diseases.” Academician Chen also pointed out that the prevention and treatment of stable coronary heart disease, in addition to the rational use of anti-platelet drugs, the active control of risk factors is also very important, including the monitoring and control of hypertension, dyslipidemia, hyperglycemia, hyperuricemia, etc., the use of the right drugs in place, as well as the need for close testing of liver and kidney function and regular re-examination. Finally, academician Chen Keji also gave some suggestions to keep coronary heart disease in a “stable” state. First, keep a happy mood, avoid anger. Because when people are excessively angry, can make the whole body small arteries contraction, resulting in a rise in blood pressure, heartbeat accelerated, myocardial contraction enhanced, aggravating the coronary heart disease patients ischemia, hypoxia, thus triggering angina or myocardial infarction. Secondly, exercise is measured and not excessive. For patients with stable coronary heart disease, the choice of exercise should be moderate, such as slow walking, jogging, should not be overloaded exercise, otherwise it will aggravate the degree of ischemia and hypoxia of the heart and brain vessels. Third, pay attention to the cold to keep warm and avoid being cold. Patients with stable coronary heart disease, especially in winter, should pay attention to the warmth of the whole body, if cold, will cause vasoconstriction, so that the heartbeat accelerates or coronary artery spasm, blood pressure increases. Fourth, a reasonable diet, avoid smoking and alcohol and avoid too much. Smoking, excessive drinking and eating too much can increase the burden on the heart, and even induce angina and acute myocardial infarction, therefore, patients with coronary heart disease should have less meat and more vegetables (vegetables), eat more meals, keep seven or eight portions full. Five is to keep the bowels open. Coronary heart patients are prone to constipation, must be adjusted through the diet or drugs to keep the stool smooth, do not force and stool, otherwise it will increase the burden on the heart, serious cases can directly induce the occurrence of acute myocardial infarction. Sixth, regular medication, do not stop on their own. Generally speaking, patients with coronary heart disease need to take medication for life, must follow the doctor’s recommendations to take drugs, regular review, do not think that the self, stop the medication, that will make the stable coronary heart disease “unstable”, further inducing the occurrence of cardiovascular and cerebrovascular events.