In recent years, the incidence and death rate of coronary heart disease in China are increasing dramatically and rapidly getting younger. There are people who usually look healthy but suddenly develop cardiovascular diseases and unfortunately leave the world. Gao Xiumin, Hou Yaowen, Ma Ji and other famous people are very typical examples. With the continuous progress of medical science, the concept of coronary heart disease prevention and treatment is also being updated. Understanding and mastering these new knowledge and concepts is helpful to maintain one’s health and prevent the occurrence of cardiovascular diseases.
Concept 1: To pay absolute attention to coronary heart disease
Nowadays, some people are especially nervous when they know that they have cancer, just like receiving a death sentence, but when it comes to coronary heart disease, most people do not care about it and think it is not a big problem. On the contrary, the first symptom of many coronary heart disease patients is sudden attack and death, and there is no chance of rescue treatment. In contrast, most cancer patients have years of treatment time from onset to death. In recent years, the morbidity and mortality rate of cardiovascular diseases in China has been rising sharply, and has become the first cause of death, the first killer and culprit threatening human health. According to relevant information, the number of deaths from coronary heart disease is 2.5 times higher than that of cancer, and the disability rate of coronary heart disease is significantly higher than that of cancer. This reminds us that we must pay attention to the prevention and treatment of coronary heart disease, and we should never neglect it.
Concept 2: Prevention is more important than treatment
Patients with coronary heart disease tend to be older, so people think that coronary heart disease is a disease of the elderly. In fact, coronary heart disease is not something that happens overnight, but is the result of years and years of accumulation. The saying “the disease starts in youth, middle age, and the disease develops in old age” is a very intuitive illustration of this truth. Research by American scientists shows that the proportion of atherosclerotic plaques increases rapidly from the age of 20, and 85% of people over the age of 50 have plaques in their coronary arteries. Therefore, it is very important to prevent carotid atherosclerosis at an early stage, rather than waiting until myocardial infarction and stroke occur and then mending the fold. The principles of coronary artery disease prevention are: avoid obesity, do not smoke, eat less sweets, strictly control hypertension, high blood pressure, high blood fat, diabetes, appropriate exercise, and a calm mind.
Concept 3: Coronary heart disease is related to diet
The main reason why the morbidity and mortality rate of hyperlipidemia, coronary heart disease, cerebral thrombosis, atherosclerosis, diabetes, hypertension and other diseases have increased sharply in recent years is that the diet, efficient and fast-paced lifestyle, improved nutrition or even excess, which makes the physiological and chemical indicators such as transaminases, triglycerides and cholesterol present abnormalities, eventually leading to the occurrence of diseases and affecting the quality of life. Therefore, changing the diet structure and having a reasonable diet is the most important defense to prevent the occurrence of coronary heart disease.
Concept 4: Prevention of coronary heart disease requires intensive lipid regulation
Dyslipidemia plays a very important role in the development of atherosclerosis and the cardiovascular events it causes. For any population, every 1% increase in lipid levels increases the risk of heart attack and death by 2%. Therefore, intensive lipid reduction is one of the most important initiatives to prevent coronary heart disease.
Concept 5: Accurate diagnosis of coronary artery disease requires not only ECG but also coronary angiography.
Many people are diagnosed with coronary heart disease, and the most important evidence is chest discomfort combined with an ECG showing myocardial ischemia. However, with the advancement of medical science, the understanding of coronary heart disease is constantly updated and deepened, and thus the diagnostic criteria have also changed fundamentally.
How can we further confirm the diagnosis of coronary artery disease? If there is “myocardial ischemia” on the electrocardiogram, cardiac echocardiography and cardiac stress exercise test should be done, preferably with blood glucose and lipid tests, and radionuclide myocardial imaging can be done if possible. If these tests do not reveal any problems, it is unlikely that you have coronary heart disease, and if you do, it is relatively mild. If a woman is not menopausal, does not have high blood pressure, does not have diabetes, is not fat, does not smoke, and all the above tests are normal, and only the ECG shows “myocardial ischemia”, then the possibility of coronary heart disease is almost zero. If the ECG, ultrasound and exercise test are all positive, there is an 80% to 90% chance of coronary artery disease, but there is still a 10% to 20% misdiagnosis rate. In women, the rate of misdiagnosis may be as high as 30%. Since the misdiagnosis rate is so high, is there a more accurate way to confirm the diagnosis of coronary artery disease? Of course there is, and that is coronary angiography, which is called the “gold standard” for coronary artery disease diagnosis, and this gold standard is more than 98% accurate. Some people may ask, “Is there no 100% accurate method? In fact, there is, that is, coronary angiography plus intravascular ultrasound, but the popularity of intravascular ultrasound is not high, and this technology is not yet available in most areas of China. Now there are newer developments in diagnostic technology, and multi-row spiral CT can also accurately display coronary artery images, opening up new ways for non-invasive examination and diagnosis of coronary heart disease.
Concept 6: Statins are one of the most important drugs for the treatment of coronary heart disease
So far, there is still no cure for coronary heart disease, it is still a lifelong disease and still needs lifelong treatment. Therefore, coronary angiography can reflect the degree of stenosis and the extent of stenosis more clearly, and according to experience, drug therapy is needed when the degree of stenosis is less than 50%. The goal of drug therapy is to eliminate the atherosclerotic plaque and to reopen the lumen of the vessel. So far, the most promising drugs are statin lipid regulators.
The use of these drugs has resulted in a more stable and slower progression of the disease and a 30% to 40% reduction in cardiovascular accidents and mortality, making statins one of the most important drugs in the treatment of coronary heart disease. In addition to their cholesterol-lowering effect, statins can also reduce the incidence of chronic heart failure suffering from sudden cardiac death.
Concept 7: Patients with more severe coronary heart disease should receive interventional therapy
If the stenosis of the vessel is found to be more than 70% by coronary angiography, and the symptoms of the disease are clearly related to the stenosis, interventional treatment should be done. The most common method of coronary intervention is to place a metal stent at the site of the stenosis to support the narrowed heart vessel wall, thus solving the stenosis problem and relieving myocardial ischemia. According to numerous studies worldwide, interventional therapy for patients with chronic coronary artery disease can significantly improve quality of life and reduce mortality by more than 40% compared to drug therapy alone.
Acute myocardial infarction is one of the most serious cases of coronary artery disease. If patients with acute myocardial infarction receive interventional treatment, the mortality rate can be reduced by 50% to 70%, especially for those who receive interventional treatment to open the blood vessels within 6 hours after the disease, their heart function will be little affected and most of them can live like normal people. In areas where intervention cannot be performed within 6 hours, patients with acute myocardial infarction can undergo thrombolysis, and successful thrombolysis will also benefit the patient greatly and provide the opportunity for follow-up treatment.
Concept 8: Patients who should have bypass surgery should have the courage to undergo it
There are two types of patients who need bypass surgery: patients with coronary artery disease that is too severe for interventional therapy, and patients who require multiple coronary stents at a huge cost that they cannot afford.
Many patients have a fear of bypass surgery for coronary heart patients. It is true that performing bypass surgery is risky, but with the advancement of new technologies, the risks are greatly reduced.