Why do you get coronary heart disease? And why do you get it at such a young age? There are many major risk factors for the development of coronary heart disease, such as hypertension, hyperlipidemia, smoking, diabetes and obesity. The main reasons for the high incidence of heart disease in young women are smoking and being overweight. Smoking increases the risk of coronary heart disease by 4-6 times in men and by 6-9 times in women. Also, relationship problems are more likely to cause heart disease in women than job stress, and the incidence of heart disease is three times higher in women who are not as well married than in women who are happily married. There are also causes that we tend to ignore, which are sleep and stress. If you stay up late often, the normal routine of life is disrupted and the secretion pattern of hormones is also disrupted, the incidence of cardiovascular disease certainly increases. What are the principles of drugs, stents and bypasses in the treatment of coronary heart disease? The principle of drug treatment is to improve symptoms by dilating blood vessels, reducing blood viscosity and stabilizing atheromatous plaque to achieve increased blood flow through, but only to control symptoms and cannot improve symptoms in severe patients. Intervention is to lance the artery in the thigh or wrist with a needle slightly larger than the needle used to lance the drip, then send a very thin guidewire through the needle hole, and then send a thin tube, later, through this tube to send a stent to the lesion site, propping up the diseased vessel. Bypass is an open-chest procedure that uses one’s own blood vessels to build a vessel from upstream to the distal end of the occluded vessel to reopen a channel. In what cases do you need medication, in what cases does medication not work and you choose stenting, and in what cases do you choose bypass? Hou Aijie: In fact, theoretically, drugs, interventions and bypass surgery have the same effect on low-risk stable patients, and the mortality rate is the same for interventions, bypasses and drugs. But interventional and bypass patients can climb mountains and have a good quality of life, so if the blood vessel is blocked in a life-threatening place and is above 70%, it is better to put a stent. If you can’t do intervention or intervention requires seven or eight stents to solve the problem, then simply consider bypass. What are the advantages and disadvantages of stents, such as bare stents and drug stents, and how to choose them? There are two types of stents: bare stents and drug stents. Bare stents have a 20-30% restenosis rate because of the strong increase in intima without drugs, but they also have the advantage that clopidogrel can be stopped one month after surgery and the risk of intra-stent thrombosis is not great. Drug stents have a low restenosis incidence of 2-5% due to the inhibition of intimal hyperplasia with drugs, but they also have the disadvantage that they require postoperative application of clopidogrel for at least one year, otherwise they increase the risk of in-stent thrombosis. Currently, drug stents are mostly chosen, but if the vessel diameter is large and the risk of restenosis is small, bare stents can be chosen. Also, it is better to use bare stents if the patient has diseases such as tumor at the same time and needs to perform surgical procedures in the near future, so that tumor surgery can be performed after stopping clopidogrel after one month. What are the problems after stenting and how to overcome them? Will the stent fall off when I have a lot of activities in the future? There are two main problems after stenting, one is in-stent thrombosis and the other is in-stent restenosis. We require postoperative aspirin and clopidogrel to prevent in-stent thrombosis, but even with the standard application of these drugs, there are individual patients who have in-stent thrombosis, mainly due to clopidogrel resistance. In-stent restenosis is caused by endothelial hyperplasia, with an incidence of 2-5%. Regular application of lipid-regulating drugs and control of blood glucose and blood pressure can reduce the possibility of occurrence. The stent is like a spring coil that is tightly attached to the vessel wall, and slowly the endothelium of the vessel will cover the stent, so you can’t even take it out if you want to, let alone drop it. What people call a stent falling off or a deflated stent is actually a restenosis within the stent. Is it true that no medication is needed after stenting or bypass, and are medications taken for life? No. After stenting, you must take some medications regularly, especially clopidogrel, and try not to stop taking it within a year to prevent the formation of blood clots in the stent. In addition, coronary artery disease is atherosclerosis of the heart vessels, which is commonly known as fat hanging on the blood vessels, and stents are used to prop up the diseased blood vessels with stents, which mechanically press the fatty plaque between the vessel wall and the stents, thus making the blood vessels smooth and relieving angina symptoms. It also reduces the possibility of stent problems again, just like the small cars we drive, which usually need to be loved and well maintained, and regularly have to be overhauled. Therefore, these drugs need to be applied even without stenting, but with stenting, doctors will emphasize more clearly.