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CARDIOLOGY

CARDIOLOGY

Can one tablet of aspirin per day prevent cardiovascular disease?

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Uncle Li, who was over seventy years old, suddenly fell into a coma this year. After being sent to the hospital, he found that intracranial hemorrhage reached 70 milliliters, and he could not stop the bleeding even after using the medicine for 2 days.After careful consultation by the careful doctor, he finally “pulled” the black hand behind the scene: aspirin.It turned out that Uncle Li had a cerebral hemorrhage three years ago. After he was discharged from the hospital, he was worried about “stroke” again, so he bought aspirin, Sanqi powder, and Danshen powder together to “heal”.Improper medicinal use eventually has such a result.I thought I was keeping in good health, but I didn’t know that it was actually “injuring the body” aspirin, which is a double-edged sword.On the one hand, it can prevent blood clots and relieve cardiovascular disease; on the other hand, it can also increase the risk of bleeding, of which digestive tract injury is the most common side effect.Especially in recent years, people have become more and more superstitious about the saying “aspirin, strong without disease”, and even the saying “one piece of aspirin per day can prevent cardiovascular disease”.Does one tablet of aspirin per day really prevent cardiovascular disease?Regarding this question, a study in Japan gives the answer.The 2014 Japan Primary Prevention Project [JPPP] study found that taking small doses of aspirin daily does not significantly benefit low- and medium-risk groups of cardiovascular disease.Subsequently, the US FDA integrated a large number of research data also showed that aspirin is not recommended for primary prevention of cardiovascular and cerebrovascular diseases.To use aspirin correctly, you must follow 4 rules. Aspirin can cause stomach irritation, but most clinically used aspirin is enteric-coated tablets, which have little stimulation to the stomach, so taking it on an empty stomach is best.Take 1 hour before or 2 hours after a meal.Taking aspirin should follow the principle of small dose and long-term use. Generally, the dosage of aspirin is 75 to 150 mg per day, so that it can not only achieve the best results, but also minimize the toxicity of the drug.However, it should be noted that aspirin cannot be taken together with anticoagulants, otherwise it will increase the risk of bleeding.When combined with adrenal cortex hormones, it can also induce ulcers; when used with some immunosuppressants such as methotrexate, it will increase its toxicity.Therefore, aspirin must be cautious when combining other drugs.Finally, it must be clear that not everyone can use aspirin, especially for the following three groups of people, it should be used with caution.In addition to aspirin is not available to people with gastric ulcers, aspirin should be contraindicated in people with high blood pressure, bleeding tendency, bleeding constitution, and allergy to aspirin.Finally, in addition, people with high uric acid are not suitable for taking aspirin. Aspirin will affect the excretion of uric acid and induce gout.Taking aspirin within three months of pregnancy can also cause abnormal fetal development, and pregnant women who take aspirin for a long time may have delayed delivery and bleeding.Pay attention to these side effects when taking aspirin: When taking aspirin, most of the adverse reactions are mainly symptoms of the digestive tract.The most common is gastrointestinal ulcers, including the appearance of the upper gastrointestinal tract and intestinal bleeding.In addition, long-term use of aspirin can cause subcutaneous bleeding, severe cases can also have bleeding gums or nose bleeding, especially in elderly women.At the same time, long-term use of aspirin may also have adverse effects of poisoning. Headache, dizziness, nausea, vomiting, and vision loss are all symptoms of aspirin poisoning.It can be seen that low-dose aspirin has a good anti-platelet aggregation effect, and is also commonly used by doctors for the treatment of various ischemic cardio-cerebrovascular diseases. However, the adverse reactions caused by aspirin are also very many.Aspirin must be alert to adverse reactions. If an adverse reaction or abnormal performance occurs, it should be stopped immediately and seek medical attention in a timely manner.Reprinting without permission from the author is prohibited

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CARDIOLOGY

The mortality rate associated with hypertension in the United States has soared, and China is “following the pace”!

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As we all know, hypertension is the most common chronic disease and one of the main risk factors for cardiovascular disease.Hypertension can not be effectively controlled for a long time, and it can often promote the occurrence of coronary heart disease and stroke. According to the report of Lancet in 2019, these two diseases are the top two causes of death for our residents.
Hypertension-related cardiovascular death (hereinafter referred to as: hypertension-related death) has been receiving much attention. This is not, it was released at the annual scientific conference jointly held by the American College of Cardiology (ACC) and the World Heart Congress (WCC)A clinical study counted the changes in hypertension-related deaths in the United States in the past decade. The relevant results were published simultaneously in the “JACC” magazine. Let’s take a look together.The study analyzed the proportion of hypertension-related deaths among 1050 individual deaths counted by the US Centers for Disease Control and Prevention from 2007 to 2017, and was conducted based on age, gender, degree of urbanization (urban and rural), and geographic location.Subgroup analysis.The southern and rural areas of the United States are “severely hit areas”. It was found that during this decade, hypertension-related mortality has increased year by year, and it has shown age, urbanization, and regional differences: the age-standardized death rate of urban population has increased by 20%The rural area in the southern United States has the highest mortality rate, which is 2.5 times higher than other regions. Among all age groups, the mortality rate of the oldest group (65-74 years old) has also been the highest.In addition, the study also showed that the overall mortality rate of hypertension among men was higher than that of women (25.7% vs 20.3%).The study analysis pointed out that since 2011, the overall mortality rate of cardiovascular disease in the United States has gradually slowed, while the deaths related to hypertension have shown the opposite trend, indicating that controlling hypertension in the population is imminent, and the need to implement the new version of ACC / AHA highBlood pressure guidelines.In the southern rural population, the reason for the rapid increase in hypertension-related deaths may be related to obesity, diabetes, and poor health care.The prevalence of hypertension in China continues to increase. The situation in the United States is so severe, so what is the situation in China?According to the 2012-2015 national survey, the prevalence of hypertension in the Chinese population also showed an upward trend and increased significantly with age. The prevalence of hypertension among residents over 18 years of age reached 23.2%, and 41.3% was in the pre-hypertension stagestatus.Among hypertensive patients, males are higher than females, the phenomenon of high in the north and low in the south still exists, but the difference is changing, showing the characteristics of high prevalence of hypertension in large and medium-sized cities, such as hypertension in Beijing, Tianjin and Shanghai residentsThe prevalence rates are 35.9%, 34.5% and 29.1%, which may be related to the relatively high living pressure in these areas.Surprisingly, the prevalence of hypertension in rural areas is growing faster than in cities. In this national survey, the prevalence of rural areas (23.4%) exceeded that of cities (23.1%) for the first time. This may beAlthough living conditions in rural areas have improved significantly in recent years, it is caused by a relatively lack of health awareness. Therefore, it is still necessary to carry out in-depth hypertension health education.In addition, compared among different ethnic groups, the prevalence of hypertension among Tibetans, Manchus and Mongolians is higher than that of the Han population, while the prevalence of hypertension among the Hui, Miao, Zhuang and Buyi ethnic groups is lower than that of the Han population.The awareness rate and control rate of hypertension in China are still low. In recent years, with the popularization of health education and the improvement of people’s health awareness, the awareness rate, treatment rate and control rate of hypertension in China have improved significantly, but the overallThe low level reached 46.9%, 40.7% and 15.3% respectively.By comparing different demographic characteristics, it is found that the awareness rate, treatment rate and control rate of women are higher than men, and the treatment rate of urban hypertension is significantly higher than that of rural areas; compared with northern areas, the awareness rate of residents with hypertension in southern areasThe treatment rate and control rate are higher; compared with different ethnic groups, the treatment and control rate of hypertension among ethnic minority residents is lower than that of the Han nationality.In the treatment of hypertension, calcium antagonists are the most commonly used single-agent drugs (46.5%), and 31.7% of patients are treated with two or more antihypertensive drugs.Previous studies have shown that the vast majority of patients require combined drug treatment, especially in the case of comorbidities, but 70% of patients use monotherapy.Judging from the current rate of hypertension control, drug combination therapy may be more helpful in controlling hypertension in the population.Where to go for hypertension treatment ▎Lifestyle intervention is to increase sodium and low potassium diets. Overweight and obesity are the most important risk factors for hypertension in our country. In addition, excessive drinking, long-term mental stress, and lack of physical work can also affect blood pressure levels; ageAnd family history are influential factors that cannot be changed.Therefore, to control blood pressure, we must first start from improving poor lifestyles, such as reducing sodium intake, the daily salt intake per person gradually reduced to <6 g, increasing potassium intake; balanced diet; weight control, so that BMI <24. Men's waist circumference <90 cm, women's waist circumference <85 cm; quit smoking; do not drink or limit alcohol consumption; increase exercise, exercise 4-7 times a week with moderate intensity, each time lasting 30-60 min.▎Adhering to taking medicine is the key. On the basis of improving lifestyle, patients whose blood pressure is still ≥140 / 90 mmHg and / or higher than the target blood pressure should receive long-term drug treatment. Generally, patients with hypertension should be reduced to <140/90 mmHgTolerants and some high-risk patients can be further reduced to <130/80 mmHg.Hypertension drug treatment follows the following principles: Initial dose: general patients use conventional doses; the initial treatment of elderly patients should use a smaller effective therapeutic dose, and gradually increase the dosage as needed; priority use of long-acting antihypertensive drugs for effective control24-hour blood pressure to prevent cardiovascular and cerebrovascular complications; high-risk patients with blood pressure ≥160 / 100 mmHg, 20/10 mmHg higher than the target blood pressure, or patients who do not meet the standard of single drug treatment should be combined with antihypertensive therapy; Pay attention to individualized treatment; hypertension is a lifelong treatment, and cost / benefit needs to be considered.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

Hypertension symptoms are not obvious, these performances may be “signals”

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In today’s society, people’s living standards are constantly improving, but the number of patients with hypertension is rising, and it is becoming a common “killer” that endangers the health of Chinese people.As a kind of disease that occurs frequently in the elderly population, every middle-aged and elderly people should pay attention to preventive measures, and at the same time, they should discover abnormalities and avoid risks in time.What are the symptoms of high blood pressure?(1) When it comes to headaches, what are the symptoms of high blood pressure? Many hypertensive patients react and often have pain in the back of the head. When the pain is more severe, they will also be accompanied by nausea and vomiting.(2) Tinnitus Due to the increase of intracranial pressure, patients may have binaural tinnitus with a longer duration.Many times patients will feel buzzing tinnitus when listening to the sound, which will make their tempers become very anxious and easy to lose their temper.(3) The symptoms of vertigo and hypertension are not obvious. Usually, the patient will have sudden vertigo after the blood pressure rises. Generally, it will occur when the patient squats or stands up suddenly. It is necessary to take precautions to avoid unexpected risks.(4) After the limb numbness and blood pressure increase, the patient will also have numbness in the fingers and toes, and there is also a sense of skin ant behavior, and even other body parts also feel numbness and discomfort. In severe cases, sudden hemiplegia may occur.(5) Palpitation and shortness of breath and high blood pressure can also cause patients to have many diseases such as myocardial hypertrophy, cardiac enlargement, and cardiac insufficiency. The occurrence of these conditions will make the patient feel shortness of breath and shortness of chest and chest discomfort.High blood pressure will cause huge risk damage to the human body. We must pay more attention to our physical changes. When abnormal conditions occur in the body, we must pay attention to them and go to the hospital for treatment in time.

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CARDIOLOGY

Dyslipidemia and statin application, these 16 questions must be known!

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Regarding dyslipidemia and statin application, we must understand the following issues.
01 What are the dangers of dyslipidemia?If total cholesterol, LDL-C, triglycerides are too high or HDL-C is too low, it can adversely affect human health and is called dyslipidemia.Among the above parameters, the most important thing is LDL-C. The higher the index, the greater the risk of cardiovascular and cerebrovascular diseases.In addition, severely increased triglycerides (≥5.6 mmol / L) increase the risk of acute pancreatitis and require timely treatment.02 Who needs blood tests?The following persons need to have blood lipid examinations every year: (1) patients who have suffered from coronary heart disease, cerebrovascular disease or peripheral atherosclerotic disease; (2) patients with hypertension, diabetes, obesity, smokers; (3) crownedPeople with a family history of heart disease, stroke, or other atherosclerotic diseases, especially those with immediate onset or death from immediate family members, and those with hyperlipidemia in the family; (4) People with xanthomas or verrucous warts;(5) Men over 45 years old and postmenopausal women; (6) Dizziness, headache, insomnia, chest tightness, shortness of breath, decreased memory, inattention, forgetfulness, overweight, heavy limbs or numbness, etc .; other healthAdults are best tested once a year, at least every 3 to 5 years.03 What should I pay attention to before testing blood lipids?(1) Maintain a relatively stable diet and exercise habits within 2 weeks before blood collection. Do not drink a lot of alcohol within a few days before blood collection; (2) Do not exercise vigorously within 24 hours before blood collection; (3) Do not eat any food within 12 hours before blood collection(Including snacks and snacks), you can drink a small amount of water (usually not more than 500ml) the night before blood collection, but it is not recommended to drink a lot of water from the morning of the day (a small amount of water can be taken when taking medicine);However, the doctor should be informed of the type and dosage of the drug used; (5) sit still for at least 5 minutes before blood collection, and usually take a seat during blood collection; (6) if you need to send blood samples by yourself, you should send them to the laboratory as soon as possible after blood collection.Avoid shaking the test tube violently during sample delivery, and avoid exposing to cold or hot environments.The need for fasting before blood lipid testing has been hot in recent years.At present, the test standards in many countries stipulate that the fasting range from 8 to 16 hours before the blood lipid test.However, recent studies have found that whether fasting has little effect on the results of blood lipid tests, so in special cases, blood tests can be taken after eating and drinking.04 Do all the lipid parameters on the test list be normal without treatment?The test sheets of most hospitals will indicate the normal range of blood lipid indicators. In fact, the so-called normal reference value does not have much meaning.Every blood lipid parameter is within the normal value range, the concept of health is wrong.It should not be considered that all the indicators on the blood lipid test sheet are within the normal range and no treatment is needed. You cannot decide whether to use the medicine or not. You must follow the doctor’s advice.The need for medication depends mainly on the specific situation of the patient and his LDL-C level.The relative safe cholesterol level varies from person to person. If someone is younger, non-smoker, non-obese, parents have no cardiovascular disease, no hypertension and diabetes, their LDL-C should not exceed 4.1 mmol / L;If you have coronary heart disease or cerebral infarction, you should reduce its LDL-C below 2.0 mmol / L (preferably 1.8 mmol / L).05 At what level should LDL-C be controlled?LDL-C is the primary intervention target for the prevention and control of ASCVD, and non-HDL-C can be used as the secondary intervention target.Reducing LDL-C levels is one of the core strategies for preventing and treating cardiovascular and cerebrovascular diseases.The Chinese guidelines for the prevention and treatment of dyslipidemia in adults (2016 revision) recommend that LDL-C control targets be determined according to risk stratification.Studies show that reducing LDL-C by 1 mmol / L reduces the risk of myocardial infarction, cerebral infarction, and cardiovascular death by about 10% in the first year, about 16% after 2 years, and about 20% after 3 years.When prolonged for one year, the risk of these serious events was further reduced by 1.5%, and the risk was reduced by 20% to 25% after 5 years of treatment.06 How to choose the type and dosage of statins?At present, the lipid-lowering drugs commonly used in clinical practice in China mainly include statins, fibrates, nicotinic acid, and cholesterol absorption inhibitors.Among them, statins have the most sufficient clinical research evidence and can significantly improve the prognosis of patients.Therefore, statins are regarded as the most important drugs for preventing and treating cardiovascular and cerebrovascular diseases.China’s guidelines recommend the use of moderate-intensity statins as a common drug for dyslipidemia.How to choose statins?The simplest method is: (1) check the LDL-C level; (2) determine the control target of the patient’s LDL-C according to Table 1 and the extent to which LDL-C needs to be reduced to reach this target; (3) select according to Table 2Appropriate dosage and type of statin.07 What to do if the patient cannot tolerate statin treatment?Clinically, a small number of patients may not tolerate conventional doses of statins.The following measures can be considered: (1) change to another statin; (2) reduce the statin dose or change to another drug every other day; (3) switch to other types of alternative drugs (such as ezetimibe); (4) alone or in combinationUse fibrates or nicotinic acid sustained release agents; (5) Further strengthen lifestyle treatment.If patients need to use but cannot tolerate high-dose statin treatment, small and medium doses of statin combined with ezetimibe can be used.08 Are the side effects of statins big?Any drug may have a corresponding adverse reaction, as do statins.However, the incidence of side effects of such drugs is very low and has good safety.As long as the indications are in place, the benefits of statin therapy are significantly greater than its side effects.The side effects of statins mainly include liver damage and muscle damage. During the treatment process, liver function and creatine kinase should be tested regularly according to the doctor’s requirements.If these indicators are significantly abnormal, the dosage of the drug should be reduced or even discontinued under the guidance of a doctor.In the process of medication, if symptoms such as waist or leg muscle pain or tenderness, muscle weakness, fatigue and fever, etc., should be treated in time and the doctor decides whether to take treatment.09 I’m afraid that statins have side effects. Wouldn’t it be better to lower lipids with other drugs?No, unless serious adverse reactions are identified and statin therapy cannot be continued.Although there are many other lipid-lowering drugs in clinical use, their efficacy is not as reliable as statins.Objectively speaking, no drug can replace statins.A few people do have some side effects after using statins, such as abnormal liver function and muscle pain, but in most cases these side effects are minor and can be resolved under the guidance of a doctor.Only very few people can’t tolerate statin treatment.10 How to deal with adverse reactions during statin treatment?When statins are used, liver transaminase and creatine kinase (CK) should be tested and monitored regularly during treatment.If symptoms of muscle discomfort or weakness occur during treatment, and brown urine should be reported in time, CK should be further tested.If myositis occurs or is highly suspected, statin therapy should be stopped immediately.Other situations are dealt with as follows: (1) If the patient reports possible muscle symptoms, CK should be detected and compared with the pre-treatment level; (2) Because patients with hypothyroidism are prone to myopathy, patients with muscle symptoms should also be treated withTest thyroid stimulating hormone levels; (3) If the patient has muscle tenderness, tenderness or pain, with or without elevated CK, common causes such as exercise and physical labor should be ruled out; (4) Once the patient has muscle tenderness,Tenderness or pain, CK is 10 times higher than the upper limit of normal, statin therapy should be discontinued; (5) When the patient has muscle tenderness, tenderness or pain, CK does not increase or moderately increases (increased 3 to 10 times)CK levels should be tested weekly until the effects of the drug have been ruled out or the symptoms have deteriorated to the above-mentioned severity (the drug should be discontinued in time).If the patient has muscle discomfort and / or weakness, and a continuous increase in CK is detected, careful consideration should be given to reducing the statin dose or temporarily discontinuing the drug.Then decide whether or when to start statin therapy again.When starting treatment again, you should start with a small dose of statin, or choose a different statin.11 Does dyslipidemia require long-term treatment?Persistent non-drug treatment is an important measure to correct dyslipidemia.Diet control and active exercise should continue even after initiating medication, and lifestyle interventions cannot be relaxed because of medication.Most patients, especially those who have developed coronary heart disease and / or diabetes, require long-term medication.As long as there are no obvious side effects, the vast majority of people need to take medicine for a long time and cannot stop it without authorization.Do not discontinue the medication or reduce the dose because the cholesterol drops below the target value after a period of treatment, otherwise the risk of myocardial infarction or stroke will be significantly increased.12 If I eat statins for a long time, will my cholesterol drop too low?Statins can significantly reduce LDL-C levels, prevent new plaques, and prevent further enlargement of existing arterial plaques; they can also make atheromatous plaques more stable and less likely to rupture (plaque rupture is an acute myocardial infarctionAnd the main cause of cerebral infarction).Therefore, for patients with coronary heart disease and cerebral infarction, long-term use of statins is very important.LDL-C in these patients needs to be reduced below 1.8 mmol / L.Even patients with coronary heart disease who have LDL-C levels below target should still be treated with statins.These patients should choose lower-intensity statins.If LDL-C is reduced below 1 mmol / L during treatment, the statin dose can be further reduced.However, as long as there are no adverse reactions, all patients should be treated with statins for a long time.There is no consensus on how low the LDL-C can be reduced.Existing research shows that lowering cholesterol lowers the risk of cardiovascular and cerebrovascular disease.No adverse effects have been found in reducing cholesterol to very low levels, and taking moderate doses of statins does not reduce cholesterol to too low a level, so there is no need to worry about this.After taking statins to reduce cholesterol to the desired range, will taking the drug continue to lower cholesterol?No, conventional doses of statins do not have such a strong effect, so this concern is unnecessary.13 What cardiovascular drugs cannot statins be combined with?Unreasonable combination medications may increase the risk of liver and muscle damage from statins.Clinically, patients with cardiovascular disease often use multiple drugs at the same time, so it is necessary to pay attention to the effects of these drugs on statin metabolism in order to reduce the incidence of statin adverse events.Medications to avoid: gefitizil and lovastatin gefitizil and pravastatin gefitizil and simvastatin require a limited dose of statin:? Combination with amiodarone: lovastStatin ≤40 mg / day, simvastatin ≤20 mg / day? Combined with amlodipine: lovastatin and simvastatin are both ≤20 mg / day? Combined with diltiazem: lovastatin ≤20 mg / day, xinVastatin ≤10 mg / day? Combined with dronedarone: lovastatin and simvastatin are both ≤10 mg / day? Combined with ranolazine: lovastatin and simvastatin are both ≤20 mg / day? And substituteGrenolone: ​​Both lovastatin and simvastatin ≤40 mg / day? Combination with verapamil: lovastatin ≤20 mg / day, simvastatin ≤10 mg / dayWant to eat statins?The purpose of installing the stent is to reopen the originally narrowed or occluded coronary arteries, reopen the blood flow, and thus relieve myocardial ischemia.But this only solves the problem of coronary artery stenosis through physical or mechanical means, and has no effect on the fundamental mechanism of atheromatous plaque formation.Many patients often have multiple plaques in multiple arteries. Installing a stent can only solve one or a few places where severe stenosis or occlusion has occurred. It has no effect on plaques in other parts.If prevention is not strengthened, other plaques will continue to grow and form new ischemic lesions, which can also cause serious consequences.Therefore, the installation of the stent does not mean that the coronary heart disease has been cured. Long-term treatment with drugs such as statins and aspirin is still required.Continued taking statins after stent installation helps to keep cholesterol low and prevent coronary arteries from forming new plaques. It is also often helpful to maintain blood vessels in the stent area.15 To detect carotid plaques, should I take statins?This issue cannot be generalized, and should be considered in combination with the degree of carotid stenosis, the presence of cardiovascular disease or cardiovascular risk factors, and the level of LDL-C.If the carotid plaque causes a significant carotid stenosis (stenosis ≥50%), the treatment principle is the same as that of diagnosed coronary heart disease or ischemic stroke (both belong to ASCVD), and statin should be immediately treated to control LDL-C to 1.8mmol / L or less.If carotid plaque does not cause significant stenosis (degree of stenosis <50%), the patient needs to be evaluated for cardiovascular disease or other cardiovascular risk factors.There are the following situations:? Have been diagnosed with coronary heart disease or ischemic stroke, regardless of whether the carotid artery is significantly narrowed, you should immediately receive statin treatment to control LDL-C below 1.8 mmol / L;? Without coronary heart disease and ischemiaStroke, but with diabetes and hypertension, statins should also be taken to control LDL-C below 1.8mmol / L;? Diabetic patients aged 40 years and older, and LDL-C> 2.6 mmol / L, need to receive statinsTreatment;? Chronic kidney disease (stage III or IV) and LDL-C> 2.6 mmol / L require statin therapy;? Hypertension or other risk factors and LDL-C> 3.4 mmol / L, statin therapy is recommendedReduce LDL-C to <3.4 mmol / L.The above is a simple judgment method, and it is necessary to comprehensively analyze other patients' comprehensive conditions in clinical practice.16 Do you need to check blood lipids frequently during treatment?. After 3 to 6 months of treatment with diet and non-lipid-lowering drugs, blood lipid levels should be reviewed, and treatment can be continued if it meets the requirements, but it must be reviewed every 6 months to 1 year.If it continues to meet the requirements, it can be reviewed once a year.Check blood lipids, liver function, and creatine kinase (an indicator reflecting muscle damage) 4 to 8 weeks after the start of drug treatment.If there are no special circumstances, gradually review every 6 to 12 months.If 3 to 6 months after the start of treatment, the blood lipid does not reach the target value, then adjust the dose or drug type, or combine drug treatment, and then check again after 4 to 8 weeks.After reaching the target value, it will be extended to review every 6-12 months.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

Thrombosis is divided into “red” and “white”, with different methods of prevention and treatment!

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The heart beats with its own healthy beat. If your heart thumps, your chest is tired, or even dizzy, beware of atrial fibrillation.Atrial fibrillation is a common arrhythmia. About 10 million patients have been diagnosed with atrial fibrillation in China, and the age of onset is more than 40 years old.Don’t look at the symptoms. When atrial fibrillation occurs, the heart’s blood flow tends to coagulate into blood clots. If the blood clots follow the blood flow to the brain and block the blood vessels in the brain, it will cause cerebral infarction (commonly known as “stroke”).Thrombosis is divided into “red” and “white”. Stroke caused by “red thrombus” is more dangerous. Data shows that the risk of stroke in patients with AF is 5-8 times that of ordinary people, and stroke has also become a fatal cause of patients with AF.An important cause of disability.Therefore, the number one priority for patients with AF is to stop thrombosis and prevent stroke.However, most patients only know that taking aspirin can prevent blood clots, but they don’t understand that blood clots are still “red” and “white”.①White thrombus Generally speaking, “white thrombus” is yellowish white in color and small in volume. It is mainly composed of atherosclerotic plaques and platelets falling off the arterial wall. Such thrombi are more common in patients with hypertension and hyperlipidemia;② Red blood clots and “red blood clots” are red to the naked eye and are relatively large. They are made up of red blood cells. The blood clots formed during atrial fibrillation are “red blood clots”.Compared with “white thrombus”, “red thrombus” has a larger volume, causing a larger area of ​​cerebral blood vessel blockage and a higher lethality rate.To prevent “red blood clots”, anticoagulant drugs only work. Because of the different nature of blood clots, treatment methods should also be differentiated.①Red blood clots. To prevent “red blood clots” caused by atrial fibrillation with anticoagulants, consider reducing the risk of thrombosis, and use anticoagulants, such as traditional anticoagulants warfarin or new oral anticoagulants. ② White thrombosis., Antiplatelet therapy to prevent “white thrombosis” should reduce the degree of platelet aggregation, use antiplatelet drugs, such as aspirin.Obviously, anticoagulants and antiplatelet drugs target different types of thrombus, and if aspirin is used incorrectly in patients with AF, it will not be effective in preventing stroke.But unfortunately, the awareness of anticoagulation therapy in patients with AF in China is generally low.According to the Chinese Stroke Screening Survey, only 2.2% of patients with atrial fibrillation who have had a stroke have used anticoagulants.Although patients’ awareness of disease has improved in recent years, more than 30% of patients with atrial fibrillation in Beijing, Jiangsu and other places take oral anticoagulants to prevent stroke, but the rate is still far lower than in developed countries such as Europe and the United States.To make matters worse, more than 40% of patients with atrial fibrillation are still using aspirin for stroke prevention.Therefore, patients with atrial fibrillation need to strengthen their awareness of anticoagulation and regularly take anticoagulants under the guidance of a doctor, which is the key to preventing stroke.At present, in the area of ​​anticoagulant therapy, there are two main types of traditional oral anticoagulants warfarin and new oral anticoagulants.The new type of oral anticoagulant overcomes many shortcomings of warfarin, has little interaction with food and drugs, does not require regular blood tests, is simple to use, and has a stable dose.In addition, because patients with AF are mostly elderly, emergency surgery is more likely to occur as the elderly get older, such as falls and fractures. At this time, the efficacy of anticoagulant drugs needs to be “released” quickly to make the operation smooth.get on.At present, dabigatran in a new type of oral anticoagulant has a specific reversal agent, which can reverse its anticoagulant effect in a few minutes in order to respond to the above-mentioned emergency situation. It can be said that it provides patients with an “accident protection””.

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CARDIOLOGY

How is CPR performed in patients with confirmed or suspected new coronary pneumonia?

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AHA Vice Chairman (responsible for emergency cardiovascular care and innovation), Dr. Comilla Sasson from the University of Colorado Hospital, stated in a statement that this is a challenging time and that healthcare providers need to be committed to helping patients, and AHA should do its bestIt makes things easier.Dr. Sasson noted that the information they provided was largely based on recommendations from the Centers for Disease Control and Prevention (CDC) and the World Health Organization, including patient care, and guidance to emergency medical services (EMS) and other emergency personnel.Specific protective measures AHA recommends that standard care measures based on the route of transmission should be used in the care of patients with confirmed or suspected COVID-19.Specific guidelines are as follows: • CPR and aerosol generation procedures such as tracheal intubation can expose providers to greater risk of disease transmission and should be considered in an airborne infection isolation room (AIIR).Use respiratory protective equipment during the process.During the operation, only those who are critical to patient care and operation can be present; postoperative room cleaning and disinfection should be performed.• Patients with confirmed or suspected COVID-19 should be treated in a single ward with the door closed.AIIR should be reserved for patients undergoing aerosol-generating procedures.? Use an N95 or higher respirator instead of a mask during the aerosol-generating operation.• The provider should wear a gas mask or mask before entering the patient’s room or care area (when there is no gas mask).Once the supply chain is restored, gas masks should be provided for patients with confirmed or suspected COVID-19.? Wear goggles, gloves and protective clothing.• When protective clothing is lacking, priority should be given to medical personnel involved in aerosol-generating operations, droplets or sprays that are expected to occur, and medical personnel in close contact with the patient to avoid the transfer of pathogens to the hands and clothing of medical personnel.• If tracheal intubation is required, consider rapid sequence intubation (Rapid Seqence Intubation) and wear appropriate personal protective equipment (PPE).• If possible, try to avoid aerosol-generating operations, such as bag-valve masks, nebulizers, and non-invasive positive pressure ventilation.• Consider tracheal intubation directly in patients with acute respiratory failure.Avoid using high-flow nasal cannula (HFNC) and mask continuous positive airway pressure (CPAP) or bilevel CPAP because they are more at risk for aerosols.Specific recommendations for EMS and other first responders include: • Emergency medical dispatchers need to ask callers if they may be infected with COVID-19.When immediate rescue measures are required, callers should be given rescue instructions before arrival.• When patients with suspected need for emergency transfer have COVID-19, they should inform pre-hospital care providers and other appropriate protection.The development of EMS clinical practice should be based on the latest COVID-19 clinical recommendations and appropriate medical guidance information from the public health department and EMS.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

“Magic medicine” is here!

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Recently, “NEJM” simultaneously published two papers of Phase III clinical research results of Incilisiran on the homepage. Both articles showed that Incilisiran significantly reduced the level of low-density lipoprotein cholesterol (LDL-C).Compared with the control group, the decrease rate is 52.3%, and the effective period of the drug is 180 days, which may help to improve the compliance of patients.
(Two papers published by NEJM in one breath. On the left side, Inclisiran’s test on patients with high LDL-C, and on the right side, Inclisiran’s test on heterozygous familial hypercholesterolemia.) It is worth noting that,At the annual scientific conference co-organized by the Society of Disease Research (ACC) and the World Heart Congress (WCC), Incilisran’s Phase III clinical study will also be published online in the Featured Clinical Research I feature.Inclisiran is an interfering RNA therapeutic that reduces the level of LDL-C in the circulatory system and the overall risk of cardiovascular events, mainly by reducing the level of PCSK9 synthesized by the liver.Therefore, the decline of PCSK9 is also a measure of the drug research.Who are the target groups?ORION-10 and ORION-11, two randomized controlled double-blind parallel studies, although mainly aimed at patients with atherosclerotic cardiovascular disease (ASCVD), were slightly different in the included samples.ORION-10 was mainly included in American patients. A total of 1561 people were included in the randomized controlled double-blind trial, of which 781 were in the treatment group and 780 in the control group.ORION-11 was mainly included in European and South African patients. 1617 patients were enrolled in the trial, of which 810 entered the treatment group and 807 in the control group.Different from the former, the white patients enrolled in the latter group were more, the whites in the treatment group accounted for 97.7%, and the proportion of whites in the US group was only 83.6%.The basic disease of the two groups of patients is slightly different. Except that all patients with ORION-10 have ASCVD, more patients have diabetes or hypertension at the same time.And not all patients with ORION-11 have ASCVD. Approximately 13% of patients are judged by researchers to have the same risk disease. Measures include type 2 diabetes, familial hypercholesterolemia, or according to FraminghamThe 10-year risk of cardiovascular events assessed by a cardiovascular disease risk score or equivalent criteria is ≥20%.In addition, other factors in the two trials are basically the same, including the average age maintained at about 65 years old, males accounted for about 70%, the vast majority of people are using statins stably, 89.2% (high intensity in ORION-10)68.0% of users), ORION-11 94.7% (high intensity users account for 78.6%).The percentage of ezetimivir alone or in combination with statins is low (9.9% in ORION-10 and 7.1% in ORION-11).Finally, the baseline LDL-C levels in the two groups were 104.7 ± 38.3 mg / dL (2.71 ± 0.99 mmol / L) and 105.5 ± 39.1 mg / dL (2.73 ± 1.01 mmol / L).How is it administered?How to see the effect?Since it is a randomized double-blind control, there is a placebo group. In this study, the injection was administered on the 1st, 90th, 270th (180-day interval) and 450-day (180-day interval).Subjects were injected with 1.5 mL of fluid—the treatment group contained 284 mg of Inclisiran, and the control group received a corresponding placebo injection.The patients received regular follow-up within 540 days and corresponding laboratory tests were performed.How much did it drop?The statistical results show that it can make one set on NEJM at one time, and it makes sense … The results show that the LDL-C level of the ORION-10 treatment group decreased by 52.3% compared with the control group at 510 days, and the statistical time was adjusted (90-540 days) showed a decrease of 53.8% compared with the control group.Looking at the absolute decrease in LDL-C, the ORION-10 treatment group decreased by 56.2 mg / dL (1.45 mmol / L) at 510 days, while the control group decreased by only 2.1 mg / dL (0.05 mmol / L). The treatment group andThe difference between the control groups was 54.1 mg / dL (1.40 mmol / L).After time adjustment, the treatment group decreased by 53.7 mg / dL (1.39 mmol / L), the control group decreased by 0.4 mg / dL (0.01 mmol / L), and the treatment group had a difference of 53.3 mg / dL (1.38 mmol / L).After injection of the drug on the first day, the LDL-C level in the treatment group decreased significantly within 90 days, and after the three injections, it remained at a relatively low level-about 50 mg / dL. A healthy personMore difficult to achieve.The LDL-C level of the control group did not fluctuate significantly and remained at a high level.The ORION-11 test results are similar to the ORION-10 trend.After the first injection of the same drug, a significant decrease in LDL-C levels occurred within 90 days, and the same maintained at about 50 mg / dL.Specifically, at 510 days, the absolute value of LDL-C in the treatment group decreased by 50.9 mg / dL (1.32 mmol / L), the control group increased by 1.0 mg / dL (0.03 mmol / L), and the difference between the treatment group and the control group was 51.9 mg / dL (1.34 mmol / L). At 510 days, the LDL-C level in the treatment group decreased by 49.9% compared with the control group.Also remember PCSK9 we started with?Its trend is the same.Regardless of ORION-10 or ORION-11, PCSK9 and LDL-C levels in the treatment group decreased steadily and remained at a lower level.The slight difference is that PCSK9 did not reach a stable low until the 150th day.PCSK9 levels did not decrease significantly and increased slightly in all control groups.Another study on heterozygous familial hypercholesterolemia also showed a similar trend. The results showed that at 510 days, the LDL-C level in the treatment group decreased by 39.7%, the control group increased by 8.2%, and the treatment group compared with the control group.C dropped by 47.9%.In the case of statins used by most participants, a rapid and significant decrease in LDL-C levels and long-term low-level maintenance can be achieved. The effect is so obvious. How about safety?After all, lowering the LDL-C level to 50 mg / dL itself was a controversial topic at international conferences-does it matter if it is maintained at this level?The statistical results of adverse drug reactions show that: really.There was no significant difference in the comparison of adverse reactions between the treatment group and the control group, whether it was general adverse reactions, severe adverse reactions, cardiovascular-related adverse reactions, and other common adverse reactions (hypertension, back pain, upper respiratory infection, pneumonia, etc.).The group was almost the same as the placebo-injected control group.The only slight difference was that there were more patients in the treatment group with adverse reactions at the injection site, but the absolute number was smaller, only 58 cases (11 cases in the control group).Finally, the researchers stated in the conclusion that, although statins are first-line lipid-lowering drugs, many patients still have difficulty in maintaining LDL-C at a low level for a long time and safely.Inclisiran has now been confirmed in a phase III clinical study that this problem can be solved at the cost of mild to moderate adverse reactions at the injection site only once every 6 months.Let ’s take a look at what experts say ~ In March this year, “NEJM” released the results of two Incilisiran Phase III clinical studies-ORION-10 and ORION-11. This is after the results of ORION-1 in 2019.The results of another exhilarating study show that Inclisiran treatment can achieve the same effectiveness and safety as ORION-1 in different races.Although the patients included in the 2 studies differed in ethnicity and baseline status, the same was based on the statin treatment (mostly high-intensity statin) during the 510-day study period. The Inclisiran treatment group compared with the placebo group.The decrease in C is very close, with a maximum decrease of 52.3%, and a single dose of LDL-C can be sustained for 180 days. The main adverse reaction is the mild and moderate discomfort at the injection site.Statin therapy is the cornerstone of our current lipid-lowering therapy to reduce the risk of ASCVD, and combined with ezetimibe can also bring further decline in LDL-C.However, the current cross-sectional survey in China shows that the LDL-C compliance rate of extremely high-risk patients such as ASCVD in China is less than 1/3, and the proportion of patients who discontinue lipid-lowering drugs after acute cardiovascular events is also quite high.With the continuous advancement of large-scale clinical research around the world, LDL-C in extremely (ultra) high-risk patients is lower and better, and it has become a consensus.Therefore, the combined application of lipid-lowering drugs has become the general trend.As a small interfering RNA, Inclisiran can reduce the synthesis of PCSK9 in the liver to reduce LDL-C. Because of its special targeting mechanism, which mainly acts on the liver, it can continuously inhibit the synthesis of liver PCSK9, thereby reducing the level of LDL-C.It can last up to half a year.The ORION-4 study is currently underway globally, with cardiovascular events as the primary endpoint. The future will show us whether Incilisiran is effective and clinically safe for clinical endpoint events, and it is worth looking forward to.As a new PCSK9 inhibitor, Inclisiran is beneficial for patients to achieve long-term LDL-C compliance, and thus can partially address compliance issues.The clinical implications of the ORION-9, 10, and 11 series of studies. PCSK9 small molecule interfering RNA is a new method of reducing cholesterol that has attracted much attention recently. The earliest product that has shown efficacy and safety in human studies is Incilisiran.The success of ORION-9, 10, 11) marks a new era in reducing LDL-C.The biggest advantage of Inclisiran is that the frequency of administration is reduced. Once every 6 months, LDL-C can be maintained stable and greatly reduced (50%). Its mode of action is similar to the cholesterol-lowering “vaccine”, which greatly increases the lipid-lowering treatment.Compliance reduces fluctuations in cholesterol levels.Previous observations have shown that the greater the fluctuation in cholesterol levels during lipid-lowering treatment, the more adverse events there are..
An earlier study comparing Inclisiran with placebo (orally with statin alone) observed fluctuations in blood cholesterol levels in the two groups, and the results showed that cholesterol levels in the statin group fluctuated greatly, suggesting that compliance was extremely poor, while Incilisiran cholesterol declined steadily(Figure 2, N Engl J Med 2017; 376: 1430-1440).Inclisiran’s long-term and smooth cholesterol-lowering effect not only helps the secondary prevention of ASCVD, but also facilitates the early and long-term adherence of cholesterol-lowering treatment in primary prevention.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

These symptoms appear in your body, indicating that your blood has become sticky

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Human blood carries abundant nutrients to transport the whole body, and is an important basic substance of life.Smooth blood circulation is an important factor for health, and when the blood shows signs of stickiness, it may damage the capillaries and cause the capillaries to be blocked, which will cause the oxygen and nutrients to be transported normally, and eventually cause various problems to the body.Is your blood sticky?To determine if your blood is thick, you can observe if you have the following symptoms: 1. Chest tightness.If the body’s blood is thick, the blood will not be smooth, which can cause insufficient blood supply to the heart muscle, which can easily cause symptoms such as chest tightness and shortness of breath.2. Leg cramps.Leg cramps are not necessarily a calcium deficiency, but may also be a sign of blood stickiness.When blood circulation is blocked, it can affect the blood supply to local muscles and cause muscle spasms.3. Get dizzy in the morning.I wake up in the morning and have a slow response. It takes a while to wake up gradually, indicating that the blood is too viscous to supply the brain in time.4, sleepy after meals.The reason why many people feel drowsy after dinner is that most of the blood will flow into the gastrointestinal system after eating, which will reduce the blood supply to the brain. Although ordinary people will have this phenomenon, the symptoms of people with thick blood will be more obvious, And the onset of drowsiness is difficult to alleviate.If the long-term blood viscosity is left unattended, it will cause headaches, forgetfulness, and insomnia, and it will accelerate arterial vascular sclerosis, and even cause diseases such as myocardial infarction and cerebral infarction!Therefore, when we find that our body has symptoms of blood stickiness, it is recommended to unblock the blood vessels in time to restore smooth blood circulation.To improve blood viscosity, we can try the following methods: 1. Strengthen exercise.Exercise helps improve the body’s metabolism, so that wastes left in the body are expelled from the body in time, and blood circulation is promoted.2. Adjust your diet.Reduce your intake of greasy, sugary foods, and don’t allow excess fat and sugar to accumulate in your body.3. Drink plenty of water.Drinking more water helps to dilute the blood, especially sweating in the summer. The lack of water in the body can cause blood stickiness, and cause blood stickiness.

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CARDIOLOGY

Physical examination shows “arrhythmia.” Do I need treatment?

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When doing an electrocardiogram, many people report arrhythmia on the report during the physical examination, and doctors often choose to “ignore” this result.Many patients are very puzzled. Can such a big thing in the heart be treated without treatment?Let’s first understand what is called “arrhythmia”. Arrhythmia mainly refers to the fact that a person’s heartbeat is sometimes faster and slower than normal.So, does the arrhythmia need treatment?In fact, this issue cannot be generalized, it depends on the situation.Does Arrhythmia Need Treatment?Generally speaking, the human heart beats regularly and neatly, about 60-100 times per minute, and because of different ages, the normal heart rate range also varies.For older people, their heart rate is slower, usually 50 beats / minute is normal.For ordinary young adults, if the heart rate is relatively slow, it usually appears as irregular. The diagnosis result will show sinus arrhythmia, which is usually not a pathological condition, so you don’t need to worry too much.What needs to be reminded is that if it is found that the arrhythmia is caused by conduction block, that is, the heart’s conduction system has been damaged or blocked, it needs attention based on the severity.Under what circumstances does “arrhythmia” need attention?1 Conduction block: If the arrhythmia is a first-degree block and there are no symptoms, it can be left untreated.If the arrhythmia is a second-degree block, then the cause must be identified, such as coronary heart disease or arrhythmia, which must be treated differently.If it is detected as a third degree block, and the patient has syncope, a heart rate below 40 beats per minute, or a sudden cardiac arrest, then this is very serious.Therefore, if arrhythmias often occur, the cause must be identified as early as possible for treatment.2 Premature beats: In fact, premature beats are also a common type of arrhythmia. Generally speaking, premature beats can be divided into atrial and ventricular premature beats, and these patients usually feel palpitation and “cardiac pause”.If the phenomenon of premature beats is detected, do not be overly nervous first. The patient needs to perform another 24-hour ambulatory electrocardiogram test to observe the total number of premature beats. If the total number is greater than 5,000, seek medical treatment in time to determine whether it is due to heart disease or other reasons.Drinking coffee buddies, healthy people who drink too much coffee or tea, will also show a lot of premature beats, reducing consumption will return to normal.Many people have symptoms of arrhythmia in daily life. Sinus arrhythmia often does not cause serious consequences. If you don’t feel uncomfortable, you don’t need to worry too much, but if you have related clinical symptoms, you need to pay attention to it.To go to the hospital in time to find out the cause of the arrhythmia, and then treat it symptomatically.

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CARDIOLOGY

Don’t be careless for young people!

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Myocardial infarction is acute and often endangers life in as little as ten minutes. Especially in recent years, there have been more and more cases of death caused by sudden myocardial infarction in young people. We should be more careful to prevent the occurrence of myocardial infarction. Remember young peopleThe precursor of myocardial infarction may be able to save your life.What are the precursors of myocardial infarction in young people?1 Angina pectoris.Most patients with myocardial infarction have symptoms of angina pectoris a few days before the onset of illness, accompanied by palpitations, shortness of breath, and chest pain during exercise. Angina pectoris can occur suddenly or more frequently than before. The possibility of myocardial infarction should be watched.2 Chest tightness.If you are generally healthy and suddenly feel chest tightness and discomfort, your chest seems to be pressed by heavy objects like airtightness, palpitations, shortness of breath, and dyspnea appear after exercise. Be alert that this may be a precursor to myocardial infarction.3 Fatigue.Modern people work and live under a lot of pressure. Staying up late all night has become the habit of many young people. Even if they stay up late, they ca n’t get rest. It seriously disrupts the rules of life. They are often in a state of excessive fatigue. After full rest or feeling tired and lethargic, May also be a precursor to myocardial infarction.4 Heart failure.Myocardial infarction is prone to acute heart failure a few days before the onset of symptoms, such as dyspnea, cough, irritability, and inability to stay in bed.5 Keep sweating.If you are not exercising and sweating constantly, this may also be a signal before the onset of myocardial infarction.Be especially vigilant if you sweat heavily on your neck, back, palms or feet.6 Weakness.Suddenly feeling weak and tired, without strenuous exercise, lack of sleep or illness, it may also be due to bleeding problems.How to prevent myocardial infarction?Combination of work and rest: Don’t be overworked in daily life, but work and rest, especially young people should not stay up often, arrange their time reasonably, ensure adequate sleep, and maintain a good physical condition.Reasonable diet: Avoid eating too much salt and avoid overeating.Eat low-fat, fruit, and high-fiber foods.Try to choose foods that can lower blood lipids, such as garlic and onion. These foods can keep the heart active and prevent myocardial infarction.Emotional stability: One of the most common causes of acute myocardial infarction is emotional excitement. To prevent myocardial infarction, we should pay attention to emotional stability and don’t get too entangled when you are happy.

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