Is Academician Zhong Nanshan of China a vegetarian?

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In most countries and regions around the world, cardiovascular diseases are the "number one killer" threatening health and life.

Many risk factors of cardiovascular disease can be changed; There are still some unchangeable factors, and targeted preventive measures can also be taken.

On April 6th, the American Society for Cardiology Prevention (ASPC) released "10 Things to Know 10 Risk Factors of Cardiovascular Diseases (2022)". According to 10 Risk Factors of Cardiovascular Diseases, it put forward 10 things to pay attention to, so as to promote people's heart and vascular health.

These ten factors include: unhealthy diet, lack of exercise, dyslipidemia, prediabetes/diabetes, hypertension, obesity, special population, thrombosis, renal insufficiency, family history/genetic factors/familial hypercholesterolemia.

First, unhealthy diet.

1. To prevent cardiovascular diseases, we must consider the total amount and quality of calories intake, and we must be able to persist for a long time.

2. Saturated fatty acids can promote atherosclerosis by increasing inflammation and causing endothelial dysfunction. In order to prevent cardiovascular diseases, it is suggested to use unsaturated fatty acids instead; Both saturated fatty acids and trans fatty acids increase low density lipoprotein cholesterol (LDL-C), and trans fatty acids are most related to the increase of cardiovascular risk.

3. In order to prevent cardiovascular diseases, it is suggested to replace refined carbohydrates with complex carbohydrates (including whole grains, vegetables and fruits).

4. The best diet to prevent cardiovascular diseases is Mediterranean diet and DASH diet. These two dietary patterns are mainly vegetables, fruits, whole grains, fat-free or low-fat dairy products, fish, poultry meat, lean meat, nuts, beans and dietary fiber.

5. Other diets with evidence include vegetarian diet and Ernie diet. A healthy vegetarian diet usually includes vegetables, fruits, whole grains, beans, seeds and nuts. Some vegetarian diets also allow eggs and milk.

6. There is no long-term prospective clinical study to support whether ketogenic diet can prevent cardiovascular diseases.

7. Intermittent fasting may reduce total calorie intake, help overweight or obese people lose weight, and improve cognitive function and metabolic indicators related to cardiovascular diseases. Compared with eating too much at dinner, eating well at breakfast can lower blood sugar and insulin levels.

8. For people who are not deficient in vitamins, dietary supplements cannot reduce cardiovascular risk. On the contrary, getting vitamin D and calcium from healthy foods can reduce cardiovascular risk, such as dairy products.

9. Eating foods rich in omega-3 fatty acids can reduce cardiovascular risk; Supplements containing EPA and DHA can also prevent cardiovascular events.

10, clinicians should educate patients, inform them of healthy eating patterns and dietary practice guidelines, and consult nutrition experts.

Second, lack of exercise.

1, lack of exercise is one of the main risk factors of cardiovascular disease, which can directly or indirectly increase the risk of premature death of 10%.

2. It is recommended that healthy adults do at least 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise every week, and do muscle strength exercise 2-3 times a week.

3. Physical activity can be evaluated by evaluation tools, which is helpful to improve patients' compliance.

4. For patients with obesity, diabetes and hypertension whose blood pressure is well controlled, resistance training at least three times a week is beneficial to reduce cardiovascular risk.

Increasing physical activity and regular physical exercise can usually improve metabolic indicators.

6. In addition to improving cardiovascular risk factors, increasing physical activity and regular physical exercise can also improve cardiac function, reduce inflammation, improve endothelial cell function, prevent myocardial ischemia, promote myocardial regeneration, promote vasodilation, improve autonomic nerve balance, reduce sympathetic nervous tension, reduce arrhythmia risk and slow down resting heart rate.

7. Regular physical activity and physical exercise help to keep weight down.

Older people aged 8 or 65 can benefit from various sports activities, including aerobic exercise and resistance training.

9. Except physical exercise, less than 5,000 steps a day is considered sedentary, but any exercise above the baseline is beneficial.

10. Physical activity during pregnancy can reduce the risk of pregnancy-induced hypertension, pregnancy-induced diabetes, overweight during pregnancy, delivery complications and postpartum depression.

Third, dyslipidemia.

1 and low density lipoprotein cholesterol (LDL-C) are the main targets of lipid-lowering therapy in most lipid-lowering guidelines.

2. Patients with the highest cardiovascular risk need the most active blood lipid management strategy.

3. When it is unclear whether statins should be used, the coronary artery calcification (CAC) score may be helpful for cardiovascular risk stratification.

4. Lipoprotein A is one of the identified cardiovascular risk factors, which contributes to cardiovascular risk stratification.

5. Statins are the most commonly recommended drugs for the treatment of hypercholesterolemia. High-intensity statins are usually recommended as first-line treatment drugs for patients with cardiovascular diseases or high-risk cardiovascular patients.

6. The commonly used non-statins oral lipid-lowering drugs include ezetimibe and bemidonic acid, which can reduce LDL-C by about 65438 08%, and the reduction range is 38% when they are used together.

7. PCK9 inhibitor is an injection preparation, which can reduce LDL-C by 50% and cardiovascular risk when combined with statins with high intensity or maximum tolerance dose.

8. Hypertriglyceridemia (150mg/dl) usually increases cardiovascular risk.

9. Nutrition intervention (ω-3 fatty acids), exercise and drug therapy (Bates) can reduce the level of triglycerides.

10 and fibrates can reduce triglyceride levels.

Fourth, pre-diabetes/diabetes

1. For most diabetic patients, the goal of hypoglycemic therapy is to glycate hemoglobin.

2. Diabetes is one of the main risk factors of cardiovascular diseases. Diabetic patients need to actively control other common cardiovascular risk factors, such as overweight or obesity, hypertension, abnormal blood lipid metabolism, smoking and so on.

3. In the aspect of lipid-lowering therapy, regardless of the estimated cardiovascular risk in 10, diabetic patients aged 40-75 can benefit from moderate and high-intensity statin therapy.

4. Clinical research shows that intensive hypoglycemic therapy can significantly reduce the risk of coronary events without increasing the risk of death.

5. Metformin is beneficial to control cardiovascular risk factors and has the potential benefit of reducing cardiovascular diseases.

6. For diabetic patients with ischemic cardiovascular disease and heart failure, SGLT2 inhibitor is suggested as comprehensive lifestyle adjustment and second-line treatment with metformin.

7.GLP- 1 receptor agonists have cardiovascular benefits for patients with ischemic heart disease complicated with diabetes who receive comprehensive lifestyle intervention and metformin treatment, and should be considered as second-line treatment.

8. The effects of sulfonylureas on cardiovascular diseases are neutral, but they increase the risk of weight and hypoglycemia. For diabetic patients with cardiovascular disease or cardiovascular risk, sulfonylureas are the last hypoglycemic drugs to be considered.

9. For patients with cardiovascular diseases, some evidences support that pioglitazone can reduce ischemic cardiovascular diseases, but it can increase weight and increase the risk of congestive cardiomyopathy.

10. Some studies show that insulin may increase the risk of major adverse cardiac events in patients with stable coronary heart disease and acute coronary syndrome.

Verb (abbreviation for verb) hypertension

1. Ambulatory blood pressure monitoring can be used to diagnose hypertension and help to evaluate the effect of antihypertensive treatment.

2. Recommended by American Heart Association and American Heart Association.

3. As long as antihypertensive treatment does not cause symptoms and signs of hypotension or other evidence, antihypertensive treatment can reduce cardiovascular risk.

4. Hypertension is one of the risk factors of heart failure, coronary heart disease, stroke, peripheral vascular disease, chronic renal insufficiency and arrhythmia (the most common atrial fibrillation). Patients with hypertension need to treat other cardiovascular risk factors more actively.

5. Non-drug non-invasive antihypertensive measures include: low sodium diet (sodium intake

6. For patients whose average blood pressure exceeds the target value of 20/ 10 mm Hg, it is suggested to start using two different types of first-line drugs for antihypertensive treatment.

7. Guidelines and research evidence support that chlorothiazide is superior to hydrochlorothiazide in thiazide diuretics.

8. In addition to lowering blood pressure, ACEI (angiotensin converting enzyme inhibitor) and ARB (angiotensin receptor antagonist) are also beneficial to the treatment of heart failure and coronary heart disease.

9. Patients with heart failure with reduced ejection fraction should avoid using calcium channel blockers, and beta blockers can be used, but their antihypertensive effect may not be as good as other antihypertensive drugs.

Hypertension management based on community and remote monitoring may be beneficial to blood pressure control.

Six, overweight or obese

1. For obese people, cardiovascular diseases and cancer are the most common causes of death. Obesity will directly and indirectly increase cardiovascular risk.

2. For obese people, losing weight can usually improve the main cardiovascular risk factors.

3. At present, no diet pills and doses have been proved to prevent cardiovascular events.

4. When liraglutide is used at a dose of 3.0mg/ day, it can be used as a weight-reducing drug, which has metabolic benefits while losing weight.

5. For obese patients with cardiovascular diseases without type 2 diabetes and congestive cardiomyopathy, liraglutide should be included in the initial treatment and used at its weight-reducing dose.

6. Metformin and SGLT2 inhibitors have no indications for weight loss, but they can slightly reduce weight. All kinds of diet pills can reduce cardiovascular risk factors in addition to losing weight.

7. For obese patients with cardiovascular disease and type 2 diabetes but without congestive cardiomyopathy, initial drug therapy should include metformin, GLP- 1 receptor agonist and SGLT2 inhibitor.

8. For obese patients with cardiovascular disease, type 2 diabetes and congestive cardiomyopathy, initial drug therapy should include metformin and SGLT2 inhibitors.

9. There is no evidence to support the combined use of phentermine and topiramate in obese people to prevent cardiovascular diseases.

10. Fentamine is prohibited in patients with cardiovascular diseases.

Seven, special people

1. Different guidelines have different suggestions for the prevention of cardiovascular diseases in 75-year-old people. The prevention strategy of cardiovascular diseases in the elderly is best to be patient-centered and individualized.

2, the basic principles of cardiovascular disease prevention in the elderly include:

1) Most elderly people's antihypertensive goals are

2) Elderly people who take statins should not stop treatment unless there are unacceptable adverse reactions.

3) The elderly mainly reduce blood sugar to avoid hypoglycemia and hyperglycemia.

4) Old people should avoid smoking.

5) Proper patient-centered nutritional intervention and physical activity/exercise have many benefits.

3. Compared with Caucasians, many Asians have higher cardiovascular risk.

4. African-Americans may be particularly "salt sensitive" to hypertension, and the best goal of sodium intake is

5. An important factor to effectively prevent cardiovascular diseases in ethnic minorities is sustainable intervention measures, which can fully solve communication barriers and recognize and deal with the influence of race/national culture when discussing behaviors and other treatment suggestions.

6. The onset time of cardiovascular diseases in women is usually 10 years later than that in men, but this cardioprotective effect basically disappears in women with polycystic ovary syndrome, smoking, menopause and type 2 diabetes.

7. When acute coronary syndrome occurs, women are less likely to show chest pain than men.

8. Polycystic ovary syndrome increases cardiovascular risk. Women with this disease should actively carry out healthy nutritional intervention and regular exercise.

9. The cardiovascular risk of postmenopausal women is significantly increased. For some people, hormone replacement therapy may increase cardiovascular risk. If necessary, it should be used at the lowest effective dose in the early menopause (within 5 years), and hormone replacement therapy should not be prescribed for the purpose of preventing cardiovascular diseases.

For women, obesity, lack of exercise, type 2 diabetes and smoking may have a greater impact on cardiovascular risk, so women should also actively manage these risk factors.

Eight, thrombosis

1. Randomized clinical studies show that when aspirin is used for primary prevention of cardiovascular diseases, the risk of bleeding is greater than the health benefits.

2. The standard antithrombotic therapy for secondary prevention of cardiovascular diseases includes dual antiplatelet therapy, usually aspirin plus P2Y 12 inhibitor.

3. Aspirin is the first choice for secondary prevention after myocardial infarction. Unless there are contraindications or adverse events, it should be taken indefinitely.

4. For patients with unstable coronary heart disease, acute myocardial infarction and unstable angina pectoris, taking aspirin in acute phase is beneficial, and platelet inhibition is the fastest when chewing.

5. Patients with acute coronary syndrome should receive dual antiplatelet therapy for at least 12 months, regardless of whether stents are implanted or not, unless there are adverse reactions or contraindications.

6. The "5A" plan of other cardiovascular risk factors management helps to discuss quitting smoking with patients: ask patients about their tobacco use, advise smokers to quit smoking, evaluate smokers' willingness to quit smoking, help smokers quit smoking, and arrange follow-up.

7. In order to reduce the risk of thrombosis, cardiovascular disease, cancer and other diseases caused by smoking, it may be beneficial for smokers to participate in behavior support programs.

8. Smoking cessation drug therapy and behavioral therapy have synergistic effect, which can strengthen patients' chances of quitting smoking.

9. Most e-cigarettes contain nicotine, and long-term application is likely to increase cardiovascular risk. Some studies show that using e-cigarettes to quit smoking or prevent relapse may not be effective.

10. Teenagers and young people, pregnant women and people who have never used any tobacco products at present are advised not to use electronic cigarettes containing tetrahydrocannabinol and/or nicotine.

Nine, renal insufficiency

1, estimation of glomerular filtration rate (eGFR)

2. The treatment of chronic kidney disease usually includes the control of major cardiovascular risk factors such as diabetes, hypertension and smoking.

3.SGLT2 inhibitor and GLP- 1 receptor agonist are the most beneficial drugs for kidney.

4, chronic kidney disease patients with hypertension, antihypertensive goals.

5. It is suggested that non-dialysis patients with cardiovascular risk of 7.5% in 10 should be treated with moderate-intensity statins.

6. Smoking is one of the independent risk factors of chronic kidney disease. For patients with chronic kidney disease, antiplatelet therapy may reduce the risk of myocardial infarction, but it will increase the risk of bleeding.

7. Anemia can lead to ischemia and myocardial hypertrophy. Patients with end-stage renal disease may need higher doses of erythropoietin, especially before starting dialysis treatment.

8. For patients with chronic kidney disease with cardiovascular risk, in addition to limiting salt, super-processed carbohydrates, monosaccharides, saturated fatty acids and selecting polyunsaturated fatty acids, total protein should also be restricted, and high-fiber fruits and vegetables rich in potassium are limited to patients with hypokalemia.

9. Maintaining good cardiovascular health and a healthy lifestyle will help reduce the risk of chronic kidney disease, including regular physical activity.

Patients with 10, eGFR300 mg /24 hours or rapid decline of eGFR should see a doctor in time.

X. Family history/genetic factors/familial hypercholesterolemia

Hereditary dyslipidemia is the most common treatable cause of hereditary early atherosclerotic coronary heart disease (including familial hypercholesterolemia).

2. For patients with familial hypercholesterolemia phenotype, the diagnosis of familial hypercholesterolemia cannot be ruled out by negative DNA gene test, and there may be undetermined gene mutation.

3. In the results of physical examination, yellow tumor tendon has the greatest relationship with familial hypercholesterolemia, and physical examination is the most common diagnostic standard of familial hypercholesterolemia.

4. It is suggested that individuals and families with very high low density lipoprotein cholesterol (LDL-C) should be screened for familial hypercholesterolemia.

5. High-intensity statins are the first-line treatment drugs for patients with familial hypercholesterolemia.

6. For patients with heterozygous familial hypercholesterolemia, LDL-C is a common lipid-lowering target.

7. To a great extent, due to the high baseline level of low-density lipoprotein cholesterol (LDL-C) and the high incidence of cardiovascular complications, patients with familial hypercholesterolemia usually fail to meet the standard when using statins with the maximum tolerated dose alone. These patients may benefit from the addition of ezetimibe, PCSK9 inhibitors, phenylpyruvic acid and/or other lipid-lowering drugs.

8. Starting statin therapy as early as possible can reduce the lifetime exposure of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol (LDL-C) and delay the onset of coronary heart disease.

9. For patients with homozygous familial hypercholesterolemia, drug therapy includes statins, PCSK9 inhibitors, monoclonal antibodies against angiopoietin-like 3, lometazapine and inclisiran.

10. among patients without familial hypercholesterolemia, the increase of lipoprotein a is the most common single-gene cause of atherosclerotic cardiovascular disease, and every adult should be tested for lipoprotein (a) at least once in his life.

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