Acute myocardial infarction comes suddenly, and the patient is killed at any time. Even if he is lucky enough to escape from the gate of hell, the patient still cannot take it lightly. Some studies have pointed out that abnormal blood lipids are one of the main culprits of heart attack, and patients with myocardial infarction have a high chance of recurrence within one year after the onset of the disease. If the blood lipids continue to fail to reach the target level, they are likely to recur. Cardiologists point out that heart attacks can be prevented by reducing or controlling known risk factors, so-called “secondary prevention,” where strict control of low-density cholesterol (LDL-C) levels is especially important.
Heart disease is a major public health issue in Hong Kong. Dr. Siu Chung-wah, a specialist in cardiology, pointed out that coronary heart disease is the main cause of death from heart disease. According to data from the Department of Health, the number of deaths due to heart disease in 2020 reached 6,561, a 6.5% increase from 2019, and nearly 60% of them were acute myocardial infarction and other ischemic heart disease. The incidence of coronary heart disease in Hong Kong tends to be younger. Among men aged between 15 and 24, the annual rate has increased significantly by 10.7%. The situation cannot be ignored.
Faced with the heavy pressure on the public medical system brought about by cardiovascular disease, early prediction and prevention are the keys to managing the disease. Dr. Xiao Songhua pointed out that many studies have found that patients with myocardial infarction have a high risk of recurrence or readmission within one year. According to a study published in Hong Kong in 2019, more than 1,600 patients who had suffered myocardial infarction were tracked for more than two years. Among them, 405 patients had cardiovascular events during the period, including nearly 70% of whom died due to cardiovascular disease. In addition, according to the Singapore study, between 2007 and 2012, among more than 30,000 patients with acute myocardial infarction, 6.8% of the patients relapsed within one year.
It can be seen that the “heart bomb” of patients with myocardial infarction will break out again at any time in a short period of time, and a “bomb disposal” plan needs to be formulated as soon as possible. Dr. Xiao Songhua pointed out that high low-density lipoprotein cholesterol (LDL-C) or low high-density lipoprotein cholesterol (HDL-C) represents abnormal blood lipids and has been recognized as a major risk factor for cardiovascular disease. . According to the European Heart Association (ESC) 2019 guidelines, patients with clinically or imaging-confirmed cardiovascular disease are classified as very high-risk patients, and their target LDL-C level has been tightened from below 1.8mmol/L to 1.4mmol/L /L or less, and control the LDL-C level to half or less of the original. In addition, if a second cardiovascular and cerebrovascular event, such as myocardial infarction or ischemic stroke, occurs within two years of receiving the maximum tolerated dose of statins, reducing LDL-C levels below 1.0mmol/L.
Only about 30% of myocardial infarction patients in Hong Kong receive one-year treatment
LDL-C can be controlled at target levels
In order to understand the LDL-C control of cardiovascular disease patients in Hong Kong, the University of Hong Kong collected more than 18,000 patients who suffered from myocardial infarction, stroke/transient ischemic attack, and received “Tong Wave” in the western cluster of Hong Kong Island from 2003 to 2016. Nearly 70% of patients were prescribed statins when they were discharged from the hospital. However, the study found that only 25.8% of myocardial infarction patients received treatment for one year after discharge, and their LDL-C could be controlled at the target level (the guideline at that time was below 1.8mmol/L, and it was not tightened to below 1.4mmol/L until 2019). .
The University of Hong Kong study also found that 14.5% of patients with cardiovascular disease still did not reach the target level of LDL-C even after receiving high doses of statins. In addition, after myocardial infarction patients received treatment for one year after discharge, if the LDL-C level still did not reach below 1.8mmol/L, they had an average probability of more than 30% of having another cardiovascular event.
Dr. Huixian Chen, Associate Professor of the Department of Pharmacology and Pharmacy and Research Director of the Center for Drug Safety and Applied Research, Hong Kong University of Medicine, who is in charge of the study, pointed out that the relevant research results are similar to Asian data, showing that patients with cardiovascular disease after discharge from hospital are not properly managed LDL-C levels. , will increase their risk of recurrence, especially in patients with myocardial infarction.
Although controlling LDL-C levels is the key to preventing heart attacks, patients also need a multi-pronged approach to manage them effectively. Dr. Siu Songhua pointed out that research and development have found that there are nine important modifiable factors that increase the risk of heart attack, including: : Abnormal blood lipids, smoking (and exposure to secondhand smoke), high blood pressure, diabetes, obesity, poor dietary habits, lack of physical activity, mental stress and alcohol consumption. In other words, heart attack can be prevented by reducing or controlling known risk factors. He suggested that patients with cardiovascular disease should eat more fruits and vegetables and exercise regularly. If patients have any doubts, they should consult their attending physician and adjust the treatment plan as soon as possible.
The above information was provided by Dr. Siu Chung-wah, Specialist in Cardiology, and Dr. Chen Huixian, Associate Professor and Research Director of the Center for Drug Safety and Application, Department of Pharmacology and Pharmacy, Faculty of Medicine, HKU.
▲ Cardiology Specialist Dr. Siu Chung-wah
▲ Dr Chan Wai-yin, Associate Professor and Research Director, Centre for Drug Safety and Application, Department of Pharmacology and Pharmacy, Faculty of Medicine, HKU
This article is produced with the support of Amgen Hong Kong to encourage public awareness of health information
The content of this article is for reference only and does not replace clinical medical advice. If you have any questions, please consult your doctor.
HK-08394 -REP-2022-Jun
Date of Approval: May 2022
(Special appointment)
