常见问题:心脏病
Dr. 威廉·格罗斯曼, 加州大学旧金山分校心血管疾病预防中心主任, 解答一些关于心脏病的常见问题.
Q: Many people take two to four — or more — Advil or other ibuprofen daily for joint issues, 比如关节炎. 标签似乎表明可能有心脏病风险. 这种风险有多严重?
答:布洛芬, 比如Advil, 布洛芬或布洛芬, can cause marked worsening of existing hypertension (high blood pressure) or development of new high blood pressure. 它还会对肾脏造成损害(肾毒性)。, 心力衰竭加重, 甚至心脏病发作或中风. 在心血管系统之外, 它的主要风险是胃, 哪里会引起溃疡和胃肠道出血.
布洛芬是非甾体抗炎药的一种, 其中包括布洛芬, 甲氧萘丙酸(萘普生, 都属, Anaprox), 苏灵大(Clinoril), 双氯芬酸(Voltaren), 吡罗昔康(费啶), 吲哚美辛(消炎痛), 美洛昔康(Mobic)和塞来昔布(Celebrex).
所有这些药物都有FDA的黑框警告, which reads: "Cardiovascular Risk: May increase risk of serious and potentially fatal cardiovascular thrombotic events, 心肌梗死与中风. 风险可能随着使用时间的延长而增加. 如果存在心血管疾病或危险因素,风险会增加."
底线是短期偶尔使用, 这些药物对我们大多数人来说可能是安全的, 但我个人很少使用它们. 如果我有真正需要的病人, 我确保他们定期检查血压, 每天服用婴儿阿司匹林,并尽量尽快停用.
Heart-friendly medicines for joint issues or arthritis that I do use personally and recommend are:
- 普通阿司匹林——每4到6小时吃两片普通阿司匹林
- Acetaminophen (Tylenol) — Two regular or extra-strength every four to six hours
- 维柯丁5/500:每4 - 6小时服用1 - 2片
这些都没有FDA的黑框警告. 最后, there are some folks for whom NSAIDs are not harmful and are absolutely necessary for improved quality of life. So, check with your internist, cardiologist or both as to what is right for you.
Q: There are mixed messages about whether or not eggs are okay to eat if a person is on a watchful cardio diet. 吃鸡蛋可以吗?如果可以,一周吃多少?
A: Eggs are an excellent source of protein and are available in a cholesterol-free form (Egg Beater Pour Spout and similar products at Safeway). 这些不含胆固醇的鸡蛋可以无限制地食用. 然而,对于普通的或“真正的”鸡蛋,一些限制可能是可取的.
If you have elevated LDL cholesterol (the "bad" cholesterol) and other risk factors for heart attack or stroke, 比如高血压, 糖尿病, 或者有心脏病或中风的家族史, 你应该把鸡蛋限制在每周不超过两个. 然而, 如果你正在服用他汀类药物,比如辛伐他汀(Zocor), 阿托伐他汀(立普妥)或瑞舒伐他汀(Crestor), 你的低密度脂蛋白现在很低, 你可以更经常地吃鸡蛋, 也许每天.
I suggest doing a "before and after" test: Check your LDL cholesterol on your best-effort diet low in eggs, 然后想吃多少鸡蛋就吃多少,并重新检查你的低密度脂蛋白胆固醇. 对我的很多病人来说, the statin completely overpowers the effects of the eggs (or cheese for that matter).
作为一个全面披露的项目, I have an egg-cheese omelet most Sundays and a slice of extra-sharp cheddar cheese as part of my regular, 每天的早餐, 还包括一碗草莓吗, 香蕉, 葡萄干、杏仁或核桃.
Q: According to recent articles, it seems that salt is not the "no-no" it once was. Is it true that, unless you have high blood pressure, the intake of salt is not bad for you?
A:问得好, and there is definitely some truth to the statement that salt is not bad for everyone. 事实上是有一些十大赌博靠谱网络平台的, 比如艾迪生氏病, 可的松缺乏和慢性低血压, 盐是治疗的一部分吗. And there are many people who tolerate salt well and have no need to restrict it. Unfortunately, many of us — including yours truly — have a problem with large quantities of salt.
当我40多岁的时候,我患上了高血压(160/100毫米汞柱)。. I saw an internist who put me on medication that brought my blood pressure right down. In those days it was fashionable to conduct a urine test on all newly diagnosed hypertensives. 我的检测显示钠含量很高. The internist told me to stop adding salt at the table and to cut down on salty foods, which I did. 接下来的一年, 在此期间,我还减掉了20磅, my blood pressure came down and I was able to get off the antihypertensive medication. That was 20 years ago, and my blood pressure has remained 120/80 mmHg or less ever since.
盐可能造成危险的其他情况包括充血性心力衰竭, 水肿(液体潴留)和肾脏疾病. 和大多数事情一样,适度可能是最明智的做法.
Q: I am a 65-year-old woman taking medication prescribed by my internist for high blood pressure and high cholesterol. 做一个心脏筛检合适吗, 心脏病专家的评估和治疗建议? 心脏筛查应该成为常规体检的一部分吗, 如果是这样的话, 检查的频率和内容?”
A: This question is actually several good questions, all of which are difficult to answer.
First, does everyone with high blood pressure and high cholesterol need to see a cardiologist? 我的答案是否定的——如果他或她有一个好的内科十大赌博平台排行榜. The problem is that many internists are very busy and may not be expert in the latest treatment of these conditions.
If your blood pressure has come down to 120 mmHg systolic (the top number) or less, 你和你的内科十大赌博平台排行榜做得很好. 如果你的低密度脂蛋白胆固醇降到70%或更低, 恭喜你和你的内科十大赌博平台排行榜, 心脏病专家不太可能添加任何东西. Asking your internist for a one-time consultation with a cardiologist might not be a bad idea if you have doubts about the thoroughness of his or her cardiologic evaluation.
Regarding heart screening, there are many different types of heart screening tests. Everyone should have complete blood screening tests — including full cholesterol profile, 高灵敏度c反应蛋白, 肾脏和糖尿病检查——以及心电图检查.
我不建议常规的跑步机或核压力测试, echocardiograms or CT scans on everyone; I order them based on issues in each individual case.
如果有心脏杂音,超声心动图特别有用, 呼吸急促(气促), 液体潴留, 或者是心脏衰竭的迹象. The treadmill and nuclear stress tests are helpful if there is chest pain or pressure, 或者心电图异常. The CT scans expose you to a lot of radiation — more than 100 times that of a standard chest X-ray —, and I reserve those for cases where I am really concerned about a particular question, 比如肺栓塞或主动脉瘤.
最后, 关于常规心脏筛查钙评分CT, 我很少做这个测试,也不觉得它有用. 有太多的误报- i.e., 检查表明有严重的疾病, 但进一步, 更具体的测试表明,这些都不存在.
加州大学旧金山分校健康医学专家已经审查了这些信息. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.