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常见问题:心脏病
Dr. 威廉·格罗斯曼, Director of the Center for Prevention of Heart and Vascular Disease at UCSF, answers some frequently asked questions about heart disease.
问:许多人每天服用两到四种或更多的阿维或其他布洛芬来治疗关节问题, 比如关节炎. Labeling seems to indicate a possible heart risk. 这种风险有多严重?
答:布洛芬, 比如Advil, 布洛芬或布洛芬, 是否会导致现有高血压(高血压)的显著恶化或出现新的高血压. It can also cause damage to the kidneys (nephrotoxicity), 心力衰竭加重, 甚至心脏病发作或中风. Outside of the cardiovascular system, 它的主要风险是胃, where it can cause ulceration and gastrointestinal bleeding.
Ibuprofen is a member of the class of drugs called NSAIDs, 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), meloxican (Mobic) and celecoxib (Celebrex).
All of these drugs have a black box warning from the FDA, 上面写着:“心血管风险:可能增加严重和潜在致命的心血管血栓事件的风险?, 心肌梗死与中风. Risk may increase with duration of use. Increased risk if existing cardiovascular disease or risk factors."
The bottom line is that for short-term occasional use, these drugs are probably safe for most of us, 但我个人很少使用它们. If I have patients who really need them, I make sure that they check their blood pressure regularly, take their daily baby aspirin and try to get off them as soon as possible.
我个人使用并推荐的治疗关节问题或关节炎的对心脏有益的药物有:
- Plain regular aspirin — Two regular aspirin every four to six hours
- Acetaminophen (Tylenol) — Two regular or extra-strength every four to six hours
- Vicodin 5/500 — One to two tablets every four to six hours
None of these have black box warnings from the FDA. 最后, 对一些人来说,非甾体抗炎药是无害的,对于提高生活质量是绝对必要的. 所以,向你的内科十大赌博平台排行榜、心脏病专家或两者都咨询一下,看看什么是适合你的.
问:如果一个人在进行严格的有氧运动饮食,那么关于鸡蛋是否可以吃的问题,人们给出了不同的信息. Is it okay to eat eggs, 如果是这样的话, how many per week?
答:鸡蛋是极好的蛋白质来源,而且不含胆固醇(西夫韦的打蛋器和类似产品)。. These cholesterol-free eggs can be eaten without any limitations. 然而, for regular or "real" eggs, some limitations may be desirable.
如果你有较高的低密度脂蛋白胆固醇(“坏”胆固醇)和其他心脏病发作或中风的危险因素, 比如高血压, 糖尿病, or family history of heart attack or stroke, you should probably limit eggs to no more that two per week. 然而, if you are on a statin such as simvastatin (Zocor), atorvastatin (Lipitor) or rosuvastatin (Crestor), 你的低密度脂蛋白现在很低, you can safely eat eggs more often, 也许每天.
我建议做一个“前后”测试:检查你的低密度脂蛋白胆固醇,尽量少吃鸡蛋, then eat as many eggs as you desire and recheck your LDL cholesterol. 对我的很多病人来说, 他汀类药物完全压倒了鸡蛋(或奶酪)的作用。.
作为一个全面披露的项目, 大多数星期天我都吃一个鸡蛋芝士煎蛋卷,还有一片特别锋利的切达奶酪,这是我日常饮食的一部分, 每天的早餐, which also includes a bowl of strawberries, 香蕉, 葡萄干、杏仁或核桃.
问:根据最近的文章,盐似乎不再像以前那样是“禁忌”了. 除非你有高血压,否则摄入盐对你没有坏处,这是真的吗?
A:问得好, 盐并不是对每个人都有害,这种说法肯定有一定的道理. In fact there are some conditions, 比如艾迪生氏病, cortisone deficiency and chronic low blood pressure, where salt is part of the therapy. 而且有很多人对盐的耐受性很好,没有必要限制它. 不幸的是,我们中的许多人——包括你的朋友——都有摄入大量盐的问题.
When I was in my 40s, I developed high blood pressure (160/100 mmHg). 我看了一位内科十大赌博平台排行榜,他给我开了一些药,把我的血压降了下来. 当时流行对所有新诊断的高血压患者进行尿检. My test revealed a very high sodium content. 内科十大赌博平台排行榜告诉我不要在餐桌上加盐,少吃含盐的食物,我照做了. 接下来的一年, during which I also lost 20 pounds, 我的血压降下来了,我可以停止服用降压药了. 那是20年前的事了,从那以后我的血压一直保持在120/80毫米汞柱以下.
Other conditions where salt can be dangerous include congestive heart failure, edema (液体潴留) and kidney disease. As in most things, moderation is probably the wisest course.
问:我是一名65岁的女性,内科十大赌博平台排行榜给我开了治疗高血压和高胆固醇的药. Would it be advisable to get a heart screening test, evaluation and treatment recommendation from a cardiologist? Should a heart screening be part of a routine physical, 如果是这样的话, how frequently and what tests should be given?”
答:这个问题其实是好几个问题,都很难回答.
首先,是否每个患有高血压和高胆固醇的人都需要看心脏病专家? My answer is no — if he or she has a good internist. 问题是,许多内科十大赌博平台排行榜非常忙,可能不是这些疾病的最新治疗专家.
如果你的血压降至120毫米汞柱收缩压(最高值)或更低, you and your internist are doing a great job. If your LDL cholesterol has come down to 70 mg percent or less, you and your internist are to be congratulated, and a cardiologist is not likely to add anything. 如果你对内科十大赌博平台排行榜或她的心脏病评估的彻底性有疑问,向内科十大赌博平台排行榜咨询一次心脏病专家可能不是一个坏主意.
关于心脏筛查,有许多不同类型的心脏筛查试验. 每个人都应该做完整的血液筛查测试,包括全面的胆固醇检查, high-sensitivity C-reactive protein, kidney and 糖尿病 testing — and an EKG (electrocardiogram).
I do not recommend routine treadmill or nuclear stress tests, echocardiograms or CT scans on everyone; I order them based on issues in each individual case.
The echocardiogram is particularly helpful if there is a heart murmur, 呼吸急促(气促), 液体潴留, 或者是心脏衰竭的迹象. 如果有胸痛或压力,跑步机和核压力测试是有帮助的, 或者心电图异常. CT扫描会让你暴露在大量的辐射下——比标准的胸部x光检查高出100多倍, 我把这些保留到我真正关心某个特定问题的情况下, such as pulmonary embolism or aortic aneurysm.
最后, regarding the routine heart screening calcium score CT, I rarely order this test and don’t find it useful. There are too many false positives — i.e., the test indicates the presence of serious disease, 但进一步, more specific testing shows that none is present.
加州大学旧金山分校健康 medical specialists have reviewed this information. 它仅用于教育目的,并不打算取代您的十大赌博平台排行榜或其他医疗保健提供者的建议. 我们鼓励您与您的供应商讨论您可能遇到的任何问题或疑虑.