Recently, the American Society of Preventive Cardiology issued a document, each of which proposed ten cardiovascular risk factors. Ten points of attention.
The ten factors include: Unhealthy diet, physical inactivity, dyslipidemia, prediabetes/diabetes, hypertension, obesity, special populations, thrombosis, kidney Insufficiency, family history/genetic factors/familial hypercholesterolemia.
< /p>
1. A healthy diet that can prevent cardiovascular disease must be based on evidence. Calorie intake must take into account both the total amount and the quality. The patient must also be able to adhere to it for a long time.
2. Saturated fatty acids can promote atherosclerosis by increasing inflammation, leading to endothelial dysfunction, etc.; Isocaloric unsaturated fatty acid replacement; both saturated and trans fatty acids increase LDL-C, and trans fatty acids are most associated with increased cardiovascular risk.
Despite being banned by the U.S. Food and Drug Administration in 2019, trans fats are still reported to be present in cakes, fillings In cakes, biscuits, biscuits, margarine, biscuits, microwave popcorn, donuts, etc.
3. To prevent cardiovascular disease, replace refined carbohydrates with isocaloric complex carbohydrates (including whole grains, vegetables, and fruits).
Ultra-processed foods not only promote weight gain, but also increase postprandial hyperglycemia, hyperinsulinemia, hypertriglyceridemia, Inflammation, endothelial dysfunction, sympathetic hyperactivity, risk of hypercoagulation.
4. The best diet for preventing cardiovascular disease is the Mediterranean diet and the DASH diet.
Both dietary patterns start with vegetables, fruits, whole grains, fat-free or low-fat dairy, fish, poultry, lean meats , Nuts, beans, fiber-based.
5. Other diets with evidence include vegetarian and Ornish diets.
A healthy vegetarian diet usually includes vegetables, fruits, whole grains, legumes, seeds and nuts, and some vegetarian options also allow eggs and milk.
It is important to note that plant-based foods such as fruit juices, sweetened beverages, refined grains, potatoes/chips, and sweets may increase cardiovascular risk.
6. There is no long-term prospective clinical study to support whether the ketogenic diet can prevent cardiovascular disease.
If the ketogenic diet consists of saturated fat and dietary cholesterol, LDL-C levels may be elevated.
7. Intermittent fasting may reduce total caloric intake, facilitate weight loss in overweight or obese individuals, and improve cognitive function and cardiovascular disease-related metabolic markers. But intermittent eating, compared with long-term calorie restriction, was not associated with an advantage in weight loss.
Time-restricted fasting can improve cardiovascular risk factors in some people.
Eating a good breakfast may promote more diet-induced thermogenesis and lower blood sugar and insulin than eating a large dinner level.
8. For people who are not deficient in vitamins, dietary supplementation does not reduce cardiovascular risk. In fact, calcium supplementation may also increase cardiovascular risk. Conversely, getting vitamin D and calcium from healthy foods, such as dairy products, can reduce cardiovascular risk.
9. Eating foods rich in omega-3 fatty acids may reduce cardiovascular risk; supplements containing EPA and DHA may also prevent Cardiovascular events.
10. Clinicians should educate patients about evidence-based dietary patterns and dietary practice guidelines, as well as consult nutrition professionals.
Other cost-effective suggestions include: unsalted fruits and vegetables, beans, milk, yogurt, carrots, cabbage, no salt recommended Whole grain, low-sodium foods with sugar.
1. Lack of exercise is one of the main risk factors for cardiovascular disease, which can directly Or indirectly lead to a 10% increased risk of premature death.
2. It is recommended that healthy adults do at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. There is evidence to support building muscle 2-3 times per week.
Even if you don’t reach the recommended levels of physical activity above, you can help reduce cardiovascular risk, including short periods of light physical activity each day.
3. Physical activity can be assessed through assessment tools (such as questionnaires to assess physical activity), which can help improve patient compliance.
4. For obese, diabetic and hypertensive patients with well-controlled blood pressure, resistance training at least 3 times a week is beneficial for reducing cardiovascular risk .
5. Increased physical activity and regular physical activity often improve metabolic markers.
6. In addition to improving cardiovascular risk factors, increased physical activity and regular physical activity can improve cardiac function, reduce inflammation, and improve endothelial cell function , Prevent myocardial ischemia-reperfusion injury, promote myocardial regeneration, promote vasodilation, enhance fibrinolysis, improve autonomic balance, reduce sympathetic tone, reduce the risk of arrhythmia, slow down resting heart rate.
7. Regular physical activity and physical activity may help maintain weight loss.
8. Older adults ≥65 years can benefit from a variety of physical activities, including aerobic exercise and resistance training.
9. In addition to physical exercise, non-exercise physical activity including daily activities (eg standing, walking, climbing stairs) may usually be Activities with the highest percentage of energy expenditure. Less than 5,000 steps per day is considered sedentary, but any amount of exercise above baseline is beneficial.
10. Physical activity during pregnancy can reduce preeclampsia, gestational hypertension, gestational diabetes, excessive weight gain during pregnancy, and childbirth complications Symptoms and risk of postpartum depression.
1. LDL-C is the main lipid treatment target in most lipid guidelines.
But for patients with diabetes, obesity, hypertriglyceridemia, very low LDL-C levels and in the case of non-fasting blood collection , Apolipoprotein B, non-HDL-C, and LDL particle numbers may be better predictors of cardiovascular risk than LDL-C.
2. A basic principle is that patients with the highest cardiovascular risk require the most aggressive lipid management strategies.
For patients with cardiovascular disease, it is recommended to initiate high-intensity statin therapy with a goal of LDL-C reduction ≥50% and LDL-C≤1.8 mmol/L. In very high-risk patients, LDL-C <1.4 mmol/L may also be suitable, and there is no obvious lower threshold.
On the basis of statin therapy, ezetimibe, PCSK9 inhibitor, bempedoic acid, bile acid chelator can also be used to Achieve LDL-C control goals.
3. When it is not clear whether statin should be used, coronary artery calcium (CAC) score may be helpful for cardiovascular risk stratification. A CAC score ≥ 400 indicates a high cardiovascular risk, and a CAC score of 0 indicates a low cardiovascular risk.
4. LP(a) is one of the established cardiovascular risk factors, which is helpful for cardiovascular risk stratification.
Statins, nutritional interventions, increased physical activity do not reduce LP(a), PCSK9 inhibitors, lipoprotein isolation, antisense oligonucleotides , Small interfering RNA can reduce LP (a).
To date, no cardiovascular outcome studies have shown that reducing LP(a) can reduce the risk of cardiovascular events.
Unless LP(a)-lowering treatments have proven health benefits, an accurate measurement of LP(a) may be sufficient to assess cardiovascular risk.
5. Statins are the most commonly recommended drugs for the treatment of hypercholesterolemia. High-intensity statins (atorvastatin 40–80 mg or rosuvastatin 20–40 mg) are generally recommended as first-line therapy in patients with cardiovascular disease or at high cardiovascular risk.
The most common clinical manifestation of statin intolerance is statin-related muscle symptoms. Daily use and other methods to reduce.
6. Commonly used non-statin oral lipid-lowering drugs include ezetimibe and bempedoic acid, which can reduce LDL-C by about 18% , the combination of the two drugsdropped by 38%.
7. PCSK9 inhibitors are injectable preparations. When combined with high-intensity or maximum tolerated doses of statins, LDL-C can be reduced by ≥ 50% while reducing cardiovascular risk. Oral PCSK9 inhibitors are currently under development.
8. Hypertriglyceridemia (≥150 mg/dl) generally increases cardiovascular risk.
9. Nutritional interventions (omega-3 fatty acids), exercise, and drug therapy (fibrates) can reduce triglyceride levels.
1. For most diabetic patients, the goal of hypoglycemic treatment is HbA1c<7%, while avoiding hypoglycemia and large blood sugar fluctuations.
Have a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, multiple comorbidities, and prolonged blood sugar that is difficult to achieve. Patients with the disease course may require more relaxed control targets, such as HbA1c <8% or higher.
2. Diabetes is one of the main risk factors for cardiovascular disease, and diabetic patients need to control other common cardiovascular risk factors more actively. For example, overweight or obesity, hypertension, dyslipidemia, smoking.
3. In terms of lipid-lowering therapy, in primary prevention, regardless of the estimated 10-year cardiovascular risk, diabetic patients aged 40-75 years had no May benefit from moderate to high-intensity statin therapy.
diabetic patients with cardiovascular risk factors are high-risk patients and may benefit the most from high-intensity statin therapy, with an LDL-C target value of <70 mg/dl.
For very high-risk patients with existing cardiovascular disease, multiple cardiovascular risk factors, and target organ damage, the target LDL-C value is <50 mg /dl may be beneficial.
4. Clinical studies have shown that intensive hypoglycemia may significantly reduce the risk of coronary events without increasing the risk of death. The optimal mechanism, rate, and extent of reduction may vary and depend on the specific antidiabetic drug.
5. Metformin is beneficial for controlling cardiovascular risk factors and potentially reducing cardiovascular disease.
6. For diabetic patients with ischemic cardiovascular disease and heart failure, SGLT2 inhibitors are recommended as a comprehensive lifestyle adjustment and metformin. of second-line treatment.
In diabetic patients with chronic kidney disease, SGLT2 inhibitors may delay the progression of kidney disease.
7. For patients with ischemic heart disease and diabetes who receive comprehensive lifestyle intervention and metformin treatment, GLP-1 receptor agonists are useful Vascular benefit should be considered as second-line therapy.
8. The effects of sulfonylureas on cardiovascular disease are neutral, but they can increase weight gain and increase the risk of hypoglycemia. For diabetic patients with cardiovascular disease or cardiovascular risk, sulfonylureas are the antidiabetic drug of last resort unless other antidiabetic drugs are unavailable.
9. For patients with cardiovascular disease, some evidence supports that pioglitazone reduces ischemic cardiovascular disease, but increases weight gain and congestion Cardiomyopathy risk.
DPP4 inhibitors have a neutral effect on body weight and cardiovascular disease, and saxagliptin may increase the risk of heart failure hospitalization.
10. Some studies have shown that insulin may increase major adverse cardiac events in patients with stable coronary heart disease and acute coronary syndrome. Risk occurs.
According to the American Diabetes Association standard of care, the effect of insulin on cardiovascular disease and heart failure is neutral.
1. Self-ambulatory blood pressure monitoring can be used to diagnose hypertension, and may be especially suitable for patients with white coat hypertension and masked hypertensionIt also helps to assess the effect of antihypertensive therapy.
2. ACC/AHA recommends <130/80 mmHg as the antihypertensive treatment target. The International Society of Hypertension recommends that for patients under the age of 65, after starting antihypertensive drugs, the blood pressure target should be <140/90 mmHg within the first 3 months, and the blood pressure target should be <130/80 mmHg after 3 months.
3. As long as antihypertensive treatment does not cause symptoms and signs or other evidence of hypotension, blood pressure can reduce cardiovascular risk.
4. Hypertension is one of the most common causes of heart failure, coronary heart disease, stroke, peripheral vascular disease, chronic renal insufficiency, and arrhythmia (atrial fibrillation is the most common ), and hypertensive patients require more aggressive treatment of other cardiovascular risk factors.
5. Non-drug non-invasive antihypertensive methods include; low-sodium diet (sodium intake <2300 mg/d), use of salt substitutes , Adequate potassium intake, regular physical activity/exercise, maintaining a healthy weight. Men and women with high blood pressure should not drink more than 2 drinks per week and 1 drink per week, respectively.
Invasive, nonpharmacological treatments for resistant hypertension may include renal sympathectomy.
6. For patients whose average blood pressure exceeds the blood pressure target of 20/10 mmHg, it is recommended to start antihypertensive treatment with two different types of first-line drugs. It can be taken as separate or fixed combination preparations.
7. Guideline recommendations and research evidence support the preference for chlorthalidone over hydrochlorothiazide among thiazide diuretics.
Patients with concomitant heart failure and estimated glomerular filtration rate <30 ml/min may prefer loop diuretics, especially tonic Rasemy.
8. In addition to lowering blood pressure, ACEI and ARB are also beneficial for the treatment of heart failure and coronary heart disease.
9. CCB should be avoided in patients with heart failure with reduced ejection fraction. β-blockers can be used, but their antihypertensive effect may not be as good as other Antihypertensive drugs.
10. Community-based and remote monitoring of hypertension management may benefit blood pressure control.
1. For obese people, cardiovascular disease and cancer are the most common causes of death. Obesity can directly and indirectly increase cardiovascular risk.
2. For obese people, weight loss usually improves major cardiovascular risk factors. Management of overweight and obesity requires a multifaceted intervention strategy, including nutrition, exercise, motivational interviewing, behavioral change, medication, and bariatric surgery if necessary.
3. No weight loss drugs and doses have been proven to prevent cardiovascular events.
4. When liraglutide is applied at 3.0 mg/d, it is used as a weight loss drug, and it also metabolizes while losing weight. benefit.
5. For obese patients with cardiovascular disease, without type 2 diabetes and congestive cardiomyopathy, initial treatment should include liralu peptides, and used in their weight loss doses.
6, metformin and SGLT2 inhibitors have no indication for weight loss, but they can reduce weight slightly. In addition to weight loss, many diet pills also reduce cardiovascular risk factors.
7. For obese patients with cardiovascular disease, type 2 diabetes but no congestive cardiomyopathy, initial drug therapy should be considered including metformin, GLP-1 receptor agonists and SGLT2 inhibitors.
8. For obese patients with cardiovascular disease, type 2 diabetes, and congestive cardiomyopathy, initial drug therapy should include metformin and SGLT2 inhibitor.
9. There is little evidence to support the combined use of phentermine and topiramate for the prevention of cardiovascular disease in obese people.
10. Phentermine is contraindicated in patients with cardiovascular disease.
1. Different guidelines for cardiovascular disease in people over 75 years oldDisease prevention recommendations vary. Cardiovascular disease prevention strategies in older adults are best based on individualized patient-centered protocols.
2. The basic principles of cardiovascular disease prevention in the elderly include:
< p>(1) The blood pressure target of most elderly people is <130/80 mmHg, which can be lower (such as cardiovascular disease or other risk factors) or higher (short life expectancy, Orthostatic hypotension or risk of falls, other antihypertensive adverse reactions, or polypharmacy).
(2) Unless there are unacceptable adverse reactions, elderly people taking statins should not interrupt treatment.
(3) The degree of hypoglycemia in the elderly is based on the consideration of underlying health conditions and risks, and the priority is to avoid hypoglycemia and hyperglycemia.
(4) The elderly should avoid smoking. The antithrombotic benefit of aspirin outweighs the risk of bleeding in patients with cardiovascular disease, but the risk of bleeding may outweigh the potential benefit when using aspirin for primary prevention in frail patients over 80 years of age.
(5) Appropriate, patient-centered nutritional interventions and physical activity/exercise have multiple benefits.
3. Compared with Caucasians, many Asians have a higher cardiovascular risk. Asians may have higher statin bioavailability when treated with the same dose of statin, so Asians typically receive lower statin doses.
4. African Americans may be especially “salt-sensitive” for hypertension, and the optimal target for sodium intake is <1500 mg/d; In Africans, diuretics and calcium antagonists may be preferred over ACE inhibitors and beta blockers.
5. An important factor in effective prevention of cardiovascular disease in minority groups is adequate resolution of communication barriers and recognition in discussions of behavioral and other treatment recommendations and sustainable interventions to address racial/ethnic cultural influences.
6. The onset of cardiovascular disease in women is usually 10 years later than that in men, but this cardioprotective effect is more important in polycystic ovary syndrome, smoking and menopausal women, and almost disappeared in women with type 2 diabetes.
Women with type 2 diabetes have a significantly higher cardiovascular risk than men; women with statin use for secondary prevention have the same effect as men, but women may More prone to statin-related diabetes and myalgia.
7. When acute coronary syndrome occurs, women are less likely to present with chest pain than men.
8. Polycystic ovary syndrome increases cardiovascular risk. Women with this disease should actively carry out healthy nutrition interventions and regular exercise. Statins There may be multiple benefits of combined metformin therapy.
9. Postmenopausal women have significantly increased cardiovascular risk. Hormone replacement therapy may increase cardiovascular risk in some individuals, and if necessary, the lowest effective dose should be administered as early as possible (within 5 years) in early menopause, and hormone replacement therapy should not be prescribed for the purpose of preventing cardiovascular disease.
10. For women, obesity, lack of exercise, type 2 diabetes, and smoking may have a greater impact on cardiovascular risk, so women These risk factors should also be actively managed. (More reading: New Guidelines: ASCVD Risk Assessment, 13 Women-Specific Risk Enhancers, to Watch!)
1. Randomized clinical studies have shown that aspirin for cardiovascular In primary prevention of disease, the risk of bleeding outweighs the health benefits.
For certain populations with high cardiovascular risk and low bleeding risk, based on patient-centered assessment and discussion, use aspirin. Primary prevention may be beneficial.
Coronary artery calcification (CAC) score may be helpful for clinical decision-making, and aspirin may have a net benefit when CAC score ≥ 100 .
2. Standard antithrombotic therapy for secondary prevention of cardiovascular disease includes dual antiplatelet therapy, usually aspirin + a P2Y12 inhibitor .
3. Aspirin is the first drug for secondary prevention after myocardial infarction. Unless contraindicated or adverse events occur, it should be continued indefinitely. take.
75-100 mg/d aspirin may have the best benefit-risk in long-term thrombosis prevention in patients with acute coronary syndrome Compare.
4. For patients with unstable coronary heart disease, acute myocardial infarction, and unstable angina pectoris, it is beneficial to use aspirin in the acute phase, and platelets when chewed or taken Fastest suppression.
It is recommended that patients with acute myocardial infarction should chew 325 mg of aspirin after calling emergency services, preferably within 30 minutes of onset.
Aspirin is not recommended for patients with acute stroke because it may worsen hemorrhagic stroke.
5. Patients with acute coronary syndrome, unless there are adverse reactions or contraindications, should receive at least two Combined antiplatelet therapy for 12 months. Thereafter, dual antiplatelet therapy can be continued if there is a potential net benefit after discussion with the patient, although the course of treatment may be shortened in patients at high risk of bleeding.
6. The “5A” regimen for the management of other cardiovascular risk factors is helpful in discussing smoking cessation with patients: Ask the patient about tobacco Use, Advise (Advise) smokers to quit smoking, Assess (Assess) the smoking cessation hospital for smokers, Assist (Assist) smokers to quit smoking, Arrange (Arrange) follow-up.
7. To reduce the risk of smoking-induced thrombosis, cardiovascular disease, cancer, and other diseases, it may be beneficial for smokers to participate in a behavioral support program (according to the Ask, Advise, Refer strategy).
8. Smoking cessation drug therapy and behavioral therapy have synergistic effects, which can enhance the chance of smoking cessation for patients.
9. Most electronic cigarettes contain nicotine, and long-term use is likely to increase cardiovascular risk. Some studies suggest that using e-cigarettes to quit smoking or prevent relapse may not be effective.
10 The CDC and FDA recommend that adolescents and young adults, pregnant women, and people not currently using any tobacco products should not use Cannabidiol and/or nicotine e-cigarettes.
Those who choose to replace tobacco with electronic cigarettes should completely switch from tobacco to electronic cigarettes, and cannot use both at the same time.
The FDA has not approved the use of e-cigarettes to aid smoking cessation.
1. Estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 increases the risk of cardiovascular events, death, and hospitalization.
Cardiovascular disease is the most common cause of death in patients with chronic kidney disease. The lower the eGFR, the higher the risk of cardiovascular death.
2. The treatment of chronic kidney disease usually includes the management of major cardiovascular risk factors such as diabetes, hypertension, and smoking.
3, SGLT2 inhibitors and GLP-1 receptor agonists were the most beneficial to the kidneys.
Except for thiazolidinediones and GLP-1 receptor agonists, all other types of hypoglycemic drugs have representative drug needs Adjust dose based on eGFR.
4. For chronic kidney disease patients with hypertension, the blood pressure target should be <130/80 mmHg, especially with proteinuria.
The following antihypertensive drugs are preferred for non-dialysis chronic kidney disease patients: ACEI or ARB, diuretics, dihydropyridine CCB, mineralocorticoids receptor antagonists.
The following antihypertensive drugs are preferred for dialysis patients: beta blockers, dihydropyridine CCBs, ACEIs or ARBs, and direct vasodilators.
For patients with eGFR< 30 ml/min/1.73 m2, the benefit-risk ratio of ACEI or ARB is unclear.
5. Meta-analysis supports the use of statins for primary prevention of cardiovascular disease in patients with mild to moderate renal insufficiency. Moderate-intensity statin therapy is recommended for nondialysis patients with 10-year cardiovascular risk ≥7.5%.
In addition to atorvastatin, other statins in patients with chronic kidney disease require dose adjustment.
Patients with advanced chronic kidney disease can be combined with statin and ezetimibe.
6. Smoking is one of the independent risk factors for chronic kidney disease.
In patients with chronic kidney disease, antiplatelet therapy may reduce the risk of MI but increase the risk of bleeding.
7. Anemia can lead to ischemia, cardiac hypertrophy, and patients with end-stage renal disease may require higher doses of erythropoietin, especially at the beginning of Before dialysis treatment.
8. For patients with chronic kidney disease at cardiovascular risk, in addition to salt restriction, ultra-processed carbohydrates, monosaccharides, saturated fatty acids and more choices In addition to unsaturated fatty acids, total protein should be limited, and potassium-rich, high-fiber fruits and vegetables should be limited to those with hypokalemia.
9. Maintaining good cardiovascular fitness and a healthy lifestyle can help reduce the risk of chronic kidney disease, including regular physical activity.
10, eGFR < 30 ml/min/1.73 m2, urine albumin > 300 mg/24 h, or patients with a rapid decline in eGFR should Consider referral to a nephrologist.
1. Hereditary dyslipidemia is hereditary premature atherosclerosis The most common treatable causes of sclerosing coronary heart disease include familial hypercholesterolemia.
2. For patients with familial hypercholesterolemia phenotype, a negative DNA gene test cannot rule out the diagnosis of familial hypercholesterolemia. There may be genetic mutations that have not yet been identified.
3. In the physical examination results, tendon xanthoma is most associated with familial hypercholesterolemia, and the diagnostic criteria for familial hypercholesterolemia The most common physical examination.
Aortic stenosis is also common in patients with familial hypercholesterolemia.
4. It is recommended that individuals and families with extremely high LDL-C should undergo cascade screening for familial hypercholesterolemia.
5. High-intensity statin is the first-line treatment for patients with familial hypercholesterolemia.
6. For patients with heterozygous familial hypercholesterolemia, the commonly used lipid-lowering target is LDL-C < 100 mg/dl, combined with LDL-C < 70 mg/dl in patients with cardiovascular disease and/or risk factors.
Patients with heterozygous familial hypercholesterolemia should be additionally tested for Lp(a).
7. Largely due to the high baseline LDL-C level and the high comorbidity rate of cardiovascular disease, patients with familial hypercholesterolemia LDL-C targets are often suboptimal on maximal tolerated doses of statins alone, and these patients may benefit from the addition of ezetimibe, PCSK9 inhibitors, bempedoic acid, and/or other lipid-lowering drugs.
8. Early initiation of statin therapy may reduce lifetime exposure to high LDL-C and delay the onset of coronary heart disease.
It is strongly recommended that patients with heterozygous familial hypercholesterolemia be considered for statin therapy at the age of 8 to 10 years.
9. For patients with homozygous familial hypercholesterolemia, drug therapy includes: statins, PCSK9 inhibitors, angiopoietin-like 3 monotherapy Clonal antibodies, lomitabide, inclisiran.
Lipoprotein replacement is recommended for familial hypercholesterolemia patients whose LDL-C cannot reach the standard after nutritional intervention, exercise and lipid-lowering drug treatment. is another option.
10. In patients without familial hypercholesterolemia, elevated Lp(a) is associated with atherosclerotic cardiovascular disease of the most common monogenic etiology, every adult should be tested for Lp(a) at least once in their lifetime.
References:
Ten Things to Know About Ten Cardiovascular Disease Risk Factors – 2022 . Am J Prev Cardiol, 6 April 2022
Disclaimer: Source China Circulation Magazine . Only for learning and communication, The copyright belongs to the original author, if there are any graphic, copyright or other issues, please contact us in time, we will delete it immediately . The opinions in this article only represent the author’s personal, I hope everyone can make a rational judgment and application!
Requirements for manuscripts: originals of more than 1500 words
Submission methods: haoyishu-zy03 (WeChat)
Remuneration: according to the quality of the article
There is no end to medicine, we Every contribution will be remembered by the world in another way. Looking forward to an excellent you!
Click the business card below to follow us quickly
Scan the QR code below to get free materials
Related reading
Morning reading | The main point, quickly get the diagnosis and risk assessment of chronic coronary syndrome!
Morning reading | Nine misunderstandings of hypertension medication, which one did you hit?
Morning reading | Classic! 53 anatomical images, easy to grasp the coronary system
Click “read original text” , start your learning journey!