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Table of Contents
PREFACE
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 1-2

Managing cardiovascular disease pandemic in China: challenges and strategies


Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China

Date of Submission19-Mar-2020
Date of Acceptance22-Mar-2020
Date of Web Publication4-Apr-2020

Correspondence Address:
Prof. Jun-Bo Ge
Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cp.cp_4_20

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How to cite this article:
Ge JB. Managing cardiovascular disease pandemic in China: challenges and strategies. Cardiol Plus 2020;5:1-2

How to cite this URL:
Ge JB. Managing cardiovascular disease pandemic in China: challenges and strategies. Cardiol Plus [serial online] 2020 [cited 2020 May 27];5:1-2. Available from: http://www.cardiologyplus.org/text.asp?2020/5/1/1/281940




  The Challenges Top


First of all, the main risk factors which lead to the outbreak of cardiovascular diseases (CVDs) are not well controlled, and this trend remains to worsen, especially diabetes mellitus, hypertension, dyslipidemia, and physical inactivity.[1] The rapid economic development and energy consumption resulted in air pollution, which is also contributed to the increase of CVDs.[2] The imbalanced availability of medical resources between urban and rural areas represents a significant obstacle.[3] People living in rural areas are much less likely to receive guideline-recommended preventions (control of risks) and treatments, such as thrombolysis therapy for ST-segment elevated myocardial infarction.[4] Sex disparity also continues to exist. For example, Chinese women with established CVD are less likely to receive secondary prevention as recommended by the guidelines.[3]

Another significant issue is the “isolated” view of CVD rather than the holistic approach that considers CVD as a continuum. A national-level investigation demonstrated that many risk factors of CVD are not adequately controlled.[4] Treatment target for both hypertension and hyperlipidemia is only achieved in a fraction of the affected people. Lifestyles that promote the development of CVD, including smoking, sedentary lifestyle, and high-salt diet, as well as air pollution, also remain widespread.

The third challenge is the lack of evidence specific for the Chinese population despite increasing academic achievements by Chinese cardiologists. A majority of the recommendations adopted in China Guidelines are based on data collected in the Western countries and thus may not be appropriate for use in the Chinese population.


  Strategies Top


Effective CVD control requires an overall strategy at the national level and infrastructure for efficient implementation and management, with the following emphasis.

Grassroots efforts, with a particular emphasis in rural areas

The ongoing efforts to build a standardized, hierarchical treatment network and an increasing number of specialized clinics should be strengthened. In the past 4 years, a growing number of chest pain units and stroke units were approved in the district- and community level-hospitals. Such efforts are expected to improve the ability to respond to emergency CVD events more rapidly and at a local level but need to be expanded to other types of specialized clinics, such as atrial fibrillation units, heart failure units, and cardiac rehabilitation units. When planning new infrastructure, disease features that are unique to the Chinese population need to be considered. For example, H-type hypertension (hypertension with elevated plasma homocysteine) is more prevalent in the Chinese population and often leads to severe outcomes such as stroke.[5] As a result, hypertension centers are particularly needed and could produce a meaningful reduction in CVD within a limited budget.

The concept of panvacular medicine

CVDs of different types share similar pathological characteristics, risk factors, and therapeutic strategies and thus should be systematically managed using a panvascular approach.[6],[7] Educational efforts to disseminate such an idea should be made at multiple levels, including the government, social organizations, community, health institution, and media, especially the newer social media. Emphasis should be placed on modifiable risks, including smoking, hypertension, dyslipidemia, obesity, and physical inactivity.[8] Environmental pollution (particularly PM2.5 air pollution) is another measure that could decrease the incidence of CVD in China.

Panvascular medicine approach also promotes interdisciplinary and translational studies. We envision that, shortly, multimodal medical imaging could provide an earlier and more accurate assessment of CVD risks in each phase of the life, which, in turn, could allow individualized management.

Information technology

Information technology has radically changed the Chinese society. Big data and artificial intelligence have created infinite possibilities to improve CVD management in a country with such a vast territory and large population. Advances in information technology can facilitate cross-regional cooperation and life-long administration. Remote consultation, education, and demonstration rapidly become a reality. We have been holding hundreds of online case conferences at a national level; physicians from less-developed areas now have many more opportunities to learn from expert cardiologists. In addition to promoting academic exchange among physicians, new information technology could certainly improve medical services geared toward individual patients, including risk evaluation, lifestyle modification, and long-term monitoring after hospital discharge.

Original research and innovation

China has a large population with a distinct genetic background. Accordingly, more original, high-quality multicenter clinical trials and real-world studies are needed to design prevention and treatment appropriate for the Chinese population. Currently, the most critical step is building a pragmatic and interactive national database.

Efforts in research and innovation should be balanced with daily work chore. For the majority offirst-line medical workers, time spends in research often competes with their devotion to patient care. The government and hospital administration must understand that service quality ultimately depends on research and innovation in the long run and should design and implement policies that encourage research efforts without a negative impact on service quality.

In conclusion, we anticipate that morbidity and mortality of CVD will continue to rise before reaching a turning point in China. To expedite the arrival of such a turning point, we must make strategic plans based on facts, with an emphasis on modifiable risks. Infrastructures must be built so that the strategic plans could be implemented. More importantly, all such efforts should be made with a panoramic view and a panvascular strategy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010;362:1090-101.  Back to cited text no. 1
    
2.
Liu C, Chen R, Sera F, Vicedo-Cabrera AM, Guo Y, Tong S, et al. Ambient particulate air pollution and daily mortality in 652 cities. N Engl J Med 2019;381:705-15.  Back to cited text no. 2
    
3.
Xia S, Du X, Guo L, Du J, Arnott C, Lam CSP, et al. Sex differences in primary and secondary prevention of cardiovascular disease in China. Circulation 2020;141:530-9.  Back to cited text no. 3
    
4.
Hu S, Gao R, Liu L, Zhu M, Wang W, Wang Y, et al. Summary of the 2018 Report on Cardiovascular Diseases in China. Chin Circ J 2019;34:209-20.  Back to cited text no. 4
    
5.
Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: The CSPPT randomized clinical trial. JAMA 2015;313:1325-35.  Back to cited text no. 5
    
6.
Ge JB, Wang Y. Panvascular Medicine, Concept and Clinical Practice. Beijing: PMPH; 2018.  Back to cited text no. 6
    
7.
Yang J, Wang K, Huo Y, Wang Y, Ge JB. The Working Group on Scientific Statement for the Prevention and Treatment of Panvasculan Disease. Scientific statement for the prevention and treatment of panvascular disease. Chin Circ J 2019;34:1041-6.  Back to cited text no. 7
    
8.
Li Y, Zeng X, Liu J, Liu Y, Liu S, Yin P, et al. Can China achieve a one-third reduction in premature mortality from non-communicable diseases by 2030? BMC Med 2017;15:132.  Back to cited text no. 8
    




 

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