Over the last 30 years,the number of people with cardiovascular disease(CVD)has continued to increase globally,with hypertension being the leading risk factor for CVD.The burden of hypertension is especially large in ...Over the last 30 years,the number of people with cardiovascular disease(CVD)has continued to increase globally,with hypertension being the leading risk factor for CVD.The burden of hypertension is especially large in countries and regions undergoing economic development and lifestyle transition.The latest survey data from China show that from 2012 to 2015,the prevalence of hypertension among residents aged18 years was as high as 27.9%;that is,one in four adults suffer from hypertension[1].It follows that the current prevention and control of hypertension is poor.Therefore,how best to improve hypertension management to reduce the CVD burden is a major global consideration.Here we depict the challenges that cardiologists and neurologist face in the present era of CVD.展开更多
Stroke is the most important cause of death and disability in China,and most strokes(~80-90%)are preventable.Recent advances in a number of measures to reduce stroke are discussed in this narrative review,including sm...Stroke is the most important cause of death and disability in China,and most strokes(~80-90%)are preventable.Recent advances in a number of measures to reduce stroke are discussed in this narrative review,including smoking cessation,a Mediterranean pattern of eating,salt restriction,B vitamins to lower homocysteine,antiplatelet therapy,anticoagulants and the management of patent foramen ovale and carotid stenosis.Lowering of homocysteine with B vitamins does prevent stroke,but patients with variants of MTHFR require higher doses of folic acid,and because of harm from cyanocobalamin among persons with renal impairment,we should use methylcobalamin or oxocobalamin instead.Aspirin resistance appears to be due to enteric coating,and>50% of Chinese have a reduced response to clopidogrel because of variants of CYP2C19,required to convert the prodrug to its active form.Direct acting oral anticoagulants(DOACs)have revolutionized anticoagulation;important differences among the DOACs are discussed.Percutaneous closure of patent foramen ovale(PFO)does reduce the risk of stroke,but in most patients with stroke and PFO the PFO is incidental;it is important to identify the subgroup in whom paradoxical embolism was the probable cause of the stroke.Some patients with PFO would be better treated with anticoagulants because of the risk of pulmonary embolism.Carotid stenting carries a higher risk in older patients,and most patients with asymptomatic carotid stenosis would be better treated with intensive medical therapy than with either stenting or endarterectomy;the few who could benefit can be identified.展开更多
文摘Over the last 30 years,the number of people with cardiovascular disease(CVD)has continued to increase globally,with hypertension being the leading risk factor for CVD.The burden of hypertension is especially large in countries and regions undergoing economic development and lifestyle transition.The latest survey data from China show that from 2012 to 2015,the prevalence of hypertension among residents aged18 years was as high as 27.9%;that is,one in four adults suffer from hypertension[1].It follows that the current prevention and control of hypertension is poor.Therefore,how best to improve hypertension management to reduce the CVD burden is a major global consideration.Here we depict the challenges that cardiologists and neurologist face in the present era of CVD.
文摘Stroke is the most important cause of death and disability in China,and most strokes(~80-90%)are preventable.Recent advances in a number of measures to reduce stroke are discussed in this narrative review,including smoking cessation,a Mediterranean pattern of eating,salt restriction,B vitamins to lower homocysteine,antiplatelet therapy,anticoagulants and the management of patent foramen ovale and carotid stenosis.Lowering of homocysteine with B vitamins does prevent stroke,but patients with variants of MTHFR require higher doses of folic acid,and because of harm from cyanocobalamin among persons with renal impairment,we should use methylcobalamin or oxocobalamin instead.Aspirin resistance appears to be due to enteric coating,and>50% of Chinese have a reduced response to clopidogrel because of variants of CYP2C19,required to convert the prodrug to its active form.Direct acting oral anticoagulants(DOACs)have revolutionized anticoagulation;important differences among the DOACs are discussed.Percutaneous closure of patent foramen ovale(PFO)does reduce the risk of stroke,but in most patients with stroke and PFO the PFO is incidental;it is important to identify the subgroup in whom paradoxical embolism was the probable cause of the stroke.Some patients with PFO would be better treated with anticoagulants because of the risk of pulmonary embolism.Carotid stenting carries a higher risk in older patients,and most patients with asymptomatic carotid stenosis would be better treated with intensive medical therapy than with either stenting or endarterectomy;the few who could benefit can be identified.
