Keith A.A.Fox教授 2013ESC大会主席英国爱丁堡大学
霍勇教授 北京大学第一医院
<International Icirculation>: Professor Fox， as the Chairman of this year’s ESC Congress， what do you think are the highlights of this meeting?
Prof. Fox: I am delighted to be able to discuss this with you. The first thing is that we have highlighted the spotlight of the Congress which is the heart interacting with systemic organs， so conditions like diabetes are absolutely fundamental because it interconnects the different organ systems. It highlights the interaction between the heart and the brain， the kidneys， the lungs and the other systemic organs and allows us to bring in experts from all of these relevant areas into our discussions. I have just seen the latest figures from today and we have 29500 people already registered here as cardiologists and scientists. It is a large meeting. We are delighted that we have major studies from around the world and we believe that these are trials and studies that are going to change practice.
《国际循环》：Fox教授，您好，作为今年ESC大会主席，您觉得今年大会的亮点有哪些？
Fox教授：我很高兴和你一起讨论这个问题。首先我们所强调的是大会主题“心脏与全身器官的联系”，如糖尿病这种疾病因关系到不同的器官、系统而显得尤其重要；另外，也强调心脏与脑、肾脏、肺以及其他系统、器官的相互联系，为各领域专家提供交流的机会。我看了一下最新统计数据，目前为止我们已有29 500名心脏病专家或科学家注册参会，这的确是一个盛会。我们很高兴能见到来自世界各地的主要研究，也相信这些试验和研究将会对临床实践产生深远影响。
<International Icirculation>: What do you think is the most interesting trial being presented at this meeting?
Prof. Fox: If you have 4000 presentations it can be difficult to pick out individual ones， but I can tell you that among the hotlines， there were very important trials presented today that were innovative in their design. The Scandinavian TASTE study was based on a registry and then randomization from within that registry. This is a trial that cost 1% of what a conventional trial costs and yet it is many-fold larger than the other trials on thrombus and thrombus aspiration before and it has no missing data. This is innovative and I think a model that we may be able to adopt around the world. That is just one good example. Also there is the PRAMI Study from the UK. Here is an example of something that is fundamental in how we manage acute myocardial infarction and I am sure that Professor Huo， as an interventionalist， would say that we are faced with a dilemma of what we do with these other lesions and there has been a lot of uncertainty. But now we have got definitive evidence with a mortality difference.
《国际循环》：本次大会中，您最感兴趣的试验有哪些？
Fox教授：很难从4000多个报告中选出几个，但我可以告诉你的是在热点话题中，的确有一些重要试验设计非常具有创新性。像Scandinavian TASTE研究基于注册，然后进行随机化。成本仅为常规试验的1%，但规模却比其他血栓和血栓抽吸研究大很多倍，而且无数据丢失。我想这个方法很有创新性，值得我们在全世界范围内推广。而这仅仅是其中一个很好的例子。我们还有来自英国的PRAMI研究，是急性心肌梗死处理方面的重要研究。我可以肯定即使霍教授这样的介入治疗专家也会认为目前我们面临着如何处理许多其他损伤的困境以及存在诸多不确定因素，但现在我们获得了死亡率差异的确切证据。
<International Icirculation>: Professor Huo， as the President of the Chinese Society of Cardiology， could you please talk about the current collaboration between CSC and ESC? Also what are the future plans?
Prof. Huo: We have a longtime collaboration with the European Society of Cardiology. The Chinese Society has two working meetings here at this Congress with the European Society and we have plans for the next six years as part of our collaboration. Most importantly， we have seen this meeting grow over the last twenty years from just a small meeting to， what I think，is the largest cardiology meeting in the world and we can learn a lot from the experience of the European Society of Cardiology. Also from the Society we have seen a lot of guidelines， patient education and quality of care which we can utilize to do our job.
Prof. Fox: We are very excited about this collaboration too because we fundamentally believe we have a lot to learn from each other. It is really important that we understand what is happening in different parts of the world; the importance， for example， of what is happening with stroke in the Chinese population and the way that salt intake and other factors influence this. Perhaps coronary disease is less important to you; you have less McDonalds at least at the moment. There are some novel things; for example， about sodium and the PURE study being presented here at this Congress.
Prof. Huo: In China， maybe ten years ago， we learned a great deal from the data from the GRACE registry and had several hospitals join in on that. Now we have new data in China from the past four years and we can see that for ACS patients and particularly STEMI patients， treatment is not optimal because guidelines are not implemented in these patients. Currently for STEMI patients， <5% get early reperfusion overall. In the hospital setting in Europe however， 60-70% get early reperfusion including PCI and thrombolysis， but we only achieve 30% so we still have a lot to learn from you.
Prof. Fox: However China faces these issues on an enormous scale with an enormous population， so there are very different challenges compared to a country like Denmark or the Netherlands which are comparatively small even to a Chinese province.
Prof. Huo: We need a system that is easier to organize and also on the part of the government.
Prof. Fox: The Czech Republic was a very good example of an area where they hadn’t implemented a lysis program and they went directly into a primary PCI program for the whole country. The UK used to be a thrombolysis country. Today it has changed from a thrombolysis country to now >90% of all ST-elevation MI patients getting primary PCI which is a revolutionary change.
Prof. Huo: Last year I led the China national program for STEMI for the Ministry of Health. In phase I， we had 53 hospitals as a model for improvement looking at reperfusion rate and door-to-balloon time. At the end of this year， we will start with phase II with more hospitals and 14 provinces involved in the national program. We want a more effective network for the transfer and treatment of patients with respect to door-to-balloon time and possibly more patient and public education and policy improvement including medical reimbursement.
《国际循环》：霍教授，作为中华医学会心血管病分会（CSC）的主席，您能否谈谈CSC与ESC目前的合作情况以及未来的合作计划？
霍勇教授：我们与欧洲心脏病学学会有着长时间的合作，中国的学会在此次大会上与欧洲学会合作召开了两次工作会议，是我们未来6年合作计划之一。更重要的是，过去20年间，我们见证了欧洲心脏病学学会成长成为世界最大的心脏病学学会的历程，也从中学到了很多欧洲心脏病学会的经验。从他们那里看到了很多指南、患者教育、护理质量等内容，对我们自身的临床工作很有帮助。
Fox教授：我们对中欧心脏病学会的合作也感到非常兴奋，我们相信相互之间有很多值得学习的地方。了解世界各地正在发生的事情对我们来说的确很重要。例如，中国人群的卒中发病情况、钠盐摄入方式及其他影响因素以及本次大会展示的钠盐和PURE研究。
霍勇教授： 10年前在中国，我们就从GRACE注册研究中学到了很多，很多医院加入该研究。现在我们已有中国过去4年的新数据，我们可以看到对于ACS患者，尤其STEMI患者的治疗未达到最优化，因为有些治疗指南并未在该人群中得到很好的实施。目前来讲，仅有<5%的STEMI患者得到早期再灌注治疗。而在欧洲医院中，60%~70%的患者都能得到早期再灌注治疗包括PCI和溶栓，而在中国这项数据只有30%，所以说我们还有很多向你们学习的地方。
Fox教授：中国面临人口众多、规模较大的问题，而像丹麦或荷兰等国家相对来说仅有中国一个省市那么大，因而所面临的挑战不同。
霍勇教授：我们需要一个便于操作的体系，也需要政府部门的积极协助。
Fox教授：捷克共和国就是一个很好的例子，他们就没有通过一个分解程序而直接在全国范围内实施了一个初始PCI项目。英国以前是一个习惯应用溶栓治疗的国家，而现如今超过90%的STEMI患者都能得到初始PCI治疗，这是革命性的转变。
霍勇教授：去年，我向卫生部申请并牵头开展了STEMI中国国家项目。在第1阶段，我们有53家医院改进再灌注率和门-球时间。到今年年底，我们将进入第2阶段，纳入更多医院，覆盖全国的14个省。我们需要一个更有效的患者转移和治疗网络，使门-球时间、公共教育以及政策改革包括医疗报销得以改善。
<International Icirculation>: Cardiovascular risks are higher in diabetic patients. How important do you think is controlling CV risk in the management of type 2 diabetes?
Prof. Fox: We have recognized for many years that diabetes is a fundamental risk contributor in terms of cardiovascular disease (both coronary and stroke)， peripheral vascular disease and indeed renal disease. The uncertainty was whether controlling glucose independently was going to reduce cardiovascular events and it is important that there are large trials to test that， but we believe that we need to address the combination of risk factors and not just hyperglycemia. We have to address hypertension. We have to address hyperlipidemia. Lifestyle. They are all part of that. And obviously there is smoking cessation and exercise as well.
Prof. Huo: Diabetes is a very big problem in China with 100 million diabetes patients with 60 million IGT patients. It is a very big population so it is very important for the prevention of any sort of cardiovascular disease. So in China we are starting with the primary prevention of diabetes.
Prof. Fox: It does make a lot of sense. In many of our Western communities， we are struggling with the expansion of type 2 diabetes because of obesity and it poses a real challenge. In our society as well， we should be tackling this much earlier with better prevention. We need to learn from each other.
Prof. Huo: We need risk stratification for patients before they get diabetes.
《国际循环》：糖尿病患者心血管风险程度更高，您认为应如何管理2型糖尿病患者的心血管风险？
Fox教授：许多年前我们就已认识到糖尿病是心血管疾病（包括冠心病、卒中、外周血管疾病主）的重要危险因素。但我们不确定单独控制血糖能否减少心血管事件发生。有很多大型试验进行了相关研究，我们相信是多重危险因素共同影响心血管事件发生而不单单是高血糖。我们必须强调高血压、高脂血症、生活方式的重要性。当然戒烟和运动也很重要。
霍勇教授：在中国有1亿糖尿病患者，其中有6000万糖耐量减低（IGT）患者。所以这是相当大的患者群体，需要预防各种心血管疾病发生。在中国，我们正在进行糖尿病的一级预防。
Fox教授：这的确很有意义。在我们西方国家，我们也面临因肥胖导致2型糖尿病流行的挑战。我们学会也在积极进行该疾病的早期预防工作，在这方面我们可以相互学习。
霍勇教授：我们需要对还未患糖尿病的人群进行风险分层。
<International Icirculation>: What do you think are the feasible ways of reducing the CV risk in diabetes patients?
Prof. Fox: Number one， as we have been discussing， is to start with the diet. Number two: blood pressure control. Number three: smoking cessation. Number four: hyperlipidemia. And then we get on to the more sophisticated drugs. But if we do this at an early stage， maybe we can change some of this epidemic that is happening.
Prof. Huo: I totally agree with Professor Fox.
《国际循环》：您认为减少糖尿病患者心血管风险的可行性措施有哪些？
Fox教授：第一，正如我们讨论的那样，应该从饮食开始；第二，血压控制；第三，戒烟；第四，治疗高脂血症。然后我们可以进行一些药物干预。如果我们早期就开始做这些，就可能改变正在发生的疾病。
霍勇教授：我完全同意Fox教授的意见。