CVIA China Focus Issue

Changsheng Ma

Cardiovascular diseases (CVD) have become the main cause of death and a critical public health burden in contemporary China. I was invited by Dr.Richard Conti, editor in chief of the journal as the guest editor of this issue focusing on CVD in China.It is my privilege to work with the leading cardiologists and research scientists in the field to delineate the outline of CVD in China, including epidemiology, prevention, rehabilitation, clinical management et al. This issue not only elaborates the major clinical issues but also highlights future perspectives in cardiovascular disease of China.

The first paper contributed by Dayi Hu, the founder of GW-ICC, addresses dyslipidemia and management of atherosclerotic cardiovascular diseases in China based on new evidence and new guidelines. It introduces the background and some major issues of the 2016 Chinese Dyslipidemia Guidelines. Specifically, the author emphasized that most Chinese patients do not require and cannot tolerate the high-frequency and high-dose statin therapy as recommended in the ACC/AHA guidelines.

Dr. Yiyi Wang et al. introduce the development and progression of cardiovascular immunology research in Wuhan Union Hospital in the past 2 decades. Their terrific work revealed that autoimmunity plays critical roles in dilated cardiomyopathy, stroke, myocardial injury and chronic heart failure. Furthermore, they developed a polypeptide vaccine targeting AT1 receptor to prevent and treat hypertension.

Precision medicine allows doctors to tailor therapies to an individual patient. Dr. Yan Liu et al.review the application of precision medicine to cardiovascular diseases based on large-scale cohorts,genomics and pharmacogenomics and finally discuss its impact on future health care.

Biomarkers have been used in clinical management of heart failures, such as the diagnosis, risk stratification and treatment. Dr. Xinli Li et al. summarize present biomarkers utilization of heart failure in China and address several important issues in routine clinical practice.

Echocardiography is a clinical routine approach in the diagnosis, prognosis, risk strati fi cation and follow-up of patients with hypertrophic cardiomyopathy (HCM). Sun et al. detail current techniques used in clinical practice and weigh the advantages and disadvantages of each method. The authors highlight the importance of the integrated echocardiographic parameters and other clinical information for the clinical management of HCM.

Single-pill-combination antihypertensive drug products have become popular due to improved compliance. He et al. evaluate the efficacy and safety of amlodipine/valsartan fixed-dose combination in the management of hypertension in Chinese patients by meta-analysis of 5 studies. The authors conclude that amlodipine/valsartan fixed-dose combination shows greater blood pressure-lowering effects, higher blood pressure control rate, and higher response rate with good tolerance compared with monotherapies of valsartan and amlodipine.

Dr. Ding et al. conducted a prospective randomized study to investigate the effect of home based cardiac rehabilitation on functional capacity, behavior and risk factors in patients with acute coronary syndrome in China. 80 patients with ACS were enrolled into this study. Compared to the control, patients participated in home-based cardiac rehabilitation showed improved functional capacity, behavior and laboratory testing. The authors strongly suggest that home-based cardiac rehabilitation is a feasible and available cardiac rehabilitation mode in China.

Pan et al. address an important and interesting issue of depression, anxiety, and cardiovascular disease in Chinese. The authors systematically reviewed the literature to disentangle the role of depression and anxiety disorders in the onset and prognosis of CVD with emphasis on prospective studies conducted in the Chinese population and found that both depression and anxiety are closely associated with the onset and prognosis of CVD.Their study urges the multi-disciplinary clinical group including psychiatrists in the clinical management of Chinese patients with CVD.

Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality, which leads to a huge burden on society.Catheter ablation has become the first recommendation for the treatment of majority patients with atrial fibrillation. Dr. Han and Li elegantly summarize the history of invasive AF treatment and its evolution into catheter ablation. This article mainly focuses on various ablation techniques and technology advancements leading to our current understanding of the ablation therapy of AF.

The elderly with CVD is associated with higher incidence of thrombosis-related diseases; although antithrombotic therapy significantly reduces the risk of ischemic and thrombosis events in the elderly,it results in relatively higher bleeding. Dr. Liu addresses this important issue by summarizing current evidence and updates on guidelines to weigh the pros and cons of antithrombotic therapy in the elderly with CVD.

Dr. Cui et al. conducted an epidemiological study to investigate the patient characteristics and temporal trends of hospitalizations for congenital heart disease (CHD) in Beijing from 2007 to 2011. A total of 53,064 patients were analyzed. They found that the overall rate of CHD hospitalization has been increasing in Beijing, whereas not all patient groups follow the same trend. The hospitalization rate decreased among infants while the rate for nonsevere CHD increased significantly among adults.

These findings will be of important value for future allocation of health resources.

Optical coherence tomography (OCT) has been proven to be an invaluable tool in high-resolution intracoronary imaging modality of the atherosclerotic plaque in the coronary artery. Dr. Afolabi et al.systematically review the current evidence OCT role in the diagnosis and management of patients with acute coronary syndromes, especially in the early detection of high-risk plaques.

The safety and efficacy of coronary artery bypass grafting (CABG) and second-generation drug-eluting stents (DESs) in patients with coronary artery disease is currently a very topical issue. Dr. Guo et al. systematically reviewed the literature by metaanalysis and found that second-generation DESs were associated with no significant differences to CABG for all-cause death, cardiovascular death,myocardial infarction and stroke, while there is a significantly increased risk of revascularization and major adverse cardiac and cerebrovascular event.

Dr. Wang et al. present a design paper. The authors will conduct a randomized controlled trial to investigate whether more frequent electrocardiographic (ECG) recordings with an automated ECG system would improve the detection of atrial fibrillation compared to a single annual ECG screen in the elderly Chinese population in the community health center setting. This study will provide the first evidence on the clinical effectiveness of more frequent ECG recordings by a handheld automated analysis system in the detection of atrial fibrillation in China.

Inherited cardiomyopathy is an important cause of morbidity and mortality throughout the world in children and adults. It has a substantial genetic component and predisposes to sudden cardiac death. Genetic testing has become prevalent in clinical practice. Dr. Wang et al. review the current progress of genetics and genetic testing of inherited cardiomyopathy and emphasize that next generation sequencing would highly impact not only our understanding of pathophysiology but also the clinical management of inherited cardiomyopathy.

Finally, Dr. Xingsheng Yang et al. brie fly introduce several clinical syndromes associated with cardiovascular diseases, especially highlighting the clinical manifestations of those syndromes.