Sidney C. Smith教授：世界心脏联盟（WHF）常务理事和前任主席，内科学教授，专业领域为介入心脏病学、冠状动脉血管成形术、瓣膜性心脏病、冠心病和预防心脏病学。

　

　　International Circulation: Reviewing the guidelines for cardiovascular disease prevention published in 2013 and 2014， what concepts and ideas do you think are worth promoting? And what controversies need to be solved?

 

　　《国际循环》：回顾2013~2014发布的心血管疾病预防相关指南，您认为有哪些心血管疾病预防概念或理念值得推广？尚存哪些争议？

 

　　Dr Smith: One thing that we know for sure we should promote in our new guidelines is for people not to smoke cigarettes and if they do smoke cigarettes， to stop. If we get rid of cigarettes， we get rid of a lot of strokes and heart attacks. It is crazy that we don’t do that and do it all around the world. We have seen progress. We know， for instance， in the United States and other countries where they have cut back on cigarette smoking， they have seen a 17%~20% reduction in heart attacks. We also know that low-dose aspirin in people who have had heart attacks really works quite well. We know that taking statin therapy lowers cholesterol and that is very good in treating patients with heart disease. There are some interesting arguments about how low we should treat blood pressure. We have learned， for instance， that in diabetes where we thought blood pressure should be treated lower than others， it doesn’t need to be. There is no benefit. We are wondering about older people and exactly how much medication can they take and should they take. I think we are going to have more information about the treatment of high blood pressure. We have medicines that are inexpensive and that can do a good job and we can do an even better job as we get more information.

 

　　Smith教授：在我们的新指南中，我们确定肯定要进行推广的就是呼吁人们不要吸烟，如果已经吸烟则需戒烟。如果我们能够戒烟，则能有效预防卒中及心脏病发作。毫无疑问，我们需要积极在全世界范围内控烟。在控烟方面，我们已经取得了一些进展。例如，据我们所知，吸烟率已经下降的美国及其他国家，其心脏病发生率降低了17%~20%。此外，我们还知道，小剂量阿司匹林对既往有心脏病史的人们有非常好的效果；他汀治疗可降低胆固醇，对心脏病患者的治疗有益。目前，有关应将血压降至多低的水平还存在一些争议。例如，既往我们认为与一般人群相比，应将糖尿病患者的血压降得更低些，但是现在则认为并不需要如此，因为这样做并不能为患者带来获益。对老年人群而言，我们也亟需进一步确定究竟其能服用多大剂量的药物，其应该服用多大剂量的药物。我认为，我们正在不断了解更多高血压治疗的相关信息。我们拥有便宜的药物，这有助于我们很好地进行血压控制，随着我们获取更多高血压治疗相关信息，我们在高血压管理方面将会做得更好。