The first line of defense: prevention of disease There is an old Chinese saying that “prevention is better than cure”, and the Chinese “Yellow Emperor’s Classic of Internal Medicine” stated thousands of years ago that “the top doctor treats diseases before they occur”. What does it mean to prevent and cure diseases before they happen? This is primary prevention, that is, to prevent diseases before they occur, that is, to control multiple risk factors at the source, that is, to shift the focus of disease prevention and treatment from “downstream” to “upstream”, which is a very important medical paradigm shift. How to do primary prevention? In the past, multiple risk factors were attacked and guarded separately, often with half the effort, because few people have only one risk factor, but often smoking, hypertension, dyslipidemia, diabetes, obesity, resting lifestyle and other risk factors coexist. Horizontally, cardiology and others should be closely integrated to jointly manage and control the above multiple risk factors in a comprehensive manner. Vertically specialists should focus on community interventions, join with general practitioners for prevention, and strengthen the continuing education of our community doctors, which is a collection of multiple medical functions of scientific research DD in-hospital treatment – in-hospital emergency DD pre-hospital emergency (social, community). Forming a broad alliance and building a comprehensive line of defense must start with primary prevention. For example, in high-risk hypertensive patients (20%), blood pressure cannot be controlled by diet and exercise alone, but must be intervened with drugs, and special emphasis should be placed on gentle and moderate exercise; in moderate-risk hypertensive patients (10%), lifestyle changes such as rational diet and aerobic metabolic exercise, and the “mouth” of exercise can be opened wider; 5% are Low-risk, i.e., very mild hypertensive patients, can be adjusted by exercise, control of risk factors, etc. for 6 months to see what happens later. It is important to analyze what the risk factors are for each social individual and estimate their risk level of myocardial infarction or stroke in the next 10 years. If diabetes is combined with hyperlipidemia, these two risk factors are often incompatible and must be treated with medication and must be accompanied by effective changes in poor lifestyle. For patients with mild hypertension without diabetes mellitus can be treated by lifestyle changes and salt restriction for 6 months before deciding whether to take medication. A special reminder here is that diabetes is equal to the risk of coronary heart disease myocardial infarction (called equivocal) in terms of the intensity of intervention for dyslipidemia, which must not be ignored. The most basic measure for primary prevention is to change unhealthy lifestyles. WHO announced the theme of World Heart Day 2002 as “A Heart for Life”, encouraging the public to increase physical activity, promote aerobic exercise (walking, running, rope skipping, cycling, roller skating, ball games, etc.), promote healthy diet and quit smoking, especially recommend jumping rope as an easy way of aerobic metabolic exercise worldwide. There are three focuses of primary prevention: intervention for blood glucose, intervention for blood pressure, and intervention for blood lipids. For blood glucose intervention, endocrinologists call for early identification and diagnosis of the metabolic syndrome even in non-diabetic patients. These patients should receive strong behavioral interventions, lifestyle changes, and more intensive treatment for lowering blood pressure and lipids. For blood pressure interventions, hypertensive patients should have their blood pressure controlled below 140/90 mm Hg, but the most effective control is currently 27% in the United States and only 6% in the United Kingdom, with even worse control of systolic blood pressure, which has greater prognostic significance. Interventions for dyslipidemia are the top priority for primary prevention and are the thread that runs through all five lines of defense. The second line of defense: prevention of events The basis for serious events such as myocardial infarction and stroke is “unstable plaque” and the varying degrees of thrombosis that result from its rupture. For patients with stable plaque (see stable angina), event prevention is to ensure that the plaque remains stable and does not develop in an unstable direction, while for unstable plaque (see unstable angina or acute myocardial infarction), it is to promote its transformation to stability and prevent the occurrence of heart attack and stroke. The core of event prevention is two “preventions”, the first is to build a lipid regulation (statin drugs) defense, which will make the original stable more stable, the original unstable to stable transformation. In addition to the lipid-lowering effect, statins may have an additional role in plaque stabilization, that is, through the improvement of vascular endothelial function, anti-inflammatory effect and antithrombotic effect to promote plaque stability. The second is antithrombotic, the cheapest and most effective century-old drug aspirin, preventive dosage 75mg to 80mg once a day, taken at night before bedtime. The third line of defense: prevent the consequences Here I want to send you a warning “have chest pain to the hospital”. The most common manifestation of coronary heart disease is chest pain, and more than half of the acute heart attacks have no aura, but sudden onset of chest tightness and chest pain. From thrombosis to necrosis of myocardial tissue supplied by blood vessels is 1 hour in animal studies and 6D12 hours at the latest in humans. Therefore, the most important concept of our cardiologists is “one hour of life”, which is often referred to as the time window DDD, the golden time for resuscitation. If the time window is not seized, the patient will pay the price of disability and death. We require to open the “criminal” blood vessel that causes infarction as soon as possible within the shortest time, thrombolysis is required within half an hour after arrival at the hospital, PTCA is required within 60D90 minutes after arrival at the hospital, if thrombolysis and PTCA can be completed within one hour of the onset of the disease, even with the most advanced examination technology, no trace of infarction can be detected. The drugs used for resuscitation (e.g. The cost of the drugs (thrombolytics) or devices (e.g.) used for resuscitation is fixed, and the earlier the treatment, the more myocardium is saved and the more lives are saved. Now general hospitals have established a green channel for cardiovascular disease rescue, with cardiologists around the clock, the key to the catheterization laboratory directly in the hands of the patient’s family to explain the lethality and curability of acute heart attack, explain the cost, no pre-charges, first to save lives, and then pay the cost, because the acute heart attack patients “life is 1 hour “, there are too many intermediate links, and life is gone. “Have chest pain on the hospital”, this slogan marks the popularity of the concept of pre-hospital emergency. At present, there are three misconceptions among a considerable number of people: one is to ignore the emergency signal of heart attack DD chest pain. Because heart attacks often occur in the latter part of the night to early morning, patients often wait for dawn because they do not want to wake up their relatives and miss a good opportunity. Secondly, there has been no disease, no chest pain, sudden onset of chest pain, thought it was a stomach ache, hold on to pass, this hold on the life of the hold up lost. Third, when the heart attack occurs in the daytime, the patient also went to the infirmary, the primary medical unit is concerned about the risk of referral is not transferred to a large hospital with resuscitation conditions, so that the valuable “window of time” finally closed. Therefore, when you go to the hospital with chest pain, you should not go to the infirmary, but call the emergency system as soon as possible and go to a large hospital with resuscitation conditions. The fourth line of defense: secondary prevention of recurrence For survivors of myocardial infarction or stroke who have been saved, the most important thing is secondary prevention of DD to prevent recurrence. This is an extremely high risk group for recurrence of serious cardiovascular events. Primary prevention is to prevent the disease when it is not present, and secondary prevention is to prevent a second recurrence after the disease has already occurred. There is abundant evidence from clinical trials that the A, B, C, D, and E lines of secondary prevention are of great importance. A: 1, Aspilin (aspirin); 2, ACE inhibitors (angiotensin converting enzyme inhibitors) B: 1, BDblocker (BD receptor blockers); 2, Blood pressure control (control blood pressure) C: 1, Cholesterol Lowing (cholesterol lowering); 2, Cigarette quitting (quit smoking) D: 1, Diaetes control (control diabetes); 2, Diet (reasonable diet) E: 1, Exercise (exercise); 2, Education (patient education). Fifth line of defense: prevention and control of heart failure The success of early intervention has led to the survival of more and more patients with myocardial infarction and stroke. As mentioned earlier, chronic heart failure is a common destination for survivors from infarction after 10 to 15 years, as it has become the heaviest medical burden worldwide due to its poor prognosis and enormous costs. There are many new therapies for chronic heart failure, and drugs are relatively inexpensive while hospitalization costs are high, and hospitals are reluctant to admit and patients are reluctant to stay because of the relatively long and bed-pressing course of chronic heart failure disease. We advocate to manage patients outside the hospital and in the community, and to cultivate a heart failure treatment management team with Chinese characteristics as soon as possible. The dose of chronic heart failure medication must be adjusted gradually, and a relatively fixed doctor is responsible for the individualized systemic treatment process. The model we envision is to set up a heart failure clinic in a large hospital, build a medical record for each patient, form a network with the community’s electronic medical records, and set up a home hospital bed to monitor each patient’s condition, so that the cost of treatment and hospitalization can be controlled to the lowest consumption level. This model of family ward is well done in many developed countries, such as Denmark, where there were many hospitals in the early days, then there were more nursing homes, then there were fewer hospitals and nursing homes, and patients, especially some chronic and serious patients, returned to society and families. This is a system project.