The "Chinese Expert Consensus on the Clinical Application of Cholesterol-lowering Single Tablet Compound Preparations" was newly released
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In March 2024, the "Chinese Expert Consensus on the Clinical Application of Cholesterol-lowering Single Tablet Compound Preparation" was officially released, which is not only the first expert consensus on cholesterol-lowering single-tablet compound preparations in China, but also formulates a standardized and standardized blood lipid management path for atherosclerotic cardiovascular disease (ASCVD) risk groups and patients in mainland China on how to rationally use cholesterol-lowering single tablet compound preparation (SPC), and contributes to further improving the prevention and control system of dyslipidemia in mainland China.
Academician Ge Junbo of Zhongshan Hospital Affiliated to Fudan University
The management of dyslipidemia plays an important role in the prevention and control of ASCVD and even cardiovascular diseases, and in the face of complex disease populations, we need diversified lipid-lowering regimens to cope with this situation. Single-tablet compound lipid-lowering drugs are expected to bring new changes to the blood lipid management of ASCVD patients and high-risk groups in mainland China by simplifying the treatment regimen, improving the lipid-lowering effect, and improving the treatment compliance of patients.
Professor Zha Mingfan, Chief Physician of Nanjing First Hospital, at the 27th China Congress of Interventional Cardiology
Professor Zha Mingfan, chief physician of the Department of Cardiology of Nanjing First Hospital, was very pleased with the adoption of the "consensus". He said—
I have been using the treatment for almost 20 years and only today there is an expert consensus. I attended the first expert consensus meeting in 2011, and after 13 years of practical testing, I finally reached a consensus, which is gratifying in any case.
The lipid-lowering treatment rate and compliance rate of high-risk groups and patients with ASCVD in mainland China were at a low level. According to the Chinese Guidelines for the Management of Blood Lipids (2023), the treatment rate of lipid-lowering drugs is 14.5%, and the LDL-C compliance rate is only 6.8%, and in 2021, a follow-up study of 9,944 ASCVD patients published by Fuwai Hospital of the Chinese Academy of Medical Sciences showed that 26% of ASCVD patients in mainland China were ultra-high-risk patients, but only 13% of them met the LDl-C standard.
Analyzing the reasons for this, firstly, the reduction of LDL-C under single-agent statin therapy often fails to reach the >50% target recommended by the guidelines, so the main guidelines at home and abroad recommend the combination of drugs with different mechanisms of action for lipid-lowering therapy. Second, an increase in the number of medications can greatly reduce the patient's medication adherence. Single-tablet compound preparations are of great value for improving blood lipid compliance rate, improving treatment compliance and preventing cardiovascular adverse events, and more and more attention has been paid by clinicians for a simpler, safer and more effective dosing mode.
In order to standardize the application of single-tablet compound lipid-lowering drugs in China, led by Academician Ge Junbo, relying on the Cardiovascular Physician Branch of the Chinese Medical Doctor Association, and multidisciplinary experts in neurology, endocrinology and pharmacology, after several rounds of discussion and revision, the "Chinese Expert Consensus on the Clinical Application of Cholesterol-lowering Single-tablet Compound Preparations" was officially released, in order to promote the cholesterol-lowering treatment strategy in line with the mainland population and gradually improve the puzzle of the combined lipid-lowering program.
Because statins have a well-established 6% rule, doubling the dose of any statin increases lipid-lowering by only 6%, but the damage to liver function and muscles may be much greater than that. In terms of statin selection. Atorvastatin is not as lipid-lowering as rosuvastatin, and it is more damaging to liver function than it. Since Pfizer conducted clinical trials in the early days. So it entered the guidelines and entered the clinical first-line treatment. However, few people can achieve LDL below 1.4 with this drug alone, so it has become an important factor in restenosis after intervention.
For 20 years, I have been taking a combination of statin and ezetimibe. For all the post-interventional patients, I used a combination of drugs to control the LDL at about 1.4, and very few of them were implanted with stents again. In 2005, an 80-year-old artist. Multiple stents are implanted in our department. After nearly 20 years of follow-up, his LDL has been controlled at about 1.4, his body has been stable, and he called me to thank me when he was 98 years old last year.
In 1998, when I went to Washington, D.C., with Shen Weifeng, vice president of Shanghai Ruijin Hospital, and Professor Wang Jian'an of Zhejiang Sir Run Run Shaw Hospital (now Zhejiang Er, elected academician this year), to hold a TCT conference in Washington, D.C., the total number of stent surgeries in the country was only more than 3,000 cases, and in 1999, when Professor Huo Yong and Professor Fang Weiwei and I went to Paris, France to hold the second international intervention conference on PCR, there were only 4,000 cases in the country. Last year, there were 1.3 million cases nationwide, and this year there are about 1.8 million cases. I would like to use big data to analyze the LDL status of these patients. In particular, patients who underwent reinterventional surgery were grouped into subtypes with LDL attainment and final 1.4 or less. It's bound to be inspiring.
I have also had face-to-face communication with Professor Stone, former president of TCT, and Academician Han Yaling, who attended the CBS conference of our department. Professor Stone's comparison of coronary stents and bypass surgery after surgery was also a neutral result. However, if the post-interventional subtype analysis is performed again. That is, after surgery, according to the density lipoprotein level above and below 1.4 subtype analysis, the neutral result may be positive.
Professor Mingfan Zha (right) has participated in the National Interventional Cardiology Forum for many times
In 1998, when I went to Washington, D.C., with Shen Weifeng, vice president of Shanghai Ruijin Hospital, and Professor Wang Jian'an of Zhejiang Sir Run Run Shaw Hospital (now Zhejiang Er, elected academician this year), to hold a TCT conference in Washington, D.C., the total number of stent surgeries in China was only more than 3,000 cases, and in 1999, when Professor Huo Yong and Professor Fang Weiwei and I went to Paris, France to hold the second international intervention conference on PCR, there were only 4,000 cases in the country. Last year, there were 1.3 million cases nationwide, and this year there are about 1.8 million cases.
I would like to use big data to analyze the LDL status of these patients. In particular, it will be instructive to analyze the subtypes of patients who have reached the LDL target and the terminal 1.4 or less for patients who have undergone reinterventional surgery.
When I attended the Guangzhou meeting, I was interviewed by the TV platform of the National Health Commission, hoping that the leaders of the National Health Commission could hear the voice of the clinical frontline.
In terms of specific medication, Director Zha Mingfan believes that-
To achieve the best effect of lipid lowering, the first thing to do is to take the medicine. Secondly, we must pay attention to the effect of diet on blood lipids. Practice is the only criterion for testing truth. Now is the era of big data, and many hospitals have a large amount of data on interventional post-operative follow-up. Counting all postoperative patients with LDL 1.4 as the cut-off line, and counting the subcomponent types that reached less than 1.4 and those that did not, especially those with multiple restenosis, will definitely get useful inspiration from it.
In response to the question of "is it better to use rosuvastatin or atorvastatin", which is a common concern of patients, Director Cha believes that -
Rosuvastatin and atorvastatin are both third-generation statins, and the lipid-lowering effect of the former is greater than that of the latter, and the damage to liver function and muscles is less than that of the latter. But atorvastatin has less effect on kidney function than the former, which is its advantage.
Director Zha said——
Medication must be weighed against the pros and cons and selected according to individual differences. Both drugs can enter the guidelines and consensus formulated by experts, and only one should be recognized as one over the other, which harms the interests of patients. Second, we must pay attention to racial differences. The three major complications of high blood pressure are heart failure and kidney failure in the West, while stroke is more in China.
In addition, in terms of blood lipids, the proportion of abnormally high triglycerides in Chinese is significantly higher than that in the West, which is related to the eating habits of Chinese. Staple foods are not controlled. In particular, I like to eat too many carbohydrates such as grains, rice and noodles. Eating too much will inevitably increase triglycerides, and it will automatically convert into low-density lipoprotein, which will make dyslipidemia worse.
In the 21st century, the final battleground for cardiovascular disease is atrial fibrillation and heart failure. Therefore, it is necessary to strengthen the awareness of prevention as soon as possible, go to the doctor to treat the terminal disease, and prevent the problem before it happens. Learn to dynamically observe the changes in your echocardiogram indicators. This is because atrial fibrillation correlates with left atrial size, whereas heart failure correlates with left ventricular end-diastolic size.
Director Zha believes that heart expansion disease can also be cured with medicine.
Director Zha said that when I and Academician Ge Junbo went to Hangzhou for a meeting, the two sat together and chatted, Ge said that according to the guideline, heart expansion disease can not be cured by medicine, but he did cure a case, Professor Zhang of Shanghai Ruijin Hospital on the side interjected that she had cured 5 cases, and also did genetic testing, and the conclusion was that some genes of heart expansion disease can be cured with drugs. I said that I have been cured of dozens of cases, and many of them have been followed up for more than ten years. Ultrasonography of the heart was normal.
A senior high school girl in rural Wuhu, Anhui Province. Only a few months before the college entrance examination, he was diagnosed with dilated cardiomyopathy, and the left ventricular end-diastolic diameter and left ventricular ejection score were extremely abnormal. A heart transplant is recommended.
At that time, I seized the time and used medication within three months to make his heart disease better, took the college entrance examination that year, and was admitted to a second-degree accounting major in Hefei, and continued to intensify the treatment to restore the indicators of cardiac ultrasound to normal. Three years later, she came to me in the office again and said that she had been admitted to the graduate school of law at Nanjing Normal University. After graduating with a master's degree, he went to work in the provincial company of a large insurance company. It's been more than four years now.
The fastest-growing specialty in the medical field in China is cardiovascular medicine. In 1995, I went to Hong Kong with Academician Chen Haozhu, Academician Gao Runlin, Professor Hu Dayi and other experts to attend a symposium on myocardial infarction. In 1998, Professor Shen Weifeng, Academician Wang Jian'an and other experts and I went to Washington, D.C., to attend the 10th TCT Congress, the world's largest cardiac interventional conference. In 1999, Professor Huo Yong, Professor Fang Weiwei and other experts and I went to Paris, France to attend the world's second largest cardiac interventional PCR conference. Although the number of cardiac interventional cases in the mainland has only reached 3,000 or 4,000 per year in the past two years, the mortality rate of myocardial infarction has dropped to less than 5 percent, and then with the continuous improvement of interventional technology, the mortality rate has further decreased. Countless lives have been saved.
In 2007, the president of the American Heart Association, who gave a lecture at the Changfu Palace Hotel in Beijing, mentioned that cardiovascular disease in the United States has shown an inflection point in decline. The last PPT he used was the Yellow Emperor's Neijing in Chinese: the upper heal cures the disease, the Chinese medicine cures the disease, and the lower heals the sick. At that time, Academician Gao Jianlin, Professor Hu Dayi and other experts who attended the meeting decided that China should also catch up as soon as possible.
In the same year, a blood lipid conference was held at the Diaoyutai State Guesthouse in Beijing, and an enlarged meeting of the Cardiovascular Branch of the Chinese Medical Doctor Association was held in Zunyi, Guizhou. It also issued a declaration for cardiovascular physicians to quit smoking, advocating climbing the Red Army Mountain to strengthen their own exercise. Subsequently, at the 2nd World Chinese Cardiovascular Disease Conference held in Nanjing, it was proposed to use the advanced technology of the Chinese people in the world and eastern China to help the development of cardiovascular undertakings in the central and western regions.
Now, 17 years later, the technology of interventional cardiology has become more and more mature, and the national interventional academic conference presided over by Academician Ge Junbo and Professor Huo Yong has really opened from the eastern region of the motherland to the central and western regions, so that grassroots medical staff can communicate with domestic experts face-to-face. Technology has come a long way. However, as people's living conditions are getting better and better, dietary habits and structures are changing, blood lipids are obviously abnormal, blood pressure is not controlled, cigarettes are not lost for a long time, elevators are used for transportation, and physical exercise is becoming less and less. The total number of cardiovascular interventions nationwide increased from about 1.3 million the year before to about 1.8 million last year. Cardiovascular professionals are increasingly overloaded. All-round treatment is necessary in order to usher in the inflection point of cardiovascular disease in China as soon as possible.