At present, cardiovascular disease (CVD) remains the leading cause of death among urban and rural residents in China, with 2 out of every 5 deaths due to CVD¹, and its morbidity and mortality are still increasing. The "Healthy China Action - Implementation Plan for the Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases (2023-2030)" jointly formulated by the National Health Commission and other departments puts forward a clear goal: by 2030, the mortality rate of cardiovascular and cerebrovascular diseases will be reduced to 190.7 per 100,000 and below², there is still a significant gap between this goal and the current reality, and the prevention and control work has a long way to go.
During the 2024 Annual Meeting of Laboratory Physicians of the Chinese Medical Doctor Association and the 18th National Conference on Laboratory and Clinical Laboratory (CCLM), Roche Diagnostics held a symposium on the theme of "Cardiac Marker Laboratory Testing Helps the High-quality Development of Disease Diagnosis and Treatment", and invited laboratory experts to share and discuss the key role of laboratory medicine in the prevention and control of CVD.
Figure: Symposium on "Cardiac Marker Laboratory Testing Helps the High-quality Development of Disease Diagnosis and Treatment".
Experts agreed that laboratory medicine is an important support platform for disease diagnosis and treatment, and it is also a bridge connecting basic medicine and clinical medicine, and the development of laboratory medicine is of great significance for improving medical quality, patient experience, hospital management, and clinical research. In the field of CVD, with the development and update of clinical research and evidence-based medicine, the value of cardiac marker detection has become increasingly prominent, and it plays a key role in the management of the whole course of the disease from early detection, diagnosis, treatment monitoring to follow-up, providing a solid foundation for the high-quality development of cardiovascular disease diagnosis and treatment.
The prevention and control threshold has been moved forward
Seize the "window period"
Everyone is affected by CVD, and the risk of CVD accumulates over the course of life due to a variety of factors. It is estimated that the number of CVD patients in mainland China is about 330 million, while there are about 245 million adult hypertension patients, about 129.8 million adult diabetes patients, and more than 400 million dyslipidemia people, and a huge number of potential risk groups¹.
As a chronic disease, CVD has an insidious pre-development. The onset of clinical symptoms is preceded by various transitional conditions, such as sub-health states or pre-disease states. If we can effectively seize the sub-health 'window period' before the onset of CVD, we can win an important opportunity to fight potential risks. Hypertension, diabetes mellitus, and dyslipidemia are the most important risk factors for CVD, and they are also the most important controllable and reversible metabolic risk factors. Regular, accurate laboratory testing for high-risk populations, early detection and intervention, can effectively curb the progression of the disease.
Elevated levels of the cardiac marker hs-cTn have been shown to predict future cardiovascular events in apparently healthy people³. In the general population, even a small increase in hs-cTn within the normal range can predict the long-term risk of CVD and mortality in asymptomatic individuals, and is recommended for cardiovascular risk stratification in the intermediate-risk general population with traditional cardiovascular risk stratification to predict cardiovascular events⁴.
As a key marker for the management of heart failure diseases, NT-proBNP has been unanimously recommended for early screening of high-risk groups of heart failure (such as hypertension, diabetes, obesity, alcohol history, etc.) by domestic and foreign guidelines. In patients with hypertension, the risk of death increases with elevated NT-proBNP levels⁵. NT-proBNP screening may increase life expectancy⁶ in patients over 60 years of age with heart failure, with or without type 2 diabetes.
In addition, hs-cTnT and NT-proBNP levels are highly correlated with the early stage of diabetes and the risk of heart failure in diabetic patients, and marker-based risk scores can identify individuals with abnormal blood glucose at high risk of heart failure and provide decision-making information for effective prevention interventions⁷.
Diagnose acute chest pain
Accurate detection is indispensable
Acute chest pain is one of the most common clinical symptoms, accounting for 20%~30%⁸ of the disease in the emergency department of tertiary hospitals, and has the characteristics of different clinical manifestations, rapid changes in the condition, great differences in risk, incomplete correlation between prognosis and pain severity, and strong dependence on treatment time⁹.
It is understood that there are more than 50 diseases that cause chest pain, and accurate diagnosis of high-risk chest pain patients is the first key link. As the first stop for the treatment of acute chest pain, the emergency department needs to be quickly evaluated, accurately identified and scientifically treated, so as to achieve efficient treatment and reasonable triage.
The Expert Consensus on the Detection of Cardiovascular Markers for Emergency Chest Pain suggests that in addition to conventional ECG, the detection of hs-cTn, D-dimer and NT-proBNP is recommended for the first emergency patients presenting with acute chest pain or dyspnea, so as to distinguish and diagnose patients, risk stratification, prognosis assessment and treatment decisions.
The Elecsys hs-cTnT 0/1h algorithm was able to reduce costs associated with serial blood sampling, ECG, imaging studies, and time spent investigating patients with suspected acute myocardial infarction (AMI) compared to standard care in the emergency department, reducing the length of stay in the emergency department by 33% and saving more than 38%¹⁰ in healthcare costs compared to standard care in the emergency department.
At present, China has issued a number of guidelines to recommend the use of hs-cTn testing in cardiovascular departments, emergency departments and other departments, however, according to rough statistics, the current domestic use rate of hs-cTn is only 31%¹¹, which has yet to be popularized.
Improve the prognosis of patients with heart failure
Close follow-up is key
As the "last battlefield" of CVD, heart failure has the characteristics of high morbidity, high mortality rate, and high rehospitalization rate, with about 1/8 patients readmitted to the hospital within 30 days, more than 1/3 patients readmitted within 6 months, and more than 1/2 patients dying within 5 years¹²⁻¹⁴. Post-discharge management of patients is the focus of improving the clinical outcomes of patients with heart failure, and patients still need to be monitored after their condition is stabilized, and the symptoms related to heart failure, volume load, and adverse effects of treatment are evaluated daily, and the treatment regimen is adjusted according to the etiology, triggers, and comorbidities of heart failure¹⁵. However, the current post-discharge follow-up appointment rate of patients with heart failure in mainland China is only 24.3%¹⁶, and there is a large gap between the current status of out-of-hospital management and the guideline recommendation.
Recently, the results of a multinational, open-label, randomized, prospective STRONG-HF study published in The Lancet showed that the relative risk of all-cause death or heart failure readmission at 6 months was reduced by 34%¹⁷ in the intensive treatment group (in hospitalized patients with heart failure who were scheduled to start GDMT early within 2 days prior to discharge, titrated to the maximum tolerated dose within 2 weeks of discharge, and closely monitored for follow-up with Elecsys NT-proBNP within 2 months of discharge) compared with usual care. Elecsys NT-proBNP has become a key indicator of whether patients with heart failure need to increase the dosage of the drug.
Experts at the meeting said that the high-quality development of laboratory medicine will help better serve people's health. The active application of the latest research evidence and accurate cardiac marker detection methods can help optimize the management of CVD patients. With the closer cooperation between clinical and clinical testing, the inflection point of CVD disease burden decline is expected to appear as soon as possible.
As a global leader in the field of in vitro diagnostics, Roche Diagnostics is committed to helping the high-quality development of China's medical and health industry with innovative diagnostic solutions with high medical value. In the field of cardiovascular diseases, it was the first to launch the NT-proBNP test in China in 2003, and in 2009, it introduced the first "high-sensitivity" reagent in China, hs-cTnT, and has continued to support the China Heart Failure Institute for many years, and has completed the construction of as many as 91 clinical pathways for CVD diseases, always leading the development and innovation of "heart" diagnosis. Based on this series of milestone breakthroughs, Roche Diagnostics has released a new brand of cardiac markers, "Centripetal Force of the Clan", promising to continue to deepen the field of cardiovascular diagnosis and treatment, promote cutting-edge research through continuous iteration of advanced technologies, and work together with various forces to build a "heart" line of defense, so as to inject a steady stream of power into the high-quality development of cardiovascular disease diagnosis and treatment in mainland China and benefit more Chinese patients.
Picture: "Centripetal Force of the Clan" brand launch ceremony
Bibliography:
1. Summary of China's Cardiovascular Health and Disease Report 2022 [J]. Chinese Journal of Circulation. 2023, 38(6): 583-612.
2. The website of the Central People's Government of the People's Republic of China, Healthy China Action - Implementation Plan for the Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases (2023-2030)
3.High sensitivity cardiac troponin concentration and risk of first ever cardiovascular outcomes in 154, 052 participants. J Am Co ll Cardiol , 2017, 70(5): 558 568
4. Chinese expert consensus on laboratory testing and clinical application of cardiac troponin [J]. Chin J Medical Journal,2021,101(37):2947-2961.
5.N terminal pro brain natriuretic peptide: a powerful predictor of mortality in hypertension. Hypertension. 2011 Apr; 57(4):702 9
6.Cost effectiveness of NT proBNP supported screening of chronic heart failure in patients with or without type 2 diabetes in Aust ria and Switzerland. J Med Econ. 2023 Jan Dec; 26(1):1287 1300.
7.Pandey, A. et al. J Am Coll Cardiol HF. 2021; 9(3):215-23.
8. Consensus Expert Group on Joint Detection of Cardiovascular Markers for Emergency Chest Pain, et al.Chinese Journal of Emergency Medicine,2022,31(4):448-458.
9. Chinese Society of Emergency Medicine, et al.Chinese Journal of Emergency Medicine,2019,28(4):413-420.
10.Ambavane A, et al. PLoS ONE 2017; 12:e0187662.
11. Chinese expert consensus on laboratory testing and clinical application of cardiac troponin [J]. Chin J Med ,2021,101(37):2947-2961
12.J Li, et al. P4153 30 Day readmission after hospitalization for heart failure in china , European Heart Journal, Volume 40, Issue Supplement_1, October 2019, ehz745.0725
13.Predicting Six Month Re Admission Risk in Heart Failure Patients Using Multiple Machine Learning Methods: A Study Based on the Chinese Heart Failure Population Database. J Clin Med. 2023 Jan 21; 12(3):870
14.Long term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart fail ure in Beijing: a multicenter cohort study with a 5 year follow up[J]. Chin Med J (Engl), 2021, 134(15):1803-1811.
15. Guidelines for the diagnosis and treatment of heart failure in China 2024[J]. Chinese Journal of Cardiovascular Diseases, 2024, 52(3): 235 -275.
16. Work Report of China Heart Failure Center (2021) - Current status of diagnosis and treatment of patients with heart failure
17.Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up‑titration of guideline‑directed medical therapies for acute heart failure (STRONG‑HF): a multinational, open‑label, randomised, trial [J]. Lancet, 2022, 400 (10367): 1938‑1952. DOI: 10.1016/S0140‑6736(22)02076‑1.