Roberto Ferrari      意大利Ferrara大学Anna医院心血管研究中心主任
    <International Circulation>: You are talking about coronary artery disease in young adults. What is the status of this patient group at the moment? How are they being managed?

  《国际循环》：您曾提到过年轻人的冠心病，那么目前年轻患者的现状如何？应该如何管理这些患者？

    Prof Ferrari: Coronary artery disease is the leading cause of death around the world. In the past we thought that this was typical of the civilized Western societies but we know today that it is a global disease independent of a nation’s development status. We do have a lot of ways to treat coronary artery disease and， in fact， we are very good at treating it， to the degree that cardiology has contributed seven years to the ten year increase in lifespan we have enjoyed in the last thirty years. But， despite this success， coronary artery disease and cardiovascular disease continue to be the leading cause of death. We have just delayed the problem， rather than solving it at all. It is something of an epidemic. An epidemic will be solved， not by drugs or intervention (because it would be impossible to provide intervention to everybody anyway) but by prevention. Epidemics are solved by changing the lifestyle of populations and that is what is really important. Changing lifestyles in low economic populations means providing fruit and vegetables where there are shortages or they are too expensive; and in higher economic populations， reducing the amounts and certain types of food being eaten. That is the global issue. In terms of treatment， we have the new guidelines that I have presented， in which we now understand that there is not just one doctor’s decision involved – obviously if you are a surgeon then you will opt for surgery， if you are an interventionist you would go for angioplasty and a cardiologist would give drugs – but logically a teamwork strategy and approach is required. However， I have to say， that we are very good at saying this but less impressive in applying it. We should work as a team but， in all honesty， we don’t.

    Ferrari教授:冠状动脉疾病是全世界主要的死亡原因。在过去，我们认为这是西方文明社会的象征，但今天我们发现，它是一个全球性的疾病，而同一个国家的发展状况无关。我们的确有许多治疗冠心病的方法，事实上我们也非常善于治疗这些疾病，在过去的三十年里我们将心血管疾病的生存率从7年提高到了10年这样的程度。但是尽管有这样的成绩，冠心病和心血管疾病仍然在全世界的主要的死亡原因。我们仅仅是延缓了这个问题，而并没有真正的解决它。这是个流行病学的问题，需要从流行病学角度解决，要通过预防而不是药物或者介入治疗（给每一个病人都提供介入治疗是不可能的）。最重要的是通过改变人们的生活方式来防止冠心病的流行，对于低收入经济群体提供短缺或价格较贵的蔬菜和水果，而对于较高的经济群体应减少食物数量和某些特定类型食物的摄入。这是全球性问题。在治疗方面，我们有新的指南，通过新指南我们认识到治疗决策不是一个医生所能决定的-显然，如果是外科医生会选择手术，介入医生则会选择血管成形术而心血管病专家则会选择药物-但是理论上需要的是团队的策略和方法。然而，我不得不说的是，虽然我们这样说的非常好，但是做的却不尽如人意。我们应团队协作，说实话，我们却没有。