<International Circulation>: You mentioned that height has something to do with that dysfunction and in fact Chinese women are more susceptible. Do you know why?
　　Prof. Duprez: There are two reasons. Of course， height is a major determinant because we know that shorter men and shorter women have much more wave reflection. If there is more fibrosis， it means the wave reflections will come even earlier during systole which will have a major impact on left ventricular function. On top of that， for the Chinese， it is not only height. When they enter menopause， there is no longer that protective effect of estrogen. We must not forget that despite the anatomical differences in wave reflection， the natural female estrogen hormones have a beneficial effect on endothelial function. As women approach menopause， there is an imbalance in testosterone versus estrogen and as a consequence there will be a decrease of endothelial function， a decrease in the release of nitric oxide and that is part of the active component I mentioned， the vascular smooth muscle tone， endothelial function and autonomic nervous system.

　　《国际循环》：您提到身高与舒张期功能障碍有关。事实上中国女性更容易发生舒张期功能障碍。原因是什么？
　　Duprez教授：原因有两个。当然，身高是主要的决定因素。因为我们知道身高低的男性和女性有更多的脉搏波反射。如果纤维化严重的话，这意味着脉搏波在收缩期反射回来的更早，这会对左室功能有大的影响。除此之外，对于中国女性来讲不仅仅是身高的问题。当女性进入绝经期，就没有雌激素的保护作用了。我们不该忘记，尽管在脉搏波反射上存在解剖学的差异，女性天然具有的雌激素对内皮功能具有保护作用。在女性接近绝经期时，睾酮与雌激素失衡，因此会出现内皮功能的下降，此时释放一氧化氮减少，这就是我之前提到的动态成分的一部分，即血管平滑肌张力、内皮功能和自主神经系统。
　　<International Circulation>: That explains women in general but you mentioned that Chinese women in particular have arterial stiffness. Why are Chinese women more at risk? Is it a height issue or a genetic issue?
　　Prof. Duprez: It has to do with height without any doubt. We published that in 2009. These were American-Chinese women but the height in both continents is the same. Regarding the genetics issue， you will see in the Chinese population that they are less prone to calcification I would say. There is an urgent need regarding the diagnosis of cardiovascular disease and its treatment to stratify the function of ethnicity. On the other hand， the risk factors are also different because the Asian population in general， not just the Chinese， are more susceptible to imbalances of high triglycerides and low HDL. We should not forget that more than fifty years ago， the mean cholesterol level of a Chinese person was 120mg/dl. I would even broaden it further and say everything that we have done so far in cardiovascular diagnosis and therapy was often derived from the Framingham Study where all of the participants were descended from British Caucasian origins. A cholesterol level of 120mg/dl in a Caucasian we would call abnormally low considering the cut-off level is 200mg/dl. For the Chinese people to go from 120mg/dl to 200mg/dl， an increase of 40%， their vessels have never been exposed to such high levels of lipids.

　　《国际循环》：这从总体上解释了女性的情况。但是您提到中国女性尤其容易发生动脉僵硬度增加。为什么中国女性的风险较高？是体重还是遗传因素所引起的？
　　Duprez教授：毫无疑问，这跟身高有关。我们在2009年发表了相关研究结果。该研究纳入了美国女性和中国女性，但是两个国家的身高是相同的。至于遗传学问题，中国人群不容易发生血管钙化。我们迫切需要就心血管疾病的诊断和治疗对不同种族人群的功能进行分层。另一方面，不同种族人群的心血管危险因素也是不同的。因为亚洲人群，不仅仅是中国，更容易发生高甘油三酯和低HDL这一不平衡的现象。我们不应当忘记50多年前，中国人的平均胆固醇水平为120 mg/dl。我甚至想更近一步的说，迄今为止我们在心血管疾病诊断和治疗上所做的事情通常是来自于弗雷明汉研究，该研究的所有受试者都是英国高加索人群的后代。考虑到划界值是200 mg/dl，高加索人胆固醇水平为120 mg/dl会被视为异常的低。对于中国人群来讲，如果胆固醇水平从120 mg/dl升高到200 mg/dl的话，即升高40%，中国人的血管从来没有暴露于这么高的血脂水平。
 

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