《国际循环》：鉴于目前全球卒中负担情况，为实现2025年全球卒中战略控制目标，您认为发展中国家需要从哪些方面着手努力？

　　International Circulation: With regards to the global burden of stroke and WHO targets for 2025， in order to achieve those goals， which aspects require more efforts in developing countries?

　　Sacco教授：目前，我们有很大机会降低世界各地的非传染性疾病负担。如你所知，在联合国支持下，WHO已设立了2025年慢性非传染性疾病战略控制目标，希望到2025年能将慢性非传染性疾病（包括心血管疾病、卒中、糖尿病、肺癌及慢性肺病）所致过早死亡率降低25%，这一目标非常远大。比如，对中国而言，卒中是导致死亡的主要原因。本次大会上，我们发现距离实现该目标还有很长的路要走，需要多个国家积极行动起来，控制慢性非传染性疾病可纠正的心血管危险因素。此次会议上谈论的血压控制、饮食及控烟目标是每个国家及学会都应积极努力做到的，以使“25×25”目标成为现实。

　　Dr Sacco: There is a huge opportunity for us to reduce the burden of non-communicable diseases throughout the world. As you know， WHO with the backing of the United Nations has made non-communicable diseases a big target for the year 2025. The goal， by 2025， is to reduce the premature mortality rate due to non-communicable diseases (including cardiovascular disease， stroke， diabetes， lung cancer and chronic lung disease) by 25% by the year 2025. This is a big goal. And in China， clearly stroke， which is one of the leading causes of death， is part of this goal. At this meeting， we are showing that we are far from being able to reach that goal unless multiple countries start to make serious changes in the control of modifiable cardiovascular risk factors for non-communicable diseases. We are talking about the blood pressure targets， the diet targets and the smoking targets that are key voluntary targets that every country needs to work on in practice as well as within the society to make ’25 by 25’ a reality.

　　《国际循环》：近年来，卒中性别差异日益受到关注。充分认识卒中的性别差异及其相关原因，将有助于根据不同性别的卒中特点制定相应防控策略。请您简要概述近年来卒中性别差异的研究发现？

　　International Circulation: In recent years， gender differences for stroke are getting more and more attention. By fully recognizing gender differences and related causes will help to decide corresponding prevention and control strategies. Are you able to summarize the results of related studies from recent years?

　　Sacco教授：越来越多的研究表明，女性卒中患者数量多于男性。年轻人群中，与女性相比，男性卒中发病率更高；但女性卒中患者倾向于存活时间更长，故卒中所致残疾及死亡率更高。在美国，与男性相比，每年有更多女性因卒中致死或致残；中国可能也是如此。很多研究试图查明引起上述现象的原因。起初我们认为雌激素可能在其中发挥了一定作用，但近期研究显示，雌激素非但不能降低卒中风险，甚至可能增加风险。有研究显示，肥胖和糖尿病对卒中风险有重要影响，尤其在年轻人群中。因此，我们尚不清楚为何女性比男性卒中患者数量更多，但无论如何，我们都需尽可能积极控制心血管危险因素，比如高血压是主要的危险因素。

　　Dr Sacco: It is of concern that actually more and more studies have shown that women outnumber men in terms of stroke. At younger ages， stroke has a greater incidence in men compared to women， but women tend to live longer and they are actually outnumbering men with regard to disability and death from stroke. In the United States， more women die of stroke or are disabled by stroke each year than men. Perhaps that is true even in China. There have been studies that have wondered what the reasons for this are. We thought that maybe estrogens had a role but it has been shown that estrogens can’t reduce the risk of stroke and may even increase the risk of stroke. Obesity and diabetes have had an important impact on stroke risk， particularly in younger people. So it is not totally clear why we are seeing more women than men with stroke， but we need to do everything we can to get cardiovascular risk factors under control， including high blood pressure， which is the leading cause in the modifiable risk factors for stroke.

　　《国际循环》：本次年会上展示了北曼哈顿研究的大量最新发现，作为参与者，请您介绍一下该研究在卒中预防的血压控制、隐源性或心源性卒中等方面的最新发现有哪些？

　　International Circulation: There are a lot of new data from the Northern Manhattan Study presented at this meeting. As one of the investigators， could you talk about this， such as blood pressure control for stroke prevention， cardioembolic or cryptogenic stroke and so on?

　　Sacco教授：北曼哈顿研究开展已达23年之久，本次国际卒中大会上有很多该研究的最新摘要发布。其中一个涉及到高血压。近期，JNC8将不合并慢性肾病及糖尿病的≥60岁的患者起始降压治疗的血压值更改为≥150/90 mm Hg。为确定这一改变对卒中风险的影响，我们对北曼哈顿研究中接受了平均长达13年随访的1700例无慢性肾病或糖尿病的≥60岁受试者进行分析。结果发现，血压140~149 mm Hg者的卒中风险与血压≥150/90 mm Hg者一样高。因此，我们认为应坚持目前指南推荐的无慢性肾病或糖尿病患者的≥60岁人群的降压目标值<140/90 mm Hg。我们的研究发现，在上述人群中，血压140~149 mm Hg者的预后尤其卒中预后与血压≥150/90 mm Hg者一样差。我们需敦促人们重新认真思考指南的血压控制目标。此外，本次大会上我们还报告了一项最新研究进展，鉴于其尚未正式公布，不能透露太多。该研究关注V1导联P波终末电势。由于我不是心脏病学家，所以对该指标不太熟悉，但据我所知，我们可通过测量心电图上的P波深度来衡量。我们的研究发现，该指标可作为左房增大的预测指标，有望成为卒中尤其心源性栓塞性卒中及隐源性卒中的独立危险因素。

　　Dr Sacco: The Northern Manhattan Study is now in its twenty-third year and we have a few abstracts being shown at this International Stroke Conference. One deals with high blood pressure. Recently， JNC 8 changed the treatment threshold of blood pressure for people over the age of 60， without chronic kidney disease and without diabetes to more than 150/90 mm Hg. We wondered if that would have an impact on particularly stroke risk. So in the Northern Manhattan Study， we looked at 1700 people who did not have chronic kidney disease or diabetes and who were over age 60， and followed them for 13 years on average. Those who had blood pressure from 140-149 mmHg were just as high at risk as those with greater than 150. Hence we believe we should stick to the current guidelines which define normal blood pressure as 140/90 in those over age 60 without chronic kidney disease or diabetes. Our study shows that 140-149 is just as bad as greater than 150 and particularly for stroke. We urge people to really rethink the guidelines in terms of blood pressure levels. The second thing we are reporting is a late-breaker， so I can’t give too much away prior to the presentation here， concerning P-wave terminal electricity in V1. Not being a cardiologist， I am not fully familiar with this， but it is a force of velocity than can be measured on EKG in terms of the depth of the P-wave in terminal V1. We have found that this may be a predictor of left atrial enlargement and maybe an independent risk factor for stroke， particularly cardioembolic stroke and cryptogenic stroke.

　　《国际循环》：卒中住院患者管理中，如何最大限度预防卒中再发？

　　International Circulation: When talking about inpatient stroke care， how can we maximize stroke prevention?

　　Sacco教授：现在有采用注册登记收集数据、遵循指南开展的多个项目。其中“Get With The Guidelines - Stroke”是美国心脏协会（AHA）开展的一个大项目，不久也将在中国很多医院实施。该项目旨在监测卒中诊疗情况，其中大多数针对急性卒中开展。本次大会上，我们发布了实施了“Get With The Guidelines - Stroke”项目的佛罗里达州/波多黎各卒中登记中的一些卒中管理指标。结果发现卒中管理存在性别及种族/民族差异。我们实施这些项目旨在改善卒中管理，只有多加监测、追踪并不断完善临床实践中处理急性卒中或卒中预防的能力，才能做得更好。随时间推移，我们的注册登记中所有参加“Get With The Guidelines - Stroke”项目的医院将因遵循质量改进计划，其卒中管理与预防质量均得以改善。我们希望能通过此类注册登记坚持循证医学管理，从而不断消除卒中管理方面的性别、地域及种族/民族差异。

　　Dr Sacco: There are multiple large systems now that use registries to collect data and follow the guidelines. “Get With The Guidelines - Stroke” is a huge program in the United States from the American Heart Association and will soon be available in various hospitals in China as well. This is a way to try to monitor how well you are preforming with stroke performance. Most of “Get With The Guidelines – Stroke” is based on acute stroke performance measures. At this meeting， we are showing some of these metrics from our Florida/Puerto Rico stroke registry which uses “Get With The Guidelines”， and we find that there are some differences across gender as well as across race/ethnic groups. The goal of these programs is to improve care and the more that you monitor， track and benchmark your performance and how you are dealing with acute stroke or stroke prevention， the better you will become. Over time， all of the hospitals that are in these “Get With The Guidelines” programs and in our registry improve as they follow these quality performance programs. We hope to show that we can eliminate disparities across gender， regions and race/ethnic groups if following evidence-based care with these kinds of registry programs.