International Circulation: Given that Asian patients tend to suffer higher incidences strokes than other ethnic groups do you think that larger clinical trials should enroll more Asian patients?
《国际循环》：鉴于亚洲患者与其他种族相比往往会有较高的卒中发病率，你认为更大规模的临床试验应该招募更多的亚洲患者吗？
Prof Didier Leys: Yes， I think this is a very important point because Asians represent a very big percentage of the stroke patient population around the world. Furthermore， we know that the stroke sub-types are also different between Asians， Europeans and Africans as well as the safety of drugs between these respective populations. As a result you should not apply treatment procedures and characterisitcs uniform to all groups. For this reason I think it is important to enroll enough Asian patients in stroke prevention trials to see if there is robust evidence regarding differences in drug efficacy and safety. In this respect thrombolysis is different between Asians and white Caucasians， especially in Japan， where they use even if there is no concrete proof of thrombolysis a lower dose of TPA (Tissue Plasminogen Activator). In China I think you use the same standard doses as us Europeans， and I would like to point out that the level of evidence for a lower TPA dose is not very high.
Didier Leys教授：是的，我认为这是非常重要的一点，因为在全世界卒中患者人群中亚洲人所占的比例很大。此外，亚洲人、欧洲人和非洲人之间卒中亚型不同，且在这些单独的人群之间药物的安全性也不同。因此，我们不应该将治疗程序和统一特征应用于所有群体。出于以上原因，我认为在观察药物有效性和安全性差异是否存在有力证据的卒中预防试验中，招募足够多的亚洲患者是非常重要的。在这方面，亚洲人和白种人之间溶栓有所差异，尤其是在日本，即使缺乏明确的溶栓证据，他们也会使用较低剂量的TPA（组织纤溶酶原激活物）。而在中国，我认为中国医生应用了和我们欧洲人相同的标准剂量，我想要指出的是，较低TPA剂量的证据水平不是很高。
International Circulation: How can we encourage our patients to follow a lower sodium diet and reduce smoking， which are major health concerns in China?
《国际循环》：怎样才能鼓励我们的患者遵循低钠饮食并减少吸烟？这在中国是主要的健康问题。
Prof Didier Leys: As mentioned we believe lifestyle intervention is very important in reducing the worldwide burden of stroke incidence. Lifestlye intervention is not only effective， cheap but also carries a financial incentive to the patient concerned; for example if you stop smoking you are saving money by not buying cigarettes. Smoking is a very important risk factor for all types of atherosclerosis and it has been known that smokers are more prone to suffer from problems with brain function. Again it has been well documented that high sodium diets increase arterial hypertension; which is known as a silent killer because many patients do not know that they have this problem until problems arise and treatment is required.
Didier Leys教授：如上所述，我们认为，在降低卒中发生率这一全球负担上，生活方式干预是非常重要的。生活方式干预不仅效果好，成本低，且从患者角度来看，还带有经济激励；例如，如果停止吸烟，你就节约了开销。吸烟对所有动脉粥样硬化类型来说都是一个非常重要的危险因素，且已经知道吸烟者更易发生脑血管的问题。高钠饮食增加动脉高血压也已经得到明确证实；动脉高血压是一个众所周知的无声杀手，因为很多患者直到问题出现且需要治疗时还不知道自己存在这一问题。
International Circulation:Therefore， thorough education from top to bottom is essential if not the key in reducing stroke incidence?
《国际循环》： 因此，在降低卒中发生率上，逐级地深入教育是至关重要或者关键的？
Prof Didier Leys: I think education is key yes， In Europe it has been well known of the dangerous effects of second- hand smoke and with this it is forbidden to smoke in many public areas in Europe. The benefits can be seen quite dramitically;for example in Italy when they introduced this law around 5 years ago，within the first three months there was a dramitic reduction in the number of myocardial infarction events. In France when we introduced this law， one month after the Italian example we observed the exact same effect. This effect was certainly not seasonal and I suspect that if such measures were to be introduced in Asian countries a simaler effect will be observed.
Didier Leys教授：我认为教育是关键，在欧洲，二手烟的危害众所周知，鉴于此，欧洲很多公共场合都禁止吸烟。禁烟后可以看到很显著的益处；例如，在意大利，他们在约5年前引入了这一法律，在最初三个月内心肌梗死事件的数量急剧降低。在意大利施行该法律1个月后，法国也引入了这一条文并观察到了相同的效应。这种影响当然不是季节性的，我推测如果在亚洲国家中引入这些措施则将会观察到类似的效应。
International Circulation: For the future how will ESC increase its cooperation with the Chinese stroke societies?
《国际循环》：未来，ESC将如何加强与中国卒中协会的合作？
Prof Didier Leys: I think we can firstly increase our cooperation in the form of trials particularly prevention trials. China is very efficient and has a large population with a heavy stroke burden and so recruitment of patients for these trials can be done very quickly. Secondly， we should increase the number of educational teaching activities because in some domains China is better than Europe and vice-versa and with this we can learn from each other. For example some stroke disorders are much more common in China than in Europe such as Moyamoya disease. As a result， Chinese phycisians may have better experience in dealing with this problem and would be therefore better qualified to offer advice and recommendations to their European counterparts. The few Moyamoya disease cases I saw were from Asian patients livingin Europe. In Caucasians we do not have perfect Moyamoya disease we have Moyamoya syndrome caused by other factors. We have cooperated with China as well as Korea and Japan in terms of expanding our understanding of this disease by genetically analysing both Asian and Caucasian patients with Moyamoya disease. For Asian patients，we may have found a responsive agent which could be the source of Moyamoya disease.
Didier Leys教授：我认为，我们首先可以采用试验尤其是预防试验的形式来增加双方的合作。中国人口众多且卒中负担重，因此对这些试验而言，可以非常迅速地完成患者的招募。其次，我们应该增加教育性教学活动的数量，因为在某些领域，中国优于欧洲，反之亦然，鉴于这一点，我们可以相互学习。例如，某些卒中疾病在中国比在欧洲更为常见，如烟雾病。因此，中国医生在处理这个问题上可能有更好的经验，因而对其欧洲同行更有资格提供意见和建议。我所见过的几例烟雾病病例是来自生活在欧洲的亚裔患者。在白种人中，没有原发的烟雾病，而是由其他因素所致的烟雾综合征。在通过对患有烟雾病的亚洲和白种人患者进行基因分析来增强对这个疾病的认识方面，我们已经与中国以及韩国和日本进行了合作。对于欧洲的患者，没有什么特别的发现，但对于亚洲患者，我们可能已经找到了一个可能的烟雾病的致病原因。
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