编者按：近年来，随着肥胖、代谢综合征、糖尿病、高血压等慢病和吸烟、久坐不动生活方式的流行，美国动脉粥样硬化性心血管疾病（ASCVD）的患病率逐渐增加，医疗成本持续增加。ASCVD的管理重在危险因素控制，多学科心脏康复及风险降低项目是ASCVD预防管理的重要内容，故有必要进一步加强全面的多学科心脏康复与风险降低项目对ASCVD进行一级和二级预防。在第二十六届长城国际心脏病学会议现场，《国际循环》编辑部采访了巴西Paraná联邦大学医院心脏病学教授Mario Maranhao，请他阐述心脏康复和危险因素控制的现状。
International Circulation: What are the risk factors of silent cardiac disease?
心源性猝死的危险因素
Mario Maranhao: As you know， everybody knows cardiovascular diseases are the most prominent causes of death and disability in the old. In developing countries， there are no geographic appearances， no social， no race or no gender differences. This kind of disease is democratic disease which affects the rich and the poor. It is mostly because they are associated with the risk factors， then we can deal about this. But sudden death can be the first manifestation of the disease， and most patients inherit myocardial infarction， the most prevalent in North America， in Europe and south part of China and Brazil. But stroke is also very important in those countries; I know that the stroke is major cause of death and disability in northern China. But the first manifestation could be the sudden cardiac death. So， to prevent the often manifestation of cardiovascular disease， acute myocardial infarction or sudden death， we need to deal and cope with prevention to fighting the risk factors especially trying to modifying. There are additional risk factors associated with unhealthy life style. Poor diet， lack of exercise and smoking. The smoking in China is a big， big problem， especially men. 70% of men smoke and 2% of women smoke; but most of the women are passive smokers， because their husbands， their family members or their colleagues are smoking in all the places. So， it is a problem also for women. The traditional risk factor， about most Asian families are hypertension， diabetes， over weighted and poor nutrition; but you have also the non-traditional risk factors， regarding the radiation， pollution and especially psychosocial problems. We are now also over-stressed， all the people are very stressed and also with depression. The stress and depression contribute also for increasing of myocardial infarction， stroke. In case of myocardial disease， infarctions can double the possibility of SCD. It increases 4 times as infarction and new stroke if the pressures are not coped with. It is 4 times of sudden cardiac death the possibility of sudden cardiac disease.
对老年人来说，心血管疾病是致残和致死的首要因素。发展中国家的这种现象没有地域、种族、社会因素、性别以及贫富差异，大部分患者遗传心肌梗死，在北美、欧洲、中国南部以及巴西很常见。卒中是中国北方地区致死致残首因，也可能引发心源性猝死。因此，防控相关危险因素是关键。危险因素之一是不健康的生活方式，包括吸烟、饮食不均衡和缺乏运动。中国的吸烟问题严重，尤其是男性群体。吸烟者中，70%男性和2%女性发生卒中。对亚洲人群来说，传统的危险因素包括高血压、糖尿病、超重和营养不良，当然也有不常见危险因素，如辐射、污染和心理因素，焦虑和抑郁情绪会加重心肌梗死、卒中，进而使心源性猝死风险加倍。
International Circulation: What should we do regarding the life style changes?
生活方式改善尤为重要
M: I am proud to promote the life style and behavior modifications， in regard of manage the risk factors of this. If you only persuade the people and patients to manage their own health， they can live longer with the best quality of life. We will start with the children and adolescents， because they are promoted to propagate a better life style. They can discuss question with their elder brothers， sisters， parents or even with their colleagues at school. But we need also to govern and start to campaigns regarding hypertension， diabetes， lipid lowery campaigns; and also to fight effectively the start of tobacco smoking， because we must avoid the young people to start smoking. It is much better to persuade adolescents not to smoke or to quit smoking; quit smoking is always more difficult， so the campaign should directly to the young people. I also know that in china now the government is approve the new matches， in order to fight the smoking the most major cause of death and disabilities as other risk factors.
推进健康生活方式是管理危险因素的重要手段。从青少年和儿童做起，比教育成年患者改变现有生活方式更有效。当然临床需监控高血压、糖尿病和降脂管理，进行有效烟草控制，尤其是控制年轻人吸烟。目前中国已采取新的控烟措施，为防控致死致残相关危险因素做出了重要努力。
International Circulation: Besides academically， cardiac rehabilitation is a new and prominent manner to prevent and treat cardiovascular disease， it draws more and more attention. In your opinion， what are the main content of cardiac rehabilitation?
心脏康复是心血管健康管理的重要内容
M: The cardiac rehabilitation is health to keep the patient less suffered from myocardial ischemia， stroke and other kinds of cardiovascular diseases. Together with the medical team in order to follow medical recommendations and to stay with the medication， because in many times they abandon treatment， they think they are cured. So they back to their unhealthy life style. So about the cardiac rehabilitation， in order to be cost effective to reach clinical outcomes， we need teamwork. Not only with the doctors， because doctors are all very old and also busy， but to deal with the other， a life professional physiologist， nutritionists， physical therapies. It is social works to help the patient to deal with problems. The idea of cardiac rehabilitation is to have a compressive model， patient central to give the best possibilities in order to let patient get more information about their disease， and recognize the size of symptoms if the disease are abuse or have other manifestations; and also to help them with health and better life style to change their habbits.
对心肌缺血、卒中和其他心血管疾病患者来说，心脏康复是帮助患者减轻病痛、加强患者服药依从性的重要途径。很多患者认为自己已康复而自行停药，回到亚健康的生活状态。因此要增加心脏康复对临床预后的有效性，需医生、生理学家、营养学家和物理治疗师多方协作，共同改善患者生活习惯。