As a result of continuous economic growth in the past 22 years, the Chinese have found their lives improved but have become busier than ever before and face more challenges both at work and in daily life.

"It is important for patients with coronary heart disease (CHD) to take an early prevention, diagnosis and treatment because of the disease's upward trend in both the incidence rate and mortality rate," Professor Gao Runlin, a consultant to the chief staff at Fuwai Cardiovascular Hospital, said at a seminar held in Beijing on intervention treatment for coronary heart disease on Tuesday.

During the seminar, professor Gao encourage people to embrace a healthy diet and way of life while urging them to visit physicians for early diagnosis as well as early prevention and treatment.

He also expounded on new treatments and technologies that will enable patients to seamlessly return to work and everyday life after treatment.

Gao, a leading Chinese coronary heart disease expert, pointed out that the incidence of coronary afflictions has witnessed a steady increase over the years, while the age of incidence features a downward, younger trend.

According to national health statistics between 1988 and 1996, deaths from coronary heart disease in Chinese cities rose by an average of about 2 percent every year, reaching more than 80 per 100,000 people in 1996.

In contrast, the rate of increase in rural areas was only 1.5 percent a year.

"Coronary heart disease affects more people in North China and Northeast China, with its highest incidence in Beijing," said Gao, who is also an academic at the Chinese Academy of Engineering.

Diagnosis

The most common symptom of coronary afflictions is angina, which may occur during periods of physical activity.

Patients usually develop feelings of pressure, tightness, and intense squeezing, lasting from three to five minutes in the center of the chest. Pain may spread down the left arm, up into the neck, along the jaw line, or even extend to the back. Angina generally subsides quickly with rest.

However, a third of coronary heart disease cases may never develop any symptoms, and heart attacks may come suddenly without any prior warning.

"It makes the early diagnosis difficult," said Gao. "Currently, angiography is still the most reliable technique to diagnose heart diseases, and we call it a golden standard.

"Angiography is based on the image generated to detect the pathological change in the coronary artery, through the use of radiopaque dyes and real-time X-ray visualization," he said.

It is convenient to conduct angiographies, which incur less lesions and pains, and provide a basis for the choice of further schemes of treatment."

"However, for over 20 million coronary heart disease patients in China each year, only 70,000 to 80,000 of them receive angiographies."

Treatment

Only after the patients receive the angiography will a cardiologist be able to work out a treatment scheme according to their needs. These can include bypass grafting operations, intervention treatment, or simply prescribing medicine.

Coronary artery bypass grafting was once considered the standard treatment. The surgery grafts a mammary artery or a vein taken from the leg onto the damaged coronary artery, to circumvent a narrowed or blocked passage, finally improving the blood flow to the heart.

However, it has remained an open chest surgery and so it is inevitable for the patients to suffer from great trauma and prolonged recovery time.

In contrast, intervention treatment requires doctors to insert a catheter into the artery and carry out the treatment under the guidance of medical imaging techniques, like x-rays. In fact, coronary artery stenting is becoming more favorable for both patients and doctors.

In this procedure, a small balloon is inserted into an artery in the thigh via a catheter and is guided to the site of the arterial blockage.

The balloon is then inflated, compressing the plaque; this widens the passageway and improves blood flow. A stent contained in the balloon will support the arterial wall in case of any elastic contraction.

"At present, 50 to 60 percent of coronary heart disease treatments involve using stents, compared with only a third during the 1990s, and the percentage could be even higher with further research into the technique," Gao said.

But the new treatment is not without faults of its own. Among those who receive coronary artery stents each year, about 20 percent require repeat treatment for restenosis, also known as re-narrowing or re-blockage, a result from an overproduction of cells, similar to scar tissue, at the site of stent placement.

It is a major problem associated with the bare metal stents.

Gao suggested promoting the use of the Cypher Sirolimus-eluting Stent in China, among other possible measures.

He said that the stent was developed by the Cordis Corporation and approved to be sold in the Chinese market only last year. But it has shown a great deal of promise, as it has reduced the risk of restenosis to below 5 percent for patients receiving stent treatments.

Sirolimus, a cytostatic agent released from the tent, can inhibit smooth muscle cell proliferation without destroying cells, thus reducing blockages from coronary artery lesions.

However, the Cypher stent is about three times more costly than the traditional bare metal one, amounting to US$4,000 in the Chinese market, said Zhao Yiwei, manager of market department of Cordis Corporation in China.

"It costs 50,000 to 60,000 yuan(US$6,000 to 7,200) to insert a stent, and medical fees mainly go to equipment and drugs," said Gao. "Inserting one or two stents costs about as much as bypass grafting surgery, but can be much higher if three are inserted."

Healthy lifestyle

Despite all of the conveniences brought about by newly developed intervention techniques, people must maintain discipline when it comes to diet, Gao cautioned.

He suggested that people should have less food that is high in cholesterol, such as fatty meat, eggs, or the internal organs of animals, and should consume more vegetables and fish.

A good diet should be light. Drinking a moderate amount of red grape wine might be beneficial.

Also, people should give up smoking, exercise regularly, and maintain a positive mental balance.

All of these measures are important steps in preventing coronary heart disease, Gao said.

(China Daily July 11, 2003)