Joint prevention and control of heart disease and stroke: From clinical risk assessment to individualized health education

Heart Disease and Stroke. All types of heart disease are closely related to stroke; the risk of stroke in heart patients is more than twice that of those without heart disease. Atrial fibrillation is a very important risk factor for stroke. Evidence-based medical research has confirmed that effective treatment can prevent stroke. Patients with non-valvular atrial fibrillation have an annual stroke risk of 3%–5%, accounting for approximately 50% of thromboembolic strokes. The risk of stroke in patients with atrial fibrillation increases with age, with the annual incidence rate increasing from 1.5% in those aged 50–59 to 23.5% in those aged 80–89. Warfarin and aspirin have proven effective in treating atrial fibrillation and preventing stroke; warfarin treatment can reduce the relative risk of thromboembolic stroke by 68%.

Other types of heart disease, including dilated cardiomyopathy, valvular heart disease (such as mitral valve prolapse, endocarditis, and prosthetic valves), and congenital heart disease (such as patent foramen ovale and atrial septal defect), also increase the risk of thromboembolic stroke. About 0.8% of people who experience an acute myocardial infarction will develop a stroke shortly afterward, and approximately 10% will develop a stroke within 6 years. Recommendations: Adults (≥40 years old) should have regular physical examinations for early detection of heart disease. Patients diagnosed with heart disease should actively seek treatment from specialists. For patients with non-valvular atrial fibrillation, warfarin anticoagulation therapy can be used in hospitals with the necessary facilities, but the international normalized ratio (INR) must be monitored and controlled within the range of 2.0–3.0. For those over 75 years of age, the INR should ideally be between 1.6 and 2.5. Alternatively, aspirin 50–300 mg/day or other antiplatelet aggregation drugs can be taken. High-risk patients with coronary artery disease should choose to take low-dose aspirin 50–150 mg/day or other antiplatelet aggregation drugs.

Health education needs to be individualized and based on national guidelines. Health education for cardiovascular and cerebrovascular diseases is the most important aspect of prevention and control. Patients, their families, and the general public need to acquire disease prevention and health care knowledge, establish healthy concepts, and adopt healthy behaviors and lifestyles to achieve the goal of preventing disease or improving quality of life. For many years, health education has focused on general health principles, but lacks comprehensive interpretation and individualized guidance of relevant guidelines. There is inevitably a gap between popular science education and individual realities, and patients have limited application of the knowledge they receive. Therefore, individualized health education is a key focus for the future. Regarding the prevention and treatment of cardiovascular and cerebrovascular diseases, the content to be learned can be roughly summarized into three main aspects:

1. Understanding cardiovascular and cerebrovascular diseases and their preventability.

(1) The serious harm of cardiovascular and cerebrovascular diseases should raise sufficient awareness, prompting people to take proactive preventive and treatment measures to improve treatment effectiveness;

(2) The main risk factors and triggering factors for cardiovascular and cerebrovascular diseases, and how to prevent accidents;

(3) How to cope after a myocardial infarction or stroke. For example, the symptoms, the best time to seek medical attention, which hospital to choose, and how to cooperate with medical staff for treatment and rehabilitation training, etc.

2. Understanding diseases closely related to cardiovascular and cerebrovascular diseases: the "three highs" (hypertension, hyperlipidemia, and hyperglycemia). (1) Presence and control of hypertension, hyperglycemia, and hyperlipidemia: Especially for patients with hypertension and diabetes, blood pressure should be measured frequently to understand changes, the effects of medication or changes in medication, adverse drug reactions, and whether medication dosage needs adjustment. Middle-aged people and those under 35 years old with a family history of hypertension should also have their blood pressure measured every six months to one year. Once hypertension is diagnosed, non-pharmacological or pharmacological treatment should begin and be maintained consistently.

(2) Regular physical examinations: This is especially necessary for those over 40 years of age, generally once a year: cardiac function, especially for atrial fibrillation or ischemic changes; blood glucose and blood lipids should be measured, and active treatment should be initiated if abnormalities are found.

3. Change unhealthy lifestyle habits and establish healthy lifestyle habits.

(1) Healthy diet: Nutrition should be comprehensive and balanced, with low calories. The diet structure must be reasonable, with sufficient protein, fiber, vitamins, trace elements, minerals, vegetables, and fruits. Salt intake should be low (less than 6 grams per day), and sugar and fat intake should be low. Eat until you are 70% full.

(2) Moderate exercise: >30 minutes per day, >3-4 days per week. (3) Overcome bad habits: Quit smoking, prevent secondhand smoke, and limit alcohol consumption.

Individualized health education and guidance for patients. Health education should be based on national guidelines for the prevention and treatment of cardiovascular and cerebrovascular diseases, and individualized popular science interpretation and guidance are the ideal approach. Practice has proven that the most effective health education is individualized education and guidance provided to each patient by experienced and knowledgeable doctors based on relevant guidelines. However, due to various reasons, the vast majority of patients do not have the opportunity to receive such services. The reality we face is that the vast majority of patients are in a state of confusion or ignorance regarding their diseases; therefore, hundreds of millions of patients with cardiovascular and cerebrovascular diseases and their risk factors in my country currently lack treatment or appropriate treatment. In other words, individualized popular science health education for patients is the most important and most lacking key link, and is a problem that urgently needs to be solved.

To address the above problems, since the end of 2006, the Expert Committee on the Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of the China Association of Senior Professors has been researching and developing an integrated implementation system for the guidelines to improve the efficiency of doctor-patient communication and health education. The most prominent feature of health education based on this guideline implementation system is the realization of individualized popular science education. Popular science education is closely integrated with patient diagnosis and treatment, providing targeted popular science education based on national guidelines and addressing patients' actual problems. This makes it possible for health education to follow the guidelines, enabling individualized interpretation, education, and prevention guidance for the general population. Utilizing an integrated guideline implementation system, national guidelines are interpreted in an individualized manner, highly targeted and closely integrated with patient conditions. This increases communication between doctors and patients, reducing doctors' burden of popular science education while addressing patients' lack of knowledge about their own disease prevention. The information is easy to understand and helps inspire and improve public interest and understanding of modern prevention and treatment of hypertension, hyperlipidemia, and diabetes, enhancing patients' awareness of their diseases, their active participation, and their adherence to treatment.