Unraveling the mystery of the high incidence of myocardial infarction and stroke: Analyzing the complexity of prevention and treatment processes and cognitive biases between doctors and patients.

It has been found that while developing guidelines for the prevention and treatment of cardiovascular and cerebrovascular diseases is difficult, implementing these guidelines in clinical practice and health education is even more challenging. The medical community generally agrees that cardiovascular and cerebrovascular diseases are the most preventable, yet the least preventable, chronic non-communicable epidemics. Currently, the prevention and treatment of cardiovascular and cerebrovascular diseases and related conditions are very limited, far from achieving the ideal level of preventing 70%-80% of myocardial infarctions and strokes. There are many reasons for this situation.

Cardiovascular and cerebrovascular diseases fall under multiple disciplines, making it difficult for patients to receive comprehensive treatment. From a disciplinary perspective, cardiovascular and cerebrovascular diseases and their risk factors involve several disciplines. Specialists are busy with their daily work, focusing primarily on complex cases within their own specialties, leaving little energy to address numerous non-specialty issues such as unhealthy lifestyles, smoking, obesity, metabolic syndrome, hypertension, diabetes, and dyslipidemia. Therefore, patients often do not receive comprehensive prevention, treatment, education, and management. It has been proven that as cardiovascular and cerebrovascular risk factors accumulate or worsen, the risk of cardiovascular and cerebrovascular events increases exponentially. Because most patients with cardiovascular and cerebrovascular diseases or risk factors often have multiple risk factors, the prevention and treatment of these diseases requires a comprehensive system and proactive, all-round prevention and treatment measures.

Prevention and treatment work involves numerous guidelines, which are costly to promote, inefficient, and difficult to implement. There are more than 10 thematic guidelines for the prevention and treatment of cardiovascular and cerebrovascular diseases, belonging to different disciplines (cardiology, neurology, endocrinology, etc.), and these are constantly being updated. In fact, several guidelines are updated every year, making the training, mastery, and implementation of these guidelines by clinicians, especially general practitioners and primary care workers, quite difficult.

Risk factors are numerous and often hidden, with multiple levels and stratifications, making individualized assessment and treatment complex. Recent clinical studies have shown that the boundaries of "normal values" for blood pressure, blood sugar, blood lipids, and weight are blurred, and significant cardiovascular and cerebrovascular damage can occur even within the high-normal range. Furthermore, most patients with hypertension, hyperlipidemia, and diabetes are unaware of their abnormal indicators, placing them in a state of significantly increased risk for cardiovascular and cerebrovascular diseases. Guidelines related to cardiovascular and cerebrovascular diseases emphasize the classification and stratification of these diseases and their risk factors, and establish treatment goals, treatment, monitoring, education, and management plans based on risk stratification. This means that the treatment goals for cardiovascular and cerebrovascular diseases and risk factors (blood pressure, blood sugar, blood lipids, etc.) are a set of variables. This uncertainty makes it difficult for clinicians to develop standardized, individualized comprehensive prevention and treatment methods according to the guidelines, thus limiting the effectiveness of prevention and management. Even when doctors provide correct treatment, due to the lack of individualized interpretation of the guidelines and individualized education and guidance, patients often do not fully understand their condition and the importance of treatment, resulting in poor adherence.

Clinicians face a large number of patients daily. Conducting comprehensive risk factor analysis, comprehensive risk assessment of cardiovascular and cerebrovascular events, and analyzing and developing standardized, individualized treatment goals and core treatment plans for each patient according to the guidelines, as well as providing individualized health education and guidance, is a complex and meticulous task. This presents a considerable challenge in terms of clinicians' mastery of the relevant guidelines, as well as in terms of time, energy, and physical strength.

Patients often lack sufficient awareness of the severity of their diseases. Many people believe that declining health and illness are normal processes in middle age. However, the vast majority of patients are unaware that 70%-80% of myocardial infarctions and strokes are preventable or can have their onset significantly delayed. Early stages of cardiovascular and cerebrovascular diseases often present with no or mild symptoms. Many patients, lacking clinical symptoms, fail to realize they are at risk of cardiovascular disease, do not understand the importance of controlling risk factors and treatment, and even refuse prevention and treatment. Poor treatment adherence among most patients affects treatment efficacy because they are unaware of the current state of cardiovascular and cerebrovascular disease prevention and treatment, the significant advances in evidence-based medicine over the past decade, and the effectiveness of comprehensive prevention and management combined with modern drug therapy for cardiovascular and cerebrovascular diseases and their risk factors, with minimal side effects. Long-term treatment can significantly reduce the occurrence of cardiovascular and cerebrovascular accidents.