ChinaHeartsurvey--CallforActionDayiHuPeople’sHospitalofPekingUniversity2021-4-11ThePrimaryCauseofDeath:Cardio-CerebralVascularDiseasesStroke10%5.5mCAD13%7.2mCancer12%7.1mTrauma9%5.2mInfection7%2.8mOther27%15.6mAIDS5%2.8mMalaria2%1.2mDiarrhea3%1.8mPerinatalfactors4%2.5mCOPD5%2.7mWorldHealthOrganization.AtlasofHeartDiseaseandStroke.20052MajorRiskFactorsforCAD:Hypertension,Hyperlipidemia,Hyperglycemia3Althoughtheemergenceofnewdrugsandthereleaseofmanyevidence-basedresearchoutcomesrecently,arethemortalityofcardio-cerebralvasculareventsfullyreduced?Althoughtheuseofinterventiontherapyanddrugsdramaticallyincreased,themortalityofcardio-cerebralvasculardiseasesisstillgoingupSource：Deathandriskfactors,epidemiology,trendanddistributioninChinese.PekingUnionMedicalCollegePress.Sep.2005.StandardMortality（1/10thousand）Mortalitytrendofcardio-cerebralvasculardiseaseinChinesebetween1985and2005CADCerebralvasculardisease5Cause：“Thetherapyisseparated〞6Cause：

Hyperglycemia—aneglectedriskfactorofCVDCVDRiskfactorFamilyFatnessSexDyslipidemiaHypertensionAgeHyperglycemiaSmoke7ChinaHeartSurvey:ContentBackgroundDiabetesisasdangerousasCADPatientswithCADareatthehighriskforhyperglycemiaDesignResultMeaning8DiabetesisasdangerousasCADHaffnerSMetal.NEnglJMed.1998;339:229-234.Events/100person-yrIncidenceofcardiovasculardiseaseduringseven-yearfollow-up(%)n=6918.8Nondiabeticsubjects\withoutpriorMINondiabeticsubjects\withpriorMIDiabeticsubjects\withoutpriorMIDiabeticsubjects\withpriorMIn=1304n=169n=8903.00.57.83.23.545.020.2P<0.001P<0.001MIDMDM&MI010203040509

AmericanHeartAssociation：

Diabetesiscardiovasculardisease

StevenHaffner：

ConcerneachdiabeticpatientasimportantaspatientswithMICirculation.1999;100:1134-46.10EHS〔EUROHeartSurvey〕ESCreportinSep.2004：Thesurveyinvolved110centresin25countriesrecruiting4961patientswithCAD2107wereadmittedonanacutebasisand2854hadanelectiveconsultation.Atenrolment,1524ofthesepatientswasknowntohavetype2diabetes,aFPGwasmeasuredintheremainingpatients,andanOGTTin1920ofthesepatients.TheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(2004)25,1880–189011EuroHeartSurvey:classificationofglucometabolicstate〔n=4,961〕Acute

Elective29%22%31%3%15%34%22%30%4%10%NGTIFG〔6.1mmol/L〕IGTDiagnosedDMNewlydiagnosedDMTheEuroHeartSurveyondiabetesandtheheart，EuropeanHeartJournal(2004)25,1880–189012EuroHeartSurvey:themythWhatistheepidemicabouthyperglycemiainChinesepatientswithCAD?Isthestrategyforhyperglycemiadiagnosissuitabletosuchpatients?13ChinaHeartSurvey:contentBackgroundDiabetesisasdangerousasCADPatientswithCADareatthehighriskforhyperglycemiaDesignResultMeaning14ChinaHeartSurvey:designSubjects52hospitalsin7citiesinChinaparticipatedinthesurveyTimeFromJun.1sttoAug.31th20053513patientshospitalizedforCADwasrecruited

InclusioncriteriaCoronaryheartdiseaseChronicStableAnginaHealedmyocardialinfractionAcutecoronarysyndromeArrhythmiaandheartfailurewasexcluded15MethodOGTTwasmeasuredinallpatients,exceptforthepatientswithknowndiabetesOGTTwasunnecessaryforthepatientswhoseFPG>8mmol/Lintwotesting16ChinaHeartSurvey:flowchartPreviouslyknowndiabetesNewlydiagnoseddiabetes〔FPG〕Newlydiagnoseddiabetes〔FPG〕773OGTT420Previouslyknowndiabetes411,234Acuteadmission2,279Electiveadmission3,513random3,687screened733561,490

OGTTDa-YiHu,etal.EuropeanHeartJournal2006;27:2573-2579.17ChinaHeartSurvey:contentBackgroundDiabetesisasdangerousasCADPatientswithCADareatthehighriskforhyperglycemiaDesignResultMeaning18ChinaHeartSurvey：

77%ofpatientswithCADhadhyperglycemiaKnowndiabetesNewlydiagnoseddiabetes(FPG)NormalglucosePrediabetesNewlydiagnoseddiabetes(OGTT)33%3%23%24%17%n=3,51319WithouttheuseofOGTT,over80%ofnewlydiagnoseddiabetesandpre-diabeteswillremainundiagnosedNormalIFGIGTType2diabetes人群比例(%)OGTTOGTTFPGFPGAcuteSelective020406080100Percentage(%)missedmissed20ConclusionIntheenrolledpatients(n=3,513),thepercentageofhyperglycemia(includeddiabetesandpre-diabetes)wasabout80%Theprevalenceofdiabeteswas52.92%(n=1,859)，ofwhich20.1%〔n=706〕wasnewlydiagnoseddiabetesTheprevalenceofpre-diabeteswas26.38%〔n=927),allwasnewlydiagnosedexceptedonepatient21IfFPGwasmeasuredalone,withouttheuseofOGTT80%of609newlydiagnoseddiabeticpatientswillremainundiagnosed70％

of926newlydiagnosedpre-diabeticpatientswillremainundiagnosed

75％ofnewlydiagnoseddiabeticandpre-diabeticpatientswillremainundiagnosedifFPGismeasuredalone.Conclusion22ChinaHeartSurvey:contentBackgroundDiabetesisasdangerousasCADPatientswithCADareatthehighriskforhyperglycemiaDesignResultMeaning23ChinaHeartSurvey:meaningCHSsoundthealertforourcardiologists,neurologistsandcardio-vascularsurgeons,indicatingthatweshouldconcernwhetherdysglycaemiaexistintheadmittedpatients.Asfarasdysgl