<International Circulation>:  We know that one of the goal of ACC is to turn cardiovascular knowledge into practice， my question is what the next programme of improving cardiocascular care and practice is?

《国际循环》：我们知道，ACC的目标之一是将心血管知识转化为实践，我的问题是：下一步改善心血管保健和实践的计划是什么？

Dr. Steven Nissen: You know the college is now involved in a large number of activities aroud， putting what they call quality first. I think that the center piece of those programs are a series of new registriesm， they are designed to collect data prospectively on processes of care to learn what is the optimal approach to take care of the cardiovascular patient. Another major intiative that was lauched at this meeting is something called Cardiosmart. Cardiosmart is a site with information for patients. The American College of Cardiology has never had a patient education program before and many of us are very excited that it will have very objective information for patients about their diseases. And then of course at the meeting the clinical trials results in presentations are the most important part of the meeting， the best attended. And this year they were attended better than I think I have ever seen on any clinical trial sessions in the history of the College. The ENHANCE tiral on Sunday generated a tremendous interest has been awaited for a long time. Dr. Castline presented the results which showed that there was no improvement in the rate of progression of carotid atherosclerosis and the patients that got ezetimibe added on to simvastatin. A four person panel reported on conclusions about what the trial means. And the spokesperson for the panel was Dr. Harlon Kromholds who is one of the most repected cardiologist in the country from Yale University. And he said that statins should be the first line drug used for treating hyperlipidemia. And that a use of ezetimibe should be reserved for those patients who don’t tolerate statins or who don’t get to goal on maximum does of statins. The session was obviously very intense， widely covered in the media and I think that it will be one that we will be talking about for many years to come. 

Steven Nissen博士：你知道，美国心脏病学会参与了本次大会的多个活动，强调将医疗质量放在首位。我认为，那些项目的主要部分就是一系列新开展的登记研究，设计这些研究旨在前瞻性地收集医疗诊治的数据，以便观察诊治心血管疾病患者的最佳手段。另一个重要目的就是在大会上发布Cardiosmart。Cardiosmart是有关患者信息的网站。之前，美国心脏病学会从未开展过患者健康教育项目。Cardiosmart网站上有关于心血管疾病患者非常客观的信息，我们非常高兴。当然，临床试验结果的议题是本次大会最重要的内容，也是与会者人数最多的部分。今年的参会人数比美国心脏病学会历史上的任何一届临床会议的人数都要多。周日的ENHANCE研究是我们期待以久的，其结果也引起了极大兴趣。Castline博士报告的试验结果显示，患者联用伊替米贝和辛伐他汀时颈内动脉粥样硬化的进展速度没有改善。由四人组成的专家组报道了ENHANCE研究的结论。该专家组的发言人是Harlon Komenhold博士，他来自耶鲁大学，是美国最富盛名的心脏病学家。Harlon Komenhold博士指出，他汀类药物应当作为高脂血症的一线治疗药物。只有对不能耐受他汀类药物或者是给予最大剂量他汀类药物后血压不达标的患者，才给予伊替米贝。显然，本次大会得到了媒体的广泛关注和报道。我认为，在未来几年内本次大会仍将是被谈论的话题。

 <International Circulation>: With the dramatic changes in the health care environment， particularly changes in technology， health care legislation， increased accountability to payers and patients， pressures in practice， we doctors need to improve more than the medical skill.what is your suggestions to the colleagues of other countries?

《国际循环》：随着卫生保健环境的巨大变化，特别是在技术、卫生保健立法、患者和保险部门均逐渐增加的义务以及行医实践的压力等方面的变化。我们医生需要提高的不仅仅是医疗技术。您对其他国家的同道有何建议?

Dr. Steven Nissen：I think all countries have this challenge， although we have the challenge in the US much more worse than other places do. The opening lecture， the lecture by Dr. Borwick， I thought that was exdrodinary. It points out that in America we spend twice as much on healthcare as other countries with advanced healthcare systems including of course China. But we don’t necessarily get a lot of value for that extra expenditure. We tend to throw technology at the problem. We tend to use devices and drugs more aggressively than other countries but not necessarily producing benefits that can be measured. So I think what I have learned to do in the US is to use technology more wisely and to do a better job with preventive care. And those sorts of things will prevent disease rather than spending a lot of money treating the end stage of the disease. Those are the challenges that we face. And I think that as China grows and industrializes and their economy which is growing at a very rapid rate， China will also face the pressure of increasing healthcare cost. Of course the difference is that you have got to deliver healthcare to more than one billion people. And that’s a very big challenge.  I agree with you and I have said many times that physicians need to be a part of the solution and that means that we have to participate in the discussions with our legislative branch， with the payers and others and that we can’t sit passively by and wait for change. One of the best statements， that I heard about this， is someone said that I hope this idiom comes through that physicians need a seat at the table， because if they don’t have a seat at the table， they’re likely to be on the menu. And I made up my word. 

Steven Nissen博士：我认为所有国家都面临这个挑战，但是在美国这个问题尤为严重。我认为，本次大会中Borwick 博士的开幕议题非常特别。他指出，与中国等拥有先进医疗体系的国家相比，美国医疗体系的花费为两倍。但是我们知道，这些额外花费并不一定具有很大价值。我们习惯靠技术来解决问题。因此，美国比其他国家更倾向于应用技术和药物，但是这并不一定能够产生明显的效益。因此，我认为在美国，应当学会更明智地应用技术，同时将预防性治疗做的更好。这将有助于疾病的预防，而不是把大笔资金用于终末期疾病的治疗。这就是我们所面临的挑战。我认为，随着中国的不断发展、工业化程度的增加和经济的飞速发展，中国也将面临医疗花费激增的压力。当然，与美国不同的是，中国需要解决十几亿人口的医疗保健问题。这是一个巨大的挑战。我曾提到过多次，医生应当是解决方案的组成部分之一。这意味着医生应当参与到与政府部门、医疗费用支付者和其他人员的讨论中去。不能消极对待这个问题，不能坐等变革发生，医生也要占有有一席之地。

<International Circulation>: In the past several years， the combination of two antihypertensive drugs has become a popular approach to hypertension treatment. Our interview is taking place in the context of the just announcement of ACCOMPLISH trail， Please Based on your own clinical practice， evidenced- based medicine and guideline ， what do you think of the value of combination therapy for hypertension?what is the most common combination regimen in the management of hypertension ？

《国际循环》：近些年来，两种药物的联合使用在降压治疗中渐成趋势，正值ACCOMPLISH研究公布之际，请您结合循证证据、指南以及您自己的实践经验谈谈联合用药在降压治疗中的地位？
对于临床医生而言，最常用的联合治疗模式有哪些？<