MEASURES TO IMPROVE PRECLINICAL RESEARCH CONDUCTED TO IMPROVE THE PREVENTION AND TREATMENT OF CARDIOVASCULAR DISEASES

Globally, cardiovascular disease (CVD) continues to be the primary cause of morbidity and mortality. The worldwide burden of CVD is still high despite tremendous advancements in diagnosis and treatment, highlighting the critical need for more thorough and efficient preventative measures. The purpose of this narrative summary is to assess the existing cornerstones of cardiovascular prevention critically, point out areas where current methods fall short, and suggest possible future paths. The majority of deaths worldwide are caused by cardiovascular disease (CVD), which primarily affects low- and middle-income countries (LMIC). Globally, primary and secondary prevention of CVD is not at its best, but in LMICs, the gaps between evidence and practice are considerably more noticeable. Optimal primary and secondary prevention cannot be implemented due to obstacles at the patient, healthcare practitioner, and health system levels. To develop successful methods to close the observed evidence-practice gaps, it is essential to identify the specific obstacles that occur in settings with limited resources. Additionally, the greatest improvements in mortality reduction will come from focusing on the modifiable factors—such as tobacco use, hypertension, and secondary prevention for CVD—that contribute most significantly to the worldwide burden of CVD. We examine a few innovative, resource-efficient approaches to lower premature mortality from CVD, such as: (1) efficient tobacco control measures; (2) the use of simplified screening and management algorithms for individuals with or at risk of CVD; (3) expanding the availability and affordability of simplified and cost-effective treatment regimens, such as combination CVD preventive drug therapy; and (4) streamlining health care delivery through task-sharing (non-physician health workers) and improving self-management (treatment supporters). Significant decreases in CVD and associated mortality will result from the development and implementation of care systems that overcome the aforementioned obstacles.在全球范围内，心血管疾病（cardiovascular disease, CVD）始终是引发疾病与死亡的首要病因。尽管心血管疾病的诊疗领域已取得巨大进展，但其全球疾病负担仍居高不下，这凸显了对更全面、高效的预防措施的迫切需求。本次叙述性综述旨在批判性评估当前心血管疾病预防的核心基石，指出现有防控手段的短板，并提出未来可行的发展路径。心血管疾病仍是全球多数死亡病例的元凶，且其主要受累群体为中低收入国家（low- and middle-income countries, LMIC）。从全球范围来看，心血管疾病的一级预防（primary prevention）与二级预防（secondary prevention）尚未达到最优水平，而在中低收入国家中，循证与实践之间的鸿沟尤为显著。受患者、医护人员以及卫生系统层面的多重障碍制约，无法推行最优的心血管疾病一级与二级预防方案。为制定可行方案以填补现有循证实践差距，明确资源匮乏地区的具体阻碍因素至关重要。此外，针对全球心血管疾病负担贡献最大的可干预危险因素（如烟草使用、高血压（hypertension）以及心血管疾病二级预防）进行干预，将实现死亡率降低的最大幅度提升。本文探讨了若干可降低心血管疾病过早死亡的创新型资源高效策略，具体包括：(1) 高效的烟草管控措施；(2) 为已患心血管疾病或存在患病风险的人群采用简化的筛查与管理算法；(3) 推广简化且成本效益优异的治疗方案，如心血管疾病联合预防药物疗法；(4) 通过任务分工模式（由非医师医护人员承担部分诊疗工作）优化医疗服务供给流程，并强化患者自我管理（辅以治疗支持者）。构建并落实能够克服上述障碍的医疗照护体系，将显著降低心血管疾病及其相关死亡病例的数量。