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From
Prof. Akbar Chaudhry
BEIJING (CHINA): World Congress of Cardiology
which is one of the largest attended meeting of cardiac physicians
including interventional cardiologists was held here under the umbrella
of World heart Federation from 16 – 19 June 2010 China National
Convention Centre (CNCC). It also coincided with the 3rd International
Conference on Woman and Heart Disease & Stroke. A large number of
cardiologists from Pakistan also participated who were sponsored by
various pharmaceutical companies. Prof. Shahryar Sheikh from Pakistan
who is an important Council member of WHF was also present who
contributed to the conference proceedings in different capacities.
Minister of Health of China was the Chief Guest in the inaugural
session. He was well versed with the Medical Problems, Issue of China.
In his comprehensive presentation on the Health Policies of China he
highlighted the work being done in the of preventive side, improve basic
health facilities and establish state of the art, centres of excellences
in the country. It must be mentioned herer that China is now part of
many international trials. In a new Health Policy Concept, China will
provide health services to entire population, to both rural and urban
population by year 2020, including Medical Service System, Public Health
System, Drug Supply System etc.
Photographed during the World
Congress of Cardiology held at Beijing recently from (L to R)
are Prof. M. Akbar Chaudhry, Dr. Shahbaz and Prof. Saulat
Siddique
China’s current Health Budget is 120 Yuan (18USD) per person per year.
All Children with Congenital Heart Disease get 90% re-imbursement of the
treatment costs. Government is Planning for universal access to basic
health facilities and have introduced essential drug system which has
been adopted by 38% of the health facilities. It was also interesting to
note that smoking has become a major health issue in China. Almost 50%
of doctors smoke & 25% of cardiologist are smokers. Government by
legislation has prohibited smoking in public offices and places and by
year 2011 smoking will be prohibited in restaurants (where shisha is
common in some places).
Scientific programme of the Congress consisted of seminars, debates,
clinical sessions, Pharma industry sponsored workshops, besides non-commerical
symposias and all this was spread over 260 sessions with many concurrent
sessions, in view of varying interest of delegates. Apart from oral
presentations, there wee many poster presentations as well. Other
scientific highlights included satellite scientific activity, besides
close door Pharma industry meetings held at the conferenve venue. In all
a total of 2100 scientific papers were presented at various sessions
held in 26–Halls of Convention Centre, concurrently. Some of the
sessions had very thin attendance in view of the too many concurrent
sessions going on. The topics which were discussed included Arrhythmias,
Heart Failure, Left Ventricular Function, myocardial function, valvular
disease, pulmonary circulation, myocardial pericardial, Ischaemia,
Coronary Artery Disease, cardiac interventions, peripheral circulation,
stroke, hypertension, epidemiology of different diseases related to
cardiology, dyslipiedmia and metabolic disorders, pharmacology, basic
sciences related to cardiology, cardiac impaging and computers,
paediatric cardiology, congenital heart diseases, health promotion ,
role of nurses and technician in cardiac care etc.
Of special interest were papers on antiplatelets, ischemic heart
diseases, hypertension, congenital heart diseases, myocardial and
pericardial diseases, cardiomyopathies, woman and heart diseases,
diabetes and heart etc. In addition, there were many symposias and
industry sponsored satellite activities.
Antiplatelets and oral
anticoagulants
There were multiple sessions on the use of antiplatelets and oral
anticoagulants, in various clinical conditions, and in management of
acute coronary syndromes and strokes etc.Role of aspirin was discussed
in acute M.I, TIA’s stroke and in prevention (Primary & Secondary).
Antiplatelets drugs
New and in pipeline antiplatelets were also discussed along with their
advantages and disadvantages as compared to aspirin, including risks of
bleeding and the special group of patient who could be at higher risk
i.e. age more than 70, female patients and patients with renal
insufficiency, bleeding disorders and on other drugs i.e. NSAIDs etc.
Use of Proton Pump Inhibitors especially Omeprazole along with Aspirin
is controversial hence not recommended.
The issue of aspirin resistant was also discussed which may be
approximately 28%. Aspirin resistance is lower in men and higher in
women and also in renal impairment. Lower dose of aspirin 75–81mg/day +
Omega–3 decreases aspirin resistance or one can increase the dose to
325mg/day to overcome resistance. It is recommended that even if using
low dose aspirin for long-term, occasionally do check Hb, and stool for
occult blood as even low dose can cause bleeding.
Role of aspirin in primary prevention was also discussed. The
presentation highlighted that an aspirin a day can reduce the risk of
cardiovascular death by 15% non-fatal M.I. 30%, unstable angina 46%, and
also reduces the infarction and re-infarction strokes. Aspirin should be
taken preferably at night (like statins) and is more effective. Chewing
aspirin (325mg) in acute coronary syndrome may be life saving.
There were sessions and symposias on Atrial Fibrillation. It was
highlighted that atrial fibrillation is very common an lifetime risk of
AF is 1:4 in the men and women of age more than 40yrs. Incidence is
increasing and in USA it is predicted to go-up 15.9% in next few years.
There is very high mortality over the next 10 years after development of
AF. It also affects the quality of life and 17–36% will require
hospitalization yearly. Only 1 in 12 patients with A.F. are symptomatic.
The serious complication is thrombo-embolic episodes.
The main management strategy should be to control heart rate as well
rhythm control. Anti-arrhythmic drugs along with antiplatelets and
anticoagulant drugs should be used to prevent thrombo-embolic
complications. Most of the presentations in this session were excellent
and the presenters did full justice to the topic. Participation by
people from the Pharma trade and industry was visible but most of them
observed professional ethics. Numerous Pharma companies which included
Pfizer, Servier, Boehringer Ingelhiem, Sanofi Aventis, Novartis, Abbott,
MSD, Bayer Schering Pharma and GSK had sponsored satellite academic
activities.
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