The cerebrovascular disease (CVD, also as stroke) implies a syndrome of acute vascular events with the main clinical manifestations of ischemia or hemorrhagic injury in cerebral tissues. The series of episodes normally include cerebral infarction, transient ischemic attack, and cerebral hemorrhage. CVD is characterized by the high morbidity, mortality, disability, and recurrence rate. CVD may occur on one in every 6 people and may cause one death or permanent disability within every 6 seconds according to the statistics from World Health Organization. At present, survivors suffering from CVD occurrence were more than 7 million, there are more than 2 million new CVDs per year, and the number of patients with minor stroke is approximately 20 million in China. CVD has been the major cause of disability. The deaths caused by CVD exceed one‐fifth of the total deaths, becoming the first killer of and endangering people's health. More seriously, a huge population is under high risk to develop CVD, such as people with high blood pressure, diabetes, and dyslipidemia. The occurrence of CVD therefore will possibly increase sharply with the “blowout” tendency in the future, which is a huge burden to society.
CVD is preventable and treatable. However, it still faces the following great challenges in either the prevention or the treatment of the same in China: (1) the etiology and pathogenesis of the disease are really complex, which require higher demands for the clinical management; (2) the recurrence of CVD cannot be prevented effectively due to lack of the cost‐effective screening, appropriate intervention, and strategy on high‐risk population; (3) as most of evidences from researches in Western countries, shortage of data, especially specific for Chinese stroke patients, for instance, the stenosis of intracranial large vessels, hemorrhagic stroke, the application of Chinese traditional medicine, results in a certain blindness in clinical practice and insufficiency in preclinical evaluation and translational research.
In recent years, a breakthrough has been made in the medical care of CVD, in terms of diagnosis, drug development, and critical techniques such as carotid endarterectomy, antithrombotic therapy, and neuroimaging. More importantly, the establishment of organization and management system, first aid system, and risk evaluation system, as well as the national standards and guidelines, combining with the support of biomedical engineering, computer science, and genetics research, provides the theoretical basis for the development of CVD in China.
In order to achieve the goal “three increases and three decreases” (i.e., improvement on the advancement, the feasibility, and the accuracy of medical care, and decreases in the morbidity, the mortality, and the cost of cerebrovascular diseases), as well as promoting people's health level and life expectancy, we solemnly appeal for directing the disease prevention and control based on the national strategic demands, strengthening the top design and systematic planning, coordinating the whole arrangement on several aspects of cerebrovascular diseases, in terms of the research in basic science, innovative critical techniques, practical applications and generalization, and the establishment of platform system, promoting the multidisciplinary cooperation, and improving the efficiency of translational and clinical research on cerebrovascular diseases. The following strategies as priority are suggested to be deployed:
Conduct studies on the untraditional risk factors, early warning signs, and prevention strategies of CVD in China. For example, combine the new multiomics techniques and bioinformatics analysis techniques; study on the new risk factors and etiological factors; complete the disease spectrum; establish early warning models; and develop disease‐screening strategies.
To promote the translation from “Bench” to “Bed”, it is suggested to explore the mechanisms and the key therapeutic targets of different subtypes of CVD, and to increase the application of multicenter randomized clinical trial (RCT) in preclinical medicine.
Develop strategies of prevention and treatment of the high‐risk nondisabling ischemic cerebrovascular events (HR‐NICE) which is considered to be in the best window time for treatment. Possible studies are in relation to the promotion of early identification of disease by public and professional institutions, the intervention and management strategies (such as early intensive control of blood pressure, anticoagulation, thrombolysis, and intravascular therapy), and the precision medicine application in the antithrombotic research in HR‐NICE population. We should establish the mode for continued quality improvement on secondary prevention according to the Chinese context; strengthen the training on guidelines interpretation in medical physicians; increase the compliance with guidelines in clinicians and patients; improve the generalization of CVD prevention guidelines; and finally reduce the gap between clinical practice and guidelines.
As one of the most common causes of CVD, strokes with intracranial atherosclerotic stenosis (ICAS) have a high risk of recurrence. It is significant to identify patients with a high risk of stroke recurrence and then provide active intervention to them. Therefore, it is suggested to design or conduct studies on ICAS, such as multimode imaging analysis techniques and hemodynamics monitoring techniques on intracranial stenosis in order to improve prevention and treatment.
Appeal for large RCTs on early urgent intervention on acute hemorrhagic CVD, in order to optimize the allocation of medical resources and promote early assessment and early intensive treatment of patients with hemorrhagic CVD, as well as finally advance the level of guideline evidences, improve the treatment of intracerebral hemorrhage, and benefit patients.
Design/conduct studies on the treatment strategies and diagnosis techniques of CVD, for instance the translation, application, and generalization of the integrated medical care mode (such as CVD clinics); multicenter clinical trials of diagnosis and treatment techniques; and evidence‐based medicine evaluation, in order to effectively reduce the mortality and the disability rate in acute phase of CVD.
Establish and utilize the big data platform of epidemiological surveillance and clinical practice of CVD. Integrate multisources and multidimensional epidemiology data, community population data and patient‐group data, and biological sample resources depot. Smart integration and in‐depth exploration will set solid foundation for the streamlined study and prevention of cerebrovascular diseases.
Upon the sprout of precision medicine, research data from molecular biology and massive genetics, especially those that progress from gene polymorphism and CVD studies, provide scientific basis and technical pillars for CVD, thus preventing and accelerating the individualized medication for CVD precisely.
Enhance research on basic science and translational research of stroke: revisit the conceptions of pathophysiology; further, study the functions of non‐neurons cells and tissues in stroke incidence, progression, treatment, and rehabilitation; conduct in‐depth analysis of the relationship between the acute damage and regeneration; discover and evaluate the respective or combined therapeutic targets; investigate the effects of other tissues and organs exert on stroke pathophysiology; complete and improve the animal models; probe new drug targets; combine the basic science and translational research based on the thrombolysis and thrombectomy; apply new technologies, new methods, and new drugs to study different stages of stroke in individual accurate treatment of translational research; and finally develop methods and strategies for stroke research in Chinese context.
Appeal for the cooperation with multiple disciplinary such as biomedical engineering and computer science; utilize the wearable medical and mobile medical techniques to apply on the etiology diagnosis, screening of high‐risk population, evaluation on the therapeutic effects, and the development of remote consultation, and finally to promote early prevention and treatment of CVD.
Monitor and improve stroke care quality. Conduct studies on the comparative effectiveness and generalization of critical diagnosis and treatment techniques, for instance comparative effectiveness research on the commonly used techniques of clinical diagnosis and treatment, and the applications and comparative effectiveness studies on the domestic techniques, materials, and equipment of intravascular therapy, in order to reduce healthcare costs; and then allocate the limited medical resources reasonably.
Take care of survivors from CVD by physical rehabilitation techniques such as electrical stimulation, magnetic stimulation, and ultrasound stimulation; develop new rehabilitation robots, wearable rehabilitation equipment, and a variety of rehabilitation aids; finally improve the self‐care ability and life quality on stroke patients; and reduce the family and social stress.
For the implementation of innovation‐driven development strategy, we will highlight the research priority strategies to promote CVD prevention and control in China. Let us get a move on fighting against CVD and initiate a new milestone in the health career of the “Chinese Dream!”
Experts in the panel discussion:
Chun‐Yan Li, Ji‐Zong Zhao, Jian‐Ping Dai, Yong‐Jun Wang, John Zhang, Tao Jiang, Li‐Nong Ji, Yong Huo, Li‐Ping Liu, Yi‐Long Wang, Zhong‐Rong Miao, He‐Qi Cao, Xue‐Fen Zhu, Zeng‐Qiang Yuan, Li Guo, Dong‐Ya Zhu, Jia Liu, KS Lawrence Wong, An‐Ding Xu, Qiang Dong, Jin‐Sheng Zeng, Chun Yuan, Ding‐Feng Su, Xin Wang, Guo‐Yuan Yang, Yi‐Zheng Wang, You‐Ming Lu, Gang Zhao, Shi‐Zheng Wu, Peng Xie, Yun Zhang, Guo‐Hua Xi, Yun Xu.