Over the past decade, substantial progress has been made in China in improving health-care infrastructure and enacting national policies focused on the prevention of cardiovascular disease (CVD) and other non-communicabl...Over the past decade, substantial progress has been made in China in improving health-care infrastructure and enacting national policies focused on the prevention of cardiovascular disease (CVD) and other non-communicable chronic diseases. Nevertheless, a considerable gap remains between the national goals for cardiovascular health and the burden of CVD in the Chinese population. The rapid advances in digital health-care platforms and the increasing adoption of artificial intelligence (AI) technologies across various health-care sectors underscore the potential for these innovative approaches to address existing challenges in CVD prevention. In this Review, we summarize the major challenges in implementing preventative strategies and highlight the core obstacles to achieving the national goals for cardiovascular health in China. Furthermore, we discuss the potential value of, and the challenges associated with, digital health-care and AI technology in the implementation of preventative strategies in China and other countries with similar needs.
The growing epidemics of metabolic-dysfunction-associated steatotic liver disease, type 2 diabetes mellitus, obesity and cardiovascular disease are inextricably linked. Cardiovascular-liver-metabolic (CLM) diseases coexi...The growing epidemics of metabolic-dysfunction-associated steatotic liver disease, type 2 diabetes mellitus, obesity and cardiovascular disease are inextricably linked. Cardiovascular-liver-metabolic (CLM) diseases coexist and interact to constitute a synergy of epidemics (a syndemic), with shared mechanisms and socioeconomic influences. The goal of this Review is to construct this complex public-health issue into a unified framework, using epidemiological data to illustrate the current burden of disease and the trends in the CLM syndemic and to make projections for the future. We also discuss the challenges of promoting CLM health and the need for shared solutions. The proposed micro-meso-macro framework integrates strategies to improve risk prediction and precision prevention and to disentangle the competing risks within the CLM construct (micro), while keeping communities at the heart of CLM health promotion by ensuring access to healthy foods, healthy environments and metabolic interventions (meso). In addition, we propose interventions to eliminate inequities in the social and commercial determinants of health, from communities to healthcare systems (macro). Thus, multisystem interventions could address the trajectories of the CLM disease epidemics simultaneously.
Takotsubo syndrome, also known as broken heart syndrome, was first described in Japan in the 1990s and presents as acute heart failure caused by transient contractile dysfunction that mimics acute coronary syndrome but i...Takotsubo syndrome, also known as broken heart syndrome, was first described in Japan in the 1990s and presents as acute heart failure caused by transient contractile dysfunction that mimics acute coronary syndrome but is not caused by acute coronary obstruction. Takotsubo syndrome accounts for as much as 2-3% of suspected coronary syndromes and is considerably more common in women than in men. In this Review, we discuss the historical background and clinical features of Takotsubo syndrome and our evolving understanding of its pathophysiology. The hallmark feature of Takotsubo syndrome is transient left ventricular dysfunction linked to emotional or physical stressors. Despite advances in our understanding of the clinical presentation and possible pathophysiological mechanisms of Takotsubo syndrome, this condition continues to challenge our fundamental understanding of human anatomy and physiology, particularly regarding how acute emotional and physical stressors can trigger such profound cardiovascular dysfunction. Although the definitive mechanisms remain elusive, current hypotheses largely centre on catecholamine surges and sympathetic nervous system hyperactivation. Diagnostic criteria have been developed by the Mayo Clinic and European Society of Cardiology working groups but, in the absence of randomized controlled clinical trials, no specific treatments for Takotsubo syndrome are available. In this Review, we highlight the complex pathophysiology of Takotsubo syndrome, with an emphasis on the interplay between emotional stress and cardiac health, and call for the development of evidence-based management protocols.
The miniaturization of implantable sensors and actuators, combined with advances in interactive modelling and high-resolution imaging, is propelling the use of medical devices for counteracting impaired neural control of...The miniaturization of implantable sensors and actuators, combined with advances in interactive modelling and high-resolution imaging, is propelling the use of medical devices for counteracting impaired neural control of the cardiovascular system. In this Review, we discuss the current effectiveness of this technology for modulating autonomic activity in numerous cardiovascular conditions, including high blood pressure, heart failure and cardiac arrhythmias. We advocate for smarter closed-loop bionic devices fitted with feedback from multiple sensors to allow adaptive, state-dependent control, and discuss how the adoption of artificial intelligence technology would facilitate auto-personalization to meet the needs of patients. We also describe how transcriptomics of autonomic circuits can guide device-based approaches. Finally, the use of stem cell therapies to target sympathetic circuits more precisely will help to optimize the therapeutic effects of autonomic modulation for the treatment of arrhythmia. For bioelectronic medicine to achieve clinical utility in neurocardiology, these innovations must demonstrate improved efficacy beyond that offered by contemporary interventions.