CORRESPONDENCE: LETTER TO THE EDITOR
China’s Role in International Cardiology
Tsung O. Cheng, MD, FACC*
* The George Washington University, Medical Center, Department of Medicine, 2150 Pennsylvania Avenue, NW, Washington, DC 20037 (Email: tcheng{at}mfa.gwu.edu).
Dr. DeMaria’s excellent editorial on international cardiology (1) touches on several aspects that deserve further comments and amplification from China’s point of view. After all, one of every five persons on this planet lives in China (2).
First, the Journal of the American College of Cardiology (JACC) is an excellent example of international cardiology (1). It may be of interest to Dr. DeMaria to know that JACC is the second most frequently cited foreign cardiologic journal referenced in articles published in the Chinese Journal of Cardiology, the official cardiology journal in China (2).
Second, Dr. DeMaria commented on the spectrum of cardiovascular diseases among different countries worldwide. While there are indeed such differences as illustrated by the examples cited by Dr. DeMaria, the gaps are getting narrower. For example, the metabolic syndrome has reached near epidemic proportions in the U.S., as Dr. DeMaria (1) mentioned. It has also become a problem in China where the prevalence of metabolic syndrome is 13.3% (12.7% in male and 14.2% in female subjects) (3,4). In China, obesity—which has become the nation’s newest health risk (5)—is the principal reason for the increased prevalence of the metabolic syndrome (3,4). It is a paradox to note that, whereas being underweight is one of the major causes of death in rural China (6), being overweight is one of the major concerns in urban China (2).
Third, China is the most populous country in the world, with over 1.3 billion people. Because of this enormous population and a very low migration rate, it is an ideal country to conduct clinical trials. As a matter of fact, the second largest trial of treatment of acute myocardial infarction (AMI) in the world and the largest clinical trial ever underaken in China, COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial), has just been published (7). The results of this mammoth study, involving 45,852 patients in China, will undoubtedly influence the treatment of AMI throughout the world in the future.
Finally, I wish to echo what Dr. DeMaria said, namely that the world is getting smaller. As my mentor, the late Dr. Paul D. White, said, cardiology knows no international boundary and is the world’s best goodwill ambassador (8).
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1. DeMaria AN. Editors pageinternational cardiology. J Am Coll Cardiol 2005;46:1580-1581.[Free Full Text]2. Cheng TO. The current state of cardiology in China Int J Cardiol 2004;96:425-439.[CrossRef][Web of Science][Medline] 3. Cheng TO. Metabolic syndrome in China Circulation 2004;109:e180.[Free Full Text] 4. Cheng TO. The metabolic syndrome, formerly called metabolic ‘syndrome X’ Am J Cardiol 2004;94:148-149.[Web of Science][Medline] 5. Cheng TO. Obesity is the newest health risk in modern China. Lancet 2005. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140673605673448/comments?actio. Accessed October 7, 2005.. 6. He J, Gu D, Wu X, et al. Major causes of death among men and women in China N Engl J Med 2005;353:1124-1134.[Abstract/Free Full Text] 7. COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) Collaborative Group Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarctionrandomized placebo-controlled trial. Lancet 2005;366:1607-1621.[CrossRef][Web of Science][Medline] 8. Cheng TO, Paul D. White LectureCardiology in People’s Republic of China. In: Russek HI, editor. New Horizons in Cardiovascular Practice. Baltimore, MD: University Park Press; 1975. pp. 1-27.
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