<International Circulation>:   Diagnosis of coronary heart disease in women is often misdiagnosed or delayed. What are the key points that we should pay attention to in improving this? 
    Professor Ralph Brindis: We still have a lot of challenges on how to figure out what is the proper diagnostic tool for patients both for women or men to screen for coronary heart disease whether they are asymptomatic， symptomatic or intermediate risk.  What we need to do is to develop more clinical trials and more comparative effectiveness work in assessing whether an imaging test actually affects clinical outcome. We know for example the sensitivity， specificity and accuracy is for an imaging test but there is less data on when that test affects outcome particularly in the setting of asymptomatic screening. I acknowledge that we have challenges for asymptomatic patients with adverse outcomes over time but we have yet to identify well which patients we should target for non invasive testing that is evidence based. 

 《国际循环》：女性的冠心病经常被误诊或延误诊断。我们改善这一情况的关键是什么？
    Brindis教授：无论是无症状的、有症状的还是中危的冠心病，找到合适的诊断工具来筛查冠心病都是个挑战，男性和女性患者都是如此。我们需要开展更多的临床试验和比较效果的研究，评价影像学检查能否真正改善患者的临床转归。比如我们知道影像学检查有敏感性、特异性和准确性等指标。但是，对无症状人群进行影像学筛查是否会影响到患者的临床转归，数据还较少。我得承认，我们要面临无症状患者未来发生不良事件的挑战，但是现在我们要根据证据确定哪些患者应当进行影像学检查。
    <International Circulation>:   Based on the available data what is your comment on the role of statin therapy as the primary prevention of CVD?
    Professor Ralph Brindis: I think there are aspects related to statin therapy independent of its lowering of LDL-C we still do not understand.  There may be what we call pleiotropic effects that may stabilize the vasculature which seems to have some benefit in the perioperative period.  It is certainly exciting work! The other big advance with statin therapy is that we certainly know its marked beneficial effects in decreasing deaths and recurrent heart attacks in patients with a history of coronary disease but we are now learning on how to extend its value in terms of primary prevention for patients without a prior history of coronary disease when statins should be utilized. For example， the JUPITER study which was recently published suggested  the use of high sensitivity CRP ( C-reactive protein) testing as a way of identifying patients with LDL-C that are not particularly high who will benefit from primary prevention.  A recent article even suggested we might not even need to do CRP testing for certain patients at intermediate risk for the utilization of statins for primary prevention. 
   《国际循环》：基于现有数据，您如何看待他汀在心血管疾病一级预防中的作用？
    Brindis教授：我认为，对他汀独立于降LDL-C以外的作用，我们还有某些方面并不了解。他汀可能通过多效性作用稳定斑块，这对围术期患者有益。这一发现当然令人兴奋。他汀的另一个明显优势就是显著降低冠心病患者的死亡和心脏病复发风险。不过，目前我们正在探讨如何使没有冠心病病史的患者也能得到上述益处。这些患者也应当用他汀。比如，最近公布的JUPITER研究提示，应用高敏C反应蛋白检测可以发现能够从他汀一级预防中获益的LDL-C升高不明显的患者。最近公布的一项研究发现，某些中危患者可能不需要测定C反应蛋白，可直接应用他汀进行一级预防。 

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