I think probably the one that most people were looking for was the ADVANCE study on Zetia， the trial that reported that a combination of ezetimibe (Zetia) and Simvastatin was no better than Simvastatin alone. That was a trial that has been long awaited. There was a lot of discussion in the newspapers about this trial because many patients are on this drug. It’s called Vytorin， the combination drug in the United States. People were expecting the results a long time ago and the results didn’t come. So there was a lot of questioning why didn’t the results come. But finally the results came this time. But it was a very small study， so I think most people are saying that there is a much larger studies with this drug being done and most of us are waiting to see what’s going happen when the larger studies come out.

Here is another study that I think was important. You know in the United States we have a big problem with obesity. And there is a new drug called rimonabant which blocks the cannabinoid receptor in the brain and decreases appetite and people lose weight. But it also causes depression. So the study today shows that yes， people lost weight， and there was improvement in some of the cardiac risk factors for these people who took this drug. But almost half the patients had psychological disturbance. They were depressed， they were anxious， so that’s not so good. Those are the two studies I thought the most interesting.

And there were studies on the drug eluting stent showing that they are still basically pretty safe. There is a small percentage of drug eluting stents that have late thrombosis. But that in fact most patients do very well. And they need less return for recurrent restenosis， i.e.，  for further angioplasty. Most cardiologists these days are leaving the patients on clopidogrel long term to prevent late thrombosis in the drug eluting stent (DES). The other reason that we come to this meeting is not just that we see the new things but you review once more what you knew all along， that is refresh your memory about a lot of things. 

Joseph Alpert教授：在本次大会中，我参与了几项议题。我主持的第一项议题是关于心血管领域的专职护士。目前在美国的医院中，心血管内科的专职护士越来越多。原因之一是医生紧缺，其次是降低医疗花费的需要，由护士完成大量日常工作有助于降低花费。正如中国有赤脚医生一样。医生有了帮手，就能治疗更多患者。此外，我们用一整天时间讨论了心血管内科的体格检查、心电图、心脏超声和核医学检查。另一项议题是提出一系列疑难病例，心血管内科专家和经验丰富的护士展开讨论。还有一天是面向心血管内科医生和专职护士的临床药理学内容，包括抗心律失常药、降脂药和抗心衰药物。我主持的最后一项议题是关于非ST段抬高性心肌梗死的内容，包括转归不良的预测因素以及这些因素如何帮助决策是对患者实施血管成形术还是给予药物治疗。以上就是我在此次大会上主持的几项议题。

我想大多数与会者可能关注依替米贝（ezetimibe，Zetia）试验的进展。该项临床试验显示，依替米贝和辛伐他汀联用的疗效不优于辛伐他汀单药治疗。公众对该试验期待已久。报纸上对此也争论颇多，因为很多患者都在服用依替米贝，其复方制剂在美国的商品名为Vytorin。尽管公众对试验结果关注已久，但是结果却迟迟未能公布，因而招致强烈质疑。试验结果最终得以发表。但是该项试验是一项小样本研究。我想很多学者都提到，有关依替米贝的大样本研究正在进行当中，对这些试验的结果我们将拭目以待。此外，还有另一项重要研究。众所周知美国的肥胖问题很严重。新药利莫那班（rimonabant）能够阻断大脑的类大麻受体，使患者食欲下降，体重降低。但是利莫那班同时导致抑郁。一项研究显示，利莫那班确实能够使患者体重减轻并且改善某些心血管危险因素。但是约有半数患者出现抑郁和焦虑等精神症状，对患者不利。我认为上述两项研究都是非常有意思的研究。另外，有关药物洗脱支架（drug eluting stent，DES）的研究证实DES基本安全。仅有少数患者出现迟发血栓形成，大部分患者疗效良好，有更少的患者因再狭窄而需要实施血管成形术。为了预防迟发性血栓形成，大多数心血管内科医生会让置入DES的患者长期服用氯吡格雷。我们参加本次大会的目的除了了解前沿发现以外，还有复习和更新现有的知识。 

2. <International Circulation>：Patients with complex cardiovascular problems pose a special management challenge for both the specialist and the non-specialist. To make the best treatment decisions and avoid potential problems， we need to stay on top of ever-changing standards of care. Do you have any advices and suggestions for us in the aspect? |

《国际循环》：处理复杂心脏病患者具有特殊的挑战意义，不论对与专家和是普通医生。为了避免潜在问题和制定最佳治疗决定，我们需要不断学习。您在这方面有什么意见和建议给我们吗？

Prof. Joseph Alpert：There are many elderly complex patients these days， particularly in the United States. We have， as you see in China， a lot of people who are older. In fact， today as we are sitting here， in the 24 hour period that we are a part of， more people will become age 85 in the United States than will be born. So that’s also true in western Europe. So what you are seeing is a huge increase in the number of older patients. And many of these people have more than one disease. Coronary diseases， heart failure， renal insufficiency， they may have lung disease particularly in smokers， they may have diabetes. They have hyperlipidemia， a lot of cholesterol. And these are very complex patients. And some of the drugs are contraindicated depending on what other diseases that the patients have. So for example， the patient who has chronic obstructive lung disease with wheezing， with bronchospasm， you wouldn’t want to give that patient β-blockers， or the patient th