Currently, the number of cardiovascular disease patients in China is as high as 330 million, including 245 million patients with hypertension and over 10 million patients with coronary heart disease and stroke; Cardiovascular diseases account for nearly 50% of total deaths among residents, ranking first among all types of diseases and being known as the "number one killer" that threatens residents' health.

With the deepening of the "Healthy China 2030" strategy, the prevention and control of cardiovascular and cerebrovascular diseases have been included in the key prevention and control category, and the results have been significant. However, in the context of accelerated aging, the overall prevention and control situation is still grim: on the one hand, the number of cardiovascular disease patients is huge, and the incidence rate continues to rise; On the other hand, middle-aged and elderly patients often face the problem of multiple diseases coexisting, and the "interweaving of multiple diseases" state may form a cumulative harm of "1+1>2", further increasing the health burden.

In recent years, the country has continuously advocated the concept of "three highs co management" and called for the inclusion of various risk factors related to cardiovascular and cerebrovascular diseases in the collaborative prevention and control system. In response to this, the theme of this year's World Heart Day, "Don't Miss a Beat," advocates for paying attention to every heartbeat and valuing every aspect of heart health.

The burden of cardiovascular disease among the elderly in China has been increasing year by year, and factors such as multiple comorbidities, organ dysfunction, and high incidence of complications are key issues, "said Professor Qian Juying, Vice President and Deputy Director of Cardiology at Zhongshan Hospital affiliated with Fudan University

Among the many threats of comorbidity, the threat of infectious diseases is easy to be ignored, but its impact should not be underestimated. "Cardiovascular disease will not only directly damage the heart, blood vessels and other organs, and may lead to disabling and fatal events such as heart failure, myocardial infarction, stroke, but also increase the risk of herpes zoster and other infectious diseases." Professor Liang Chun, director of the Cardiovascular Branch of Shanghai Medical Association and director of the Department of Cardiology of Shanghai Long March Hospital, said.

Cardiovascular disease causes' pain on top of pain '

According to the China Cardiovascular Health and Disease Report, the prevalence of hypertension, diabetes and dyslipidemia in Chinese adults has reached 27.9%, 11.2% and 40.4% respectively, and the total number of patients has exceeded 100 million. Due to the large number of people with the above cardiovascular disease risk factors, together with the accelerated aging of the population and changes in living habits, the incidence rate and mortality of cardiovascular diseases in China are still rising, and the inflection point for the decline of the disease burden has not yet emerged.

Data shows that cardiovascular diseases account for the highest proportion of deaths among urban and rural residents in China. In 2020, they accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively. Two out of every five deaths were caused by cardiovascular diseases.

It is worth noting that the impact of cardiovascular disease has a synergistic effect, and the incidence of cardiovascular disease in comorbid patients is doubled. In addition, a series of observational studies have shown that acute respiratory, urinary tract infections, sepsis, and other diseases can also increase the risk of cardiovascular disease. For example, cardiovascular diseases plus infectious diseases such as herpes zoster are non "small probability events". Herpes zoster, commonly known as "snake wrapped waist" or "raw snake", is a common infectious skin disease caused by varicella zoster virus (VZV).

More than 90% of adults have latent varicella zoster virus in their bodies, and about one-third of people will suffer from shingles in their lifetime. There are over 6 million cases of shingles in China every year, "said Professor Zheng Yongjun, Executive Director of the Pain and Rehabilitation Department of East China Hospital affiliated with Fudan University." Among them, middle-aged and elderly people over 50 years old and patients with chronic diseases such as cardiovascular disease are high-risk groups

In order to curb and reverse the rising trend of cardiovascular disease incidence and mortality in China, it is necessary to strengthen the prevention and management of these risk factors. Professor Zheng Yongjun added that if postherpetic neuralgia occurs, the pain may last for several months or even years. This kind of 'shared sadness and illness' not only causes suffering for patients, but also significantly increases caregiving pressure, and its impact is family oriented. After suffering from shingles, patients with cardiovascular disease often face higher difficulty in disease management and treatment costs

What's even more worrying is that cardiovascular disease can cause 'pain on top of pain'. Professor Liang Chun also told 21st Century Business Herald reporters and others that herpes zoster and cardiovascular disease both belong to the category of comorbidities. When these two diseases occur concurrently, they can cause overlapping and amplifying harm, and there may be bidirectional mutual influence. For example, during pain attacks, many patients often choose the corresponding department based on the location of the pain, which can easily lead to misunderstandings in the diagnostic process. Therefore, we need to pay attention to the possibility of comorbidities, and multidisciplinary communication should be carried out in the diagnosis of cardiology, pain management, and dermatology.

From the perspective of treatment and prevention, herpes zoster virus usually lurks in the human body and is prone to occur when the body's immune system is weakened.

"Elderly people, patients with diabetes, patients with cardiovascular and cerebrovascular diseases, patients receiving tumor targeted therapy, and those using immunosuppressants are all factors that lead to decreased immunity, so this high-risk group is prone to herpes zoster." Liang Chun pointed out that compared with the normal population, the proportion of patients with cardiovascular and cerebrovascular diseases suffering from herpes zoster is about 39% higher. Not only has the incidence rate increased, but these patients have more severe pain and longer pain duration.

Pain can affect patients' sleep, make them mentally tense, and keep their families busy. At the same time, work is easily disrupted, which may lead to elevated blood pressure, difficulty in controlling blood sugar, and subsequently trigger anxiety and tension, increasing the risk of platelet activation and thrombosis. On the contrary, having shingles increases the likelihood of cardiovascular and cerebrovascular events. For example, patients with shingles have a 68% increased risk of short-term heart attack and a 78% increased risk of cerebral hemorrhage and stroke.

Therefore, for patients with cardiovascular and cerebrovascular diseases infected with herpes zoster, treatment should not be limited to pain relief and antiviral therapy. It is also necessary to strengthen blood pressure control, blood sugar management, improve sleep quality, and enhance antiplatelet therapy to avoid other cardiovascular comorbidities caused by platelet activation. Liang Chun said that a more proactive approach is to proactively vaccinate the population with low immunity, advanced age, and cardiovascular and cerebrovascular diseases (including heart failure patients) for early prevention, which can significantly reduce mortality rates. At present, there is relevant information indicating that after receiving the herpes zoster vaccine, the risk of cardiovascular and cerebrovascular diseases in some populations has been reduced.

Guarding the 'First Line of Defense'

With the deepening of the "Healthy China Action - Implementation Plan for the Prevention and Control of Cardiovascular and Cerebrovascular Diseases (2023-2030)", China is continuously strengthening the full chain management of "prevention, treatment, and management" of cardiovascular and cerebrovascular diseases, adhering to the principle of prevention as the main focus, and paying attention to moving the checkpoint forward; The 14th Five Year Plan for Healthy Aging also emphasizes strengthening the joint treatment and management of multiple diseases, improving the comprehensive prevention and treatment system for chronic diseases in the elderly, fully reflecting the country's high attention to "joint disease management" and "prevention first", and also pointing out the direction for the practice of "active joint prevention".

Professor Zheng Yongjun also expressed his agreement with this. He pointed out that in the face of "sad risks" like shingles, active prevention is far more effective in safeguarding health than treatment after onset. It is recommended that high-risk groups, such as middle-aged and elderly people over 50 years old, and patients with chronic diseases such as cardiovascular disease, should take proactive measures to prevent and protect their own and their family's health.

As the "first line of defense" for residents' health and the "first battlefield" for vaccination services, Hua Yingxue, director of the Xinchang Community Health Service Center in Pudong New Area, introduced that chronic patients such as cardiovascular diseases are not absolutely contraindicated for vaccination, but rather need to scientifically grasp the timing of vaccination. If the disease is stable, vaccination can be administered to reduce the risk of contracting shingles. Before vaccination, you can consult our community health service center or other specialist doctors for scientific vaccination.

Public information shows that people with weakened immune function and underlying diseases are also more likely to develop shingles. Compared with the general population, patients with diabetes, chronic kidney disease, cardiovascular disease, chronic obstructive pulmonary disease, and rheumatoid arthritis have an increased risk of herpes zoster disease. For example, suffering from herpes zoster will affect the control of chronic diseases. After suffering from herpes zoster in diabetes patients, blood sugar control will be more difficult.

Therefore, in daily diagnosis and treatment, popular science education for the elderly has become an important part of promoting the health management of elderly friends. At community health centers, many doctors will educate elderly people on the knowledge of strengthening their bodies and enhancing immunity, including daily lifestyles and proactive prevention awareness, during outpatient visits. They will establish a disease prevention concept of "early recognition, early prevention, and early health", scientifically understand diseases, and improve vaccination awareness.

At the same time, it should be noted that while vaccination is important, the choice of vaccine is also crucial. Middle aged and elderly people should remember three key words before getting vaccinated: age, protective efficacy, and who should not get vaccinated (contraindications). Specific choices can be made by consulting with professional doctors. Including: actively reporting personal health status, choosing the appropriate vaccine under the guidance of a doctor; Patients with immune dysfunction or immunosuppressive diseases need to pay attention to contraindications for vaccination. They cannot receive attenuated live vaccines. For recombinant protein vaccines, low immune function or immune damage are not contraindications for vaccination.

Under the trend of "prevention first", various regions are exploring diverse collaborative new models of medical prevention integration, and communities are also the grassroots "pivot" among them. We are implementing a series of measures such as targeted health education and providing more convenient immunization services to solidly promote the integration of medicine and prevention, and also make the community a solid part of the 'active joint prevention', "said Director Hua Yingxue.