Innovative thrombolytic drugs to save lives, but how can ordinary people avoid cardiovascular disease?

In the 2019 Global Burden of Disease report published by the Lancet, a top international medical journal, cardiovascular disease is the number one cause of death worldwide. It has been the largest source of increased health loss in China over the past 30 years, including coronary heart disease (ischaemic heart disease), strokes, and age-related diseases such as lung cancer and diabetes.

As a result, cardiovascular disease has become the “big disease” that people talk about — with a large patient base, a very high rate of disability and death, a growing incidence, and a relatively “hidden” nature. “Many people do not even think they have the disease until they die suddenly of a heart attack or brain attack.

Therefore, the prevention of cardiovascular diseases is more necessary in daily life. It is not advisable to wait until a sudden emergency and rely on thrombolytic therapy to save your life, right? Moreover, thrombolytic therapy has strict indications, and it is easy to miss the golden window of treatment within 6 hours. So, while thrombolytic therapy can save lives, what can ordinary people do to avoid cardiovascular disease?

1 Risk factors for cardiovascular disease

According to the Third National Retrospective Sample Survey on Causes of Death, cerebrovascular disease has now jumped to the top of the list of causes of death, with stroke being the highest single disability rate. According to national and international experience, stroke is a terrible but preventable and manageable disease. Active and effective interventions on the risk factors of stroke can significantly reduce the incidence of stroke and reduce the burden of stroke disease.

Risk factors for stroke are also classified as either intervenable or non-intervenable. The main non-intervenable factors include age, gender, race and genetic factors. Many intervenable factors, including hypertension, abnormal glucose metabolism, dyslipidaemia, heart disease, asymptomatic carotid atherosclerosis, and lifestyle, are the easiest ones to control for many people.

In an earlier article, we described the relationship between smoking and alcohol consumption and cardiovascular diseases such as stroke. In addition to the two influencing factors of smoking and alcohol consumption, physical activity (exercise), obesity and even psychological problems are also associated with cardiovascular diseases.

2 More exercise: physical activity is essential

Numerous large-scale studies have established that inactivity increases overall mortality, cardiovascular morbidity and mortality, and stroke risk. Regular long-term physical activity improves neurocognitive function. increases nerve growth factor secretion, and strengthens the body’s ability to protect itself from stressful events via neuroendocrine regulation. It also lowers blood pressure and reduces the incidence of diabetes and obesity, thereby reducing the risk of stroke It also reduces blood pressure, diabetes and obesity, thereby reducing the risk of stroke.

The industry has come to a more consistent conclusion from prospective observational studies that regular physical activity can prevent stroke and reduce overall mortality.

The American Heart Association published two editions of guidelines to increase and promote physical activity in the population in 2013 and 2018. The guidelines noted that increased physical activity is beneficial for over 40 chronic conditions, including cardiovascular disease, and its effectiveness is comparable to or greater than that of medication.

Overall, to keep away from cardiovascular diseases such as stroke, individual human beings should choose physical activities that are suitable for them in their lives to reduce the risk of stroke. It is recommended that older people and people at high risk of stroke should develop individualised exercise prescriptions for exercise after a maximum exercise load test.

It is also recommended that healthy adults engage in aerobic exercise, lasting approximately 40 minutes of moderate or higher intensity (e.g. brisk walking, jogging, cycling or other aerobic exercises) three to four times a week.

Finally, the official guidelines also recommend that people whose daily work is predominantly sedentary get up and move around for a few minutes every hour of sedentary work, including those who already get the recommended amount of regular exercise each week.

Studies have shown that regularly physically active people have a 25% to 30% lower risk of stroke or death than those who are generally not physically active and that all types of physical activity are beneficial, such as leisure time activities, occupational sports, and walking.

3 Weight control: obese and overweight people are more likely to have strokes

It has to be said that the world is still quite unfriendly to the obese community, and although we do not want to create more body image anxiety, it is true that being obese or overweight can still have a negative impact on an individual’s health in health-related areas.

Data shows that stroke, hypertension, diabetes and heart disease are all associated with overweight and obesity. Obesity has become a social problem in China, and reducing weight can significantly reduce the risk of cardiovascular disease in overweight or obese people.

Tips: What is BMI?

Body mass index (BMI) is the square of weight (kg)/height (m). According to the BMI cut point recommended by the World Health Organization (WHO) for Asian populations, weight is classified as follows: <18.5kg/㎡ for wasting; 18.5–22.9kg/㎡ for normal; 23.0–27.4kg/㎡ for overweight; ≥27.5 kg/㎡ is obese.

The current research on the relationship between obesity and stroke is relatively consistent: both increased BMI and abdominal obesity are independent risk factors for stroke.

A prospective national study of 10 populations with a mean follow-up of 24,900 people over 15.2 years showed that the relative risk of ischaemic stroke was 1.03 times greater in overweight and 98% greater in obese compared to normal-weight individuals. Stroke was significantly associated with abdominal body fat in both men and women, but this association was not independent of diabetes, smoking and hypertension.

According to a prospective German study of 3749 people followed up for 9.3 years, abdominal fat distribution is an independent predictor of ischaemic stroke in women. A meta-analysis including 25 observational studies showed that overweight and obese patients had a 22% and 64% increased risk of ischaemic stroke, respectively, compared to the average population.

A Swedish study of 4,000 obese patients followed for 10 to 20 years found that patients who lost weight through surgery, physical activity, and a healthy diet significantly reduced the incidence of diabetes, myocardial infarction, and stroke.

As for the corresponding recommendations, overweight and obese people can reduce their weight through a healthy lifestyle, a good diet, and increased physical activity, which will help control blood pressure and reduce the risk of stroke.

4 A sensible diet is essential: active stroke prevention

Research evidence suggests that a proper diet has a positive effect on stroke prevention. A proper diet can reduce the risk of stroke by controlling many risk factors for stroke, such as essential hypertension, obesity, hyperlipidaemia and diabetes mellitus.

Consumption of foods high in potassium, magnesium, calcium, dietary fiber, unsaturated fatty acids, and low in saturated fatty acids appears to have an effect on lowering blood pressure and LDL cholesterol, as well as controlling obesity and reducing the risk of hyperlipidemia and diabetes mellitus, thereby lowering the risk of stroke.

So how can the average person eat healthily to avoid a stroke? Here are some suggestions to jot down in your notebook.

1 Daily diet should be varied to rationalise energy and nutrient intake; use balanced recipes that include whole grains, mixed legumes, potatoes, fruits, vegetables and dairy products and are low in total and saturated fats.

2 It is recommended that lowering sodium intake and increasing potassium intake is beneficial in lowering blood pressure and thus reducing the risk of stroke. The recommended salt intake is ≤6g/d.

3 Emphasis on increasing the intake of fruit, vegetables and a wide range of dairy products and reducing the intake of saturated and trans-fatty acids; total fat intake should be less than 30% of total calories, and trans fatty acid intake should not exceed 2g per day.

400–500g of fresh vegetables, 200–400g of fruit; appropriate amounts of fish, poultry, eggs and lean meat, with an average total intake of 120–200g; various dairy products equivalent to 300g of liquid milk.

Cooking vegetable oil <25g; control the intake of added sugars (or free sugars, i.e. monomeric sugars added to food, such as rock sugar, white sugar, etc.) to <50g per day, preferably <25g.

In general, physical activity, mental exercise, healthy diet and nutrition, social interaction, adequate sleep and relaxation, and control of vascular risk factors are the six pillars of brain health, and a healthy lifestyle can help the average person stay as safe as possible from cardiovascular disease.

5. Bacterial vector YB1 combined with thrombolytic drugs to enter the field of cardiovascular and cerebrovascular therapy

Of course, in the face of the increasing incidence of cardiovascular disease, it is essential to manage and prevent the disease at the lifestyle level, but it is also essential to seek medical attention as soon as there are signs of the disease.

Take stroke as an example. Antiplatelet coagulation, anticoagulation, and thrombolysis are the primary methods of treating stroke in clinical practice. Anticoagulants and thrombolytics have a relatively large market share in the global antithrombotic drug market. According to developed countries’ development experiences, the market share of domestic anticoagulants and thrombolytics will continue to grow in the future and will become the primary driver of the antithrombotic drug industry’s growth

The current status of conventional thrombolytic drug therapy is that the commonly marketed thrombolytic drugs recombinant urokinase and rt-PA have a short half-life of 4–8 minutes and do not alleviate the onset of acute thrombosis, hence the urgent need for more new drugs or therapies that effectively alleviate and treat acute thrombosis.

Recently, HK Pharma Lysis has been attracting attention from the industry market to develop innovative thrombolytic drugs. The company has developed a biomolecular drug delivery vehicle, YB1, which can carry the thrombolytic enzyme rt-PA to accumulate at the thrombus site and can be released in a targeted manner, solving the problem of its short half-life.

At present, we have laid out three YB1 thrombolytic product pipelines, namely YB1-rt-PA, a first-generation targeted thrombus ablation product, which is mainly characterised by the release of urokinase (Urokinase) through YB1 carriage and at the location of the thrombus to achieve rapid, targeted release of thrombolytic drugs; and YB1-rt-DE and YB1-rt-PL, a product pipeline of YB1 combined with fibrin-lowering enzyme and fibrinolytic enzyme. rt-PL, we hope to make further progress in the development and implementation of these products soon.

In general, it is vital to maintain a healthy lifestyle to avoid cardiovascular diseases. Of course, more innovative thrombolytic drugs like YB1 need to be launched as soon as possible to benefit more potential patients, which is also the responsibility of innovative biotech companies in the industry.