<International Circulation>: Are there any other  hormones or factors you are looking at?

　　《国际循环》：您还关注其他激素或者心血管危险因素吗？

　　Prof. Douglas: Estrogen seems to be the most important. Certainly the androgenic hormones increase in women post-menopausally or they are unopposed. They also increase with some of the breast-cancer adjuvant treatments. There is some emerging that there may be excess CV risk from that and certainly worsening the CV risk profile into a more androgenic lipid pattern and more metabolic syndrome. That is another area of important research and unanswered questions.

　　Douglas教授：雌激素看来是最重要的。当然，对于绝经后女性，或者雄激素没有拮抗的情况下，雄激素的水平也有升高。如果在接受乳腺癌辅助治疗的话，其水平也会升高。雄激素有可能增加心血管风险，使得心血管风险状况恶化为雄激素式血脂模式，使代谢综合征更严重。这是另外一个重要的研究领域，有许多等待回答的问题。

　　<International Circulation>: With your work in imaging， could you talk specifically about cardiac CT and how it compares to other imaging techniques， such as MRI or echocardiography?

　　《国际循环》：关于您在影像学方面的工作，请您介绍心脏CT及其与其他影像学技术，如MRI或超声心动图相比有哪些特点。

　　Prof.  Douglas: There are a couple of areas where we have good evidence for CT. We know that the data is good at excluding disease. This is particularly useful in an emergency room setting. We have had 3 RTCs that have all stated the same thing， namely that CT provides a more efficient throughput in the ER， at no clinical cost: both time and money. That is beneficial， evidence-based view of CT that should be adopted. The three RTCs give it an evidence level of A. In the outpatient setting with stable chest pain， the evidence is not as robust. There is clearly an ability of CT to identify lesions and to risk stratify at a very granular level， more so than conventional stress testing， which is unable to detect sub-clinical lesions and non-ischemia causing lesions. These may contribute to risk stratification even if you may not be able to help in terms of revascularization.  We are performing direct head-to-head comparisons in PROMISE. That trial should provide the evidence to robustly answer your question in the stable chest-pain population. We are still enrolling and enrolling well and we hope to have answer in about a year and a half.

　　Douglas教授：我们在几个领域都有关于CT很好的证据。我们知道CT资料能够很好地排除疾病。尤其是在急诊室环境中非常有用。我们有3个随机临床试验均取得了一致结果，即CT在急诊室的效率更高，节约了时间和花费。循证依据支持使用CT，3个随机临床试验提供了A级证据。对于有稳定型胸痛的门诊患者来说，证据就不够有力。CT无疑具有识别病变的能力以及在粒度级别危险分层的能力，优于传统的负荷试验。负荷试验无法识别亚临床病变以及不引起缺血的病变。CT的这些特点可能有助于危险分层，即使无法通过血管重建治疗帮助患者。我们在PROMISE研究中对CT和负荷试验进行了直接头对头的比较。这个试验可以就稳定型胸痛的人群CT评估的价值给出更有力的证据。这个研究仍在顺利入选患者，我们希望能够在一年半之内获得答案。

　　<International Circulation>: There is some debate between the use of imaging and functional testing. What are your opinions on this debate?

　　《国际循环》：关于影像学和功能检查的使用之间存在一些争论。您对这个争论有何看法？

　　Prof. Douglas: That is what the PROMISE trial is all about: the randomized comparison of CT angiography versus usual stress testing. The majority of the trial is nuclear testing， which reflects current practice. We will find which one to use.

　　Douglas教授：这就是PROMISE试验试图解决的问题，对CT血管造影和负荷试验进行随机比较。试验主要是采用核素显像，反应了当前的实践。我们的研究会发现应当使用哪项检查。

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