International Circulation:  Translating clinical practice guidelines into routine clinical practice remains difficult.  For the secondary prevention of cardiovascular disease， what do you think are the main reasons for the gap between actual practice and what guidelines recommend?

Sidney Smith:  Let me start by saying that I have been very honored to be invited to the 20th Anniversary of the Great Wall Meeting and 15th Anniversary of the Pharmaceutical Meeting.  We have been working very hard in the United States to close the gap between patients who should be treated and patients who are being treated.  We have seen more and more patients get treated and， in fact， as more patients are treated according to the guidelines， we see fewer cardiovascular events.  Clearly the treatment works.  We still have to look at why some patients don’t take the medicine.  Maybe it is because they cannot afford the medicine. Maybe the doctor forgets to tell them they should take it. Maybe they just don’t like to take pills and they stop.  Even though we have made tremendous progress， we still have a lot more work to do.  We have an excellent project in China which Prof. Zhao Dong is leading looking at secondary prevention guidelines in 65 hospitals all over China.  We have seen in that project an increase in the use of medicines in China.  One of the interesting problems we have come up against is that when patients leave the hospital they are more likely to take their medicine then.  But when they go to physicians who were not taking care of them in the hospital， the physicians may stop it.  We are working now in both the United States and China on outpatient treatment.