CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 1, February 2012
AFRICA
51
Drug Trends in Cardiology
Special report from the 2011 International Diabetes Federation
Getting to the heart of diabetic cardiovascular disease
Dr Andrew P Kengne, epidemiology and
preventionist topic editor, CVJA, based at
theMedical ResearchCouncil, CapeTown
This cardiovascular session, co-chaired by
Profs A Chait and R Eckel (both from the
USA) took place in the Sheikh Maktoum
A auditorium and included eight presenta-
tions, dominated by studies conducted in
Asia, with a single African contribution.
Relationship between adiponectin
and IMT
Serum adiponectin, one of the most
commonly occurring adipokines, has been
shown to be associated with cardiovascu-
lar disease and related risk factors. In the
first communication of this series, Dr
Paul Lee, on behalf of his colleagues from
the University of Hong Kong (China),
presented the results of their study on the
association of serum adiponectin with
carotid intima–media thickness (IMT), a
well-known surrogate marker of cardio-
vascular disease.
Participants were 269 adults (132
men), all members of the Hong Kong
Cardiovascular Risk Factors Prevalence
Study 2 (CRISPS 2) cohort. CRISPS 2
was a community-based cohort study
conducted from 2000 to 2004 as a follow
up of a representative community-based
survey (CRISPS 1) carried out from 1995
to 1996.
Serum adiponectin, IMT and cardio-
vascular risk factors were measured at
baseline. Mean age of participants was 53
±
12 years; 91 had hypertension and 33
had diabetes. Median (interquartile range)
baseline adiponectin level was 5.28 mg/l
(3.29–7.93). During the first five years
of follow up, carotid IMT significantly
increased from 0.62 mm (0.52–0.73) to
0.67 mm (0.57–0.78) (
p
<
0.001).
In linear regression analysis, after
adjustment for several baseline covariates,
the investigators found a modest asso-
ciation between low baseline adiponectin
levels and IMT thickening (
β =
–0.092,
p
=
0.039).
The investigators concluded that meas-
uring adiponectin level would improve
cardiovascular disease risk stratification
at the community level. The study was
however based on a small sample size,
and the investigators did not use meas-
ures of global performance to assess the
contribution of adiponectin level to risk
prediction.
Oxidative stress and vascular
complications of diabetes
There is accumulating evidence on the
important role of oxidative stress on
vascular complications of diabetes melli-
tus. Dr Iso gave a talk on behalf of her
colleagues from the School of Medicine,
Toho University in Japan, on components
of oxidative stress associated with carotid
IMT in people with diabetes.
In all, they included 52 diabetic patients
(17 women) with acceptable levels of
control of blood glucose and blood pres-
sure on a cross-sectional basis. They were
non-smokers and had non-ongoing acute
or chronic inflammatory disease, kidney
impairment or liver disease.
Urine levels of 8-hydroxydeoxyguano-
sine (8-OHdG, a marker of oxidative
DNA damage) and 8-epiprostaglandin
F2a (PGF2-a, a marker of lipid peroxi-
dation), both makers of oxidative stress,
were measured together with inflamma-
tory markers [high-sensitivity C-reactive
protein (hs-CRP)] and other clinical and
biological parameters. Maximum IMT
(max-IMT) was measured by ultrasonog-
raphy. Mean age and duration of diabetes
were 52 and five years, respectively.
In univariable linear regression anal-
ysis, age and PGF2-a were the main
characteristics associated with max-IMT.
These associations were borderline in
multivariable analysis.
The authors concluded that in diabetic
subjectswithacceptablemetabolic control,
oxidative stress may be implicated in the
progression of atherosclerosis in people
with diabetes. This claim however was
based on a small sample size and border-
line association in a cross-sectional design.
Visceral fat and cardiovascular
risk in a Chinese study
Body fat is a determinant of cardiovas-
cular disease risk, and there are sugges-
tions that the distribution of body fat may
contribute differentially to this risk. This
presentation from a group of research-
ers from Shanghai Jiao Tong University
in China was delivered by Dr Ma on the
contribution of visceral fat accumulation
to carotid IMT in a group of 1 005 Chinese
adults. Carotid IMT was quantified by
ultrasonography, and visceral (VFA) and
subcutaneous fat (SFA) were character-
ised through magnetic resonance imaging.
In multiple regression analysis, waist
circumference (an indicator of body fat
distribution) was associated with IMT
while body mass index, a measure of
the overall fat mass, was not. Similarly,
VFA, a more accurate indicator of body
fat distribution, was associated with IMT,
while SFA was not.
The authors suggested that their find-
ings were in agreement with reports from
other studies in the USA and Korea,
and concluded that VFA was effective in
identifying atherosclerosis in both lean
and obese individuals. Since other more
reliable methods for quantifying athero-
sclerosis already exist, this study extends
previous findings from other settings to
China and confirms the thesis of differen-
tial contribution of body fat distribution
to disease risk.
Gastrectomy and atheroscerlosis
progression
This presentation was from a group of
investigators from the Centre for Diabetes
and Endocrinology of Kitano Hospital in
Osaka (Japan) and was delivered by Dr
Wada. They investigated the effects of
gastrectomy on progression of atheroscle-
rosis in adults with diabetes.
They recruited 157 patients with type 2
diabetes, among whom 20 had undergone
a gastrectomy at least five years previ-
ously for cancer eradication. Carotid IMT
