41 / 74
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 6, November/December 2018
AFRICA
373
via alterations in heart rate variability: the SABPA study.
Atherosclerosis
2013;
227
(2): 391–397.
26. Schoenthaler A, Lancaster K, Midberry S,
et al.
The FAITH trial: base-
line characteristics of a church-based trial to improve blood pressure
control in blacks.
Ethn Dis
2015;
25
(3): 337.
27. Bible. Paul’s first letter to the Corinthians. The Bible: new international
version. Grand Rapids: Zondervan. 1987, 12(14–20): 1817.
28. Chun M, Knight BG, Youn G. Differences in stress and coping models
of emotional distress among Korean, Korean-American and White-
American caregivers.
Aging Ment Health
2007;
11
(1): 20–29.
29. Sesso HD, Cook NR, Buring JE,
et al.
Alcohol consumption and the
risk of hypertension in women and men.
Hypertension
2008;
51
(4):
1080–1087.
30. Wentzel A, Malan L, Scheepers JD,
et al.
QTc prolongation, increased
NT-proBNP and pre-clinical myocardial wall remodelling in excessive
alcohol consumers: The SABPA study.
Alcohol
2018;
68
: 1–8
31. Pengpid S, Peltzer K, Skaal L. Efficacy of a church-based lifestyle inter-
vention programme to control high normal blood pressure and/or high
normal blood glucose in church members: a randomized controlled trial
in Pretoria, South Africa.
BMC Public Health
2014;
14
(1): 568.
32. Kudo R, Yuui K, Kasuda S,
et al.
Effect of alcohol on vascular function.
Jap J Alcohol Drug Depen
2015;
50
(3): 123–134.
33. Oosthuizen W, Malan L, Scheepers JD,
et al.
The defense response and
alcohol intake: a coronary artery disease risk? The SABPA Study.
Clin
Exper Hypertens
2016;
38
(6): 526–532.
34. Hamer M, Malan L. Psychophysiological risk markers of cardiovascu-
lar disease.
Neurosci Biobehav Rev
2010;
35
(1): 76–83.
35. Ozbay F, Johnson DC, Dimoulas E,
et al.
Social support and resilience
to stress: from neurobiology to clinical practice.
Psychiatry (Edgmont)
2007;
4
(5): 35.
36. Maphosa C, Shumba A. Educators’ disciplinary capabilities after the
banning of corporal punishment in South African schools.
S Afr J Educ
2010;
30
(3).
37. Meng L, Chen D, Yang Y,
et al.
Depression increases the risk of
hypertension incidence: a meta-analysis of prospective cohort studies.
J
Hypertens
2012;
30
(5): 842–851.
38. Scuteri A, Spazzafumo L, Cipriani L,
et al.
Depression, hypertension,
and comorbidity: disentangling their specific effect on disability and
cognitive impairment in older subjects.
Arch Gerontol Geriatr
2011;
52
(3): 253–257.
39. Mukherjee S. Alcoholism and its effects on the central nervous system.
Curr Neurovasc Res
2013;
10
(3): 256–262.
40. Möller M, Malan L, Mels CM,
et al
. Defensive coping and essential
amino acid markers as possible predictors for structural vascular
disease in an African and Caucasian male cohort: The SABPA study.
Psychophysiology
2017;
54
(5): 696–705.
Statins don’t reduce cardiovascular disease risk in healthy older people
Statins are not associated with a reduction in cardiovascular
disease (CVD) or death in healthy people aged over 75 years,
finds a recent study. However, in those with type 2 diabetes,
statins were related to a reduction in cardiovascular disease
and death from any cause up to the age of 85 years.
The results of the study, led by the University Institute for
Primary Care Research Jordi Gol (IDIAPJGol) and Girona
Biomedical Research Institute (IDIBGI), do not support the
widespread use of statins in old and very old people, but they
do support treatment in selected people, such as those aged
75 to 84 years with type 2 diabetes, say the researchers.
Cardiovascular disease is the leading cause of death
globally, especially for those aged 75 years and over. Statin
prescriptions to elderly patients have increased in recent
decades, and trial evidence supports statin treatment for
people aged 75 years or older with existing heart disease
(known as secondary prevention).
Evidence on the effects of statins for older people without
heart disease (known as primary prevention) is lacking,
particularly in those aged 85 years or older and those with
diabetes. So, researchers based in Spain set out to assess
whether statin treatment is associated with a reduction in
cardiovascular disease and death in old (75–84 years) and very
old (85 years and over) adults with and without type 2 diabetes.
Using data from the Catalan primary care system database
(SIDIAP), they identified 46 864 people aged 75 years or
more with no history of cardiovascular disease between 2006
and 2015. Participants were grouped into those with and
without type 2 diabetes and as statin non-users or new users
(anyone starting statins for the first time during the study
enrolment period). Primary care and hospital records were
then used to track cases of CVD (including coronary heart
disease, angina, heart attack and stroke) and death from any
cause (all-cause mortality) over an average of 5.6 years.
In participants without diabetes, statin treatment was not
associated with a reduction in CVD or all-cause mortality
in both old and very old age groups, even though the risk
of CVD in both groups was higher than the risk thresholds
proposed for statin use in guidelines. In participants with
diabetes, however, statins were associated with significantly
reduced levels of CVD (24%) and all-cause mortality (16%)
in those aged 75–84 years. But this protective effect declined
after age 85 and disappeared by age 90.
This was an observational study, so no firm conclusions
can be drawn about cause and effect, and the authors cannot
not rule out the possibility that some of their results may be
due to unmeasured (confounding) factors.
But they point out that this was a high-quality study with
a large sample size, reflecting real-life clinical conditions.
Therefore they concluded that their results do not support
the widespread use of statins in old and very old populations,
but they do support treatment in those with type 2 diabetes
younger than 85 years.
In a linked editorial, Aidan Ryan at University Hospital
Southampton and colleagues, say the biggest challenge for
clinicians is how to stratify risk among those agedmore than 75
years to inform shared decision making. These observational
findings should be tested further in randomised trials, they
write. In the meantime, they say ‘patient preference remains
the guiding principle while we wait for better evidence.’
Source:
Medical Brief 2018