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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020
AFRICA
57
As always, contributors continue to provide an eclectic array
of submissions to CVJA, which I hope provide something
of interest to readers from diverse backgrounds with varying
interests.
As an official journal of PASCAR, it is a pleasure to
be able to publish the results of the PASCAR and World
Heart Federation Cardiovascular Diseases Scorecard project
for Cameroon, prepared by Dzudie and colleagues (page 103).
The objective of the scorecard is to create a clear picture of the
current state of cardiovascular disease prevention, control and
management, accompanied by similar information on related
non-communicable diseases in 12 African countries. The authors
have successfully achieved the aims of the project for Cameroon
and the article should be a useful asset for researchers, clinicians
and those planning health resources, both in that country and
the continent. Similar scorecard reports for other countries are
eagerly awaited.
Emet and co-workers (page 75) report on a non-invasive
technique based on the surface ECG measurement of the
P-wave. They consider that heterogeneity in atrial conduction,
seen as a variation in P-wave duration between differently
orientated surface electrocardiogram (ECG) leads, called P-wave
dispersion (PwD), is an easily calculated ECG parameter that
can be used to predict increased atrial strain and indicates a
poor prognosis in patients with pulmonary arterial hypertension
(PAH). They report their experience in 32 patients and a similar
number of healthy controls. They conclude that PwD can easily
be calculated from a surface ECG to estimate the functional
status and prognosis of the patient with PAH. Multiple other
factors may influence P-wave duration, including left-sided heart
disease, excluded in this series, and this non-invasive technique
requires validation in a larger cohort before it can be accepted
for widespread application.
Norman, Woodiwiss and others (page 91) remind us that
chronic kidney disease (CKD) is a major public health problem
and not only progresses to end-stage renal disease, but also
predicts cardiovascular events beyond conventional risk factors.
In a community-based study of participants over 16 years of age
in an urban setting, where obesity was common, they investigated
risk factors for the development of CKD. Information such as
they provide is important if implementation of preventative
measures may be able to slow the progression to CKD. This
is particularly important in Africa where resources for renal
replacement therapy are severely limited.
Opinion has it that consumption of rooibos tea confers health
benefits. To my knowledge there are no properly conducted
clinical trials supporting this opinion but it is a view held very
strongly by some. In a series of elegant experiments in an
animal model, Smit-van Schalkwyk and co-workers (page 81)
show rooibos co-treatment exerted beneficial vascular effects
in nicotine-exposed rats, and that this was associated with
increased antioxidant enzyme activity. However it is a long
way from animal experimentation to clinical application and
there is a need for a properly conducted clinical trial to explore
the alleged health benefits of rooibos. Until that is conducted
and published, rooibos will remain, in the opinion of some, a
pleasant, unusually flavoured and refreshing drink.
Lionel Opie was arguably one of the foremost cardiovascular
researchers on the continent and it is fitting that we publish the
excellent tribute from Ntusi (page 80).
I am overwhelmed, not only by the scale and severity of
the devastating COVID-19 pandemic, but also by the flood of
information and literature that accompanies it. Much of this
has been rushed into publication and it is difficult to evaluate
prior to careful review and commentary from learned colleagues
knowledgeable in these areas, which are new to many of us,
myself included. It also seems that clinical trials of treatments
that are unlikely candidates for cure are being planned or are
underway. Inevitably the knowledge that a medicine is in trial is
often misinterpreted by both medical and non-medical persons as
meaning that the medicine has value in a particular circumstance.
As we all know, well-planned, adequately powered, randomised,
double-blind, placebo-controlled trials remain the gold standard
and the results of such trials should be awaited before embracing
potentially harmful treatments of unproven benefit.
Pat Commerford
Editor-in-Chief
From the Editor’s Desk