CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 18, ISSUE 5, SEP 2007
- Title: Poverty and human development
: a perspective on cardiovascular disease in
sub-Saharan Africa : editorial
Authors: Brink, A.J.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 281
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Abstract: This issue of the Cardiovascular Journal of Africa is a contribution to the Council of Science Editors' global theme issue on poverty and human development.
- Title: Cardiovascular disease risk
factors and socio-economic position of Africans
in transition : the THUSA study : cardiovascular
topics
Authors: Vorster, H.H.; Kruger, A.; Venter, C.S.; Margetts, B.M.; Macintyre, U.E.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 282-289
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Abstract: In many developing countries with advanced stages of the nutrition transition, the burden of coronary artery disease (CAD) has shifted from the rich to the poor. in South Africa, it is mainly the African population that is experiencing rapid urbanisation and the nutrition transition. it is not clear where the burden of CAD lies in this population group. We tried to answer this question by comparing CAD risk factors within African groups of different socio-economic positions (characterised by total household income and education level) that participated in the THUSA study from 1996 to 1998. The THUSA study was a cross-sectional population- based epidemiological study that examined the influence of urbanisation and related changes in lifestyle and eating patterns on health and disease risk. A total of 1 854 apparently healthy African volunteers were recruited from 37 randomly chosen sites in rural and urban areas of the North-West Province.
The results indicated that although the group with the highest socio-economic position had significantly lower serum glucose levels, systolic blood pressures, higher micronutrient intakes and fewer smokers, their sustained increases in total and saturated fat intakes and higher serum total and lDl cholesterol levels, as well as increased body mass indices in men suggested that at that point in time and possibly in the foreseeable future, the burden of CAD will be carried by those Africans with higher socio-economic positions.
- Title: William Nelson ECG quiz
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 289, 294
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Abstract: This is the ECG of a 72-year-old man.
What was the evidence of dual A-V nodal pathways (before the electrophysiologists were placed on the earth)?
- Title: Prevalence of traditional
cardiovascular risk factors among Nigerians with
stroke : cardiovascular topics
Authors: Karaye, K.M.; Nashabaru, I.; Fika, G.M.; Ibrahim, D.A.; Maiyaki, B.M.; Ishaq, N.A.; Abubakar, L.Y.; Nalado, A.M.; Hassan, M.; Bello, A.K.; Yusuf, S.M.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 290-294
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Abstract: Stroke is an important cause of morbidity and mortality worldwide. The case fatality rates from stroke are two- to three-fold higher in sub-Saharan Africa, including Nigeria, than in the developed world, mainly because of limited healthcare facilities and untreated risk factors. The aim was to determine the prevalence of traditional cardiovascular risk factors among Nigerians with stroke and compare the prevalence of risk factors between young and older adults with stroke.
Methods: The study was cross-sectional in design, and was carried out on stroke patients who were 15 years of age or older, in the medical wards and neurology clinic of Aminu Kano Teaching Hospital, Nigeria. Data was collated consecutively over six months.
Results: A total of 81 patients were studied. Sixteen of them (19.8%) were under 45 years old (group 1) while the remaining 65 patients (80.2%) were 45 years or older (group 2). All patients had at least one risk factor. one-third of group 1 patients (37.5%) and 81.5% of group 2 patients had three or more cardiovascular risk factors (p = 5 0.0004). The most widespread risk factor in all patients, particularly in group 2 patients was systemic hypertension, while dyslipidaemia was most common among group 1 patients. Recurrent stroke was significantly more common among group 2 than group 1 patients (30.8 and 6.3% respectively) (p = 5 0.045).
Conclusion: Cardiovascular risk factors, particularly hypertension and dyslipidaemia were prevalent in the studied patients with stroke. The older patients in group 2 had more multiple-risk factors than the younger ones in group 1. Secondary prevention strategies including detection and treatment of risk factors may curtail the burden of the disease.
- Title: Prevalence and pattern of
rheumatic heart disease in the Nigerian savannah
: an echocardiographic study : cardiovascular
topics
Authors: Sani, Mahmoud U.; Karaye, Kamilu M.; Borodo, Musa M.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 295-299
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Abstract: Background: Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Whereas Africa has 10% of the world's population, as many as half of the 2.4 million children affected by RHD globally live on the continent. RHD accounts for a major proportion of all cardiovascular disease in children and young adults in African countries. While acute rheumatic fever is on the decline even in the developing world, there are still a large number of chronic rheumatic heart disease cases, often complicated by chronic congestive heart failure and recurrent thrombo-embolic phenomena, both posing greater challenges for management. We report on the prevalence and pattern of valve involvement in RHD using echocardiography from our centre.
Methods: in this retrospective study, transthoracic echocardiography (TTE) data collected from two echocardiography laboratories in Kano over a period of 48 months (june 2002 to May 2006) were reviewed. Patients with a diagnosis of rheumatic heart disease were selected. information obtained from the records included the age, gender, clinical diagnosis and echocardiographic diagnoses.
Results: A total of 1 499 echocardiographic examinations were done in the two centres over the four-year study period. one hundred and twenty-nine of the 1 312 patients (9.8%) with abnormal results had an echocardiographic diagnosis of RHD. There were 47 males and 82 females (ratio 1:1.7) and their ages ranged from five to 60 (mean 24.02 + 12.75) years. Mitral regurgitation was the commonest echocardiographic diagnosis present in 49 patients (38.0%). Thirty-six (27.9%) patients had mixed mitral valve disease, 25 (19.5%) had mixed aortic and mitral valve disease, 10 (7.8%) had pure mitral stenosis and four (3.1) had pure aortic regurgitation. Complications of RHD observed included secondary pulmonary hypertension in 103 patients (72.1%), valvular cardiomyopathy in 41 (31.8%), and functional tricuspid regurgitation was seen in 39 (30.2%).
Conclusion: our data show that RHD is still an important cause of cardiac morbidity and a large proportion of the patients already had complications at diagnosis. There is an urgent need to implement the ASAP programme of the Drakensberg declaration to avert this scourge.
- Title: Survey of abdominal obesities
in an adult urban population of Kinshasa,
Democratic Republic of Congo : cardiovascular
topics
Authors: On'kin, J.B. Kasiam Lasi; Longo-Mbenza, B.; Okwe, A. Nge; Kabangu, N. Kangola
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 300-307
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Abstract: Background: The prevalence of overweight / obesity, which is an important cardiovascular risk factor, is rapidly increasing worldwide. Abdominal obesity, a fundamental component of the metabolic syndrome, is not defined by appropriate cutoff points for sub-Saharan Africa.
Objective: To provide baseline and reference data on the anthropometry / body composition and the prevalence rates of obesity types and levels in the adult urban population of Kinshasa, DRC, Central Africa.
Methods: During this cross-sectional study carried out within a random sample of adults in Kinshasa town, body mass index, waist circumference and fatty mass were measured using standard methods. Their reference and local thresholds (cut-off points) were compared with those of WHo, NCEP and ifD to define the types and levels of obesity in the population.
Results: From this sample of 11 511 subjects (5 676 men and 5 835 women), the men presented with similar body mass index and fatty mass values to those of the women, but higher waist measurements. The international thresholds overestimated the prevalence of denutrition, but underscored that of general and abdominal obesity. The two types of obesity were more prevalent among women than men when using both international and local thresholds. Body mass index was negatively associated with age; but abdominal obesity was more frequent before 20 years of age and between 40 and 60 years old. local thresholds of body mass index (≥ 23, ≥ 27 and ≥ 30 kg/m2) and waist measurement (≥ 80, ≥ 90 and ≥ 94 cm) defined epidemic rates of overweight / general obesity (52%) and abdominal obesity (40.9%). The threshold of waist circumference ≥ 94 cm (90th percentile) corresponding to the threshold of the body mass index ≥ 30 kg/m2 (90th percentile) was proposed as the specific threshold of definition of the metabolic syndrome, without reference to gender, for the cities of sub-Saharan Africa.
Conclusion: Further studies are required to define the optimal threshold of waist circumference in rural settings. The present local cut-off points of body mass index and waist circumference could be appropriate for the identification of Africans at risk of obesity-related disorders, and indicate the need to implement interventions to reverse increasing levels of obesity.
- Title: A clinical study of pattern
and factors affecting outcome in Nigerian
patients with advanced heart failure :
cardiovascular topics
Authors: Familoni, O.B.; Olunuga, T.O.; Olufemi, B.W.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 308-311
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Abstract: Background: Advanced heart failure (AHf) accounts for about 25% of all cases of heart failure in Nigeria and is associated with a high mortality rate.
Objective: To undertake a clinical study of the pattern and outcome of AHf in our hospitalised patients and to determine the parameters associated with mortality and survival in these patients.
Method: Eighty-two patients with AHf were studied between january 2003 and December 2005. Baseline blood chemistry and haemodynamics were determined. A congestion score, including orthopnoea, elevated jugular venous pressure, oedema, ascites and loud P2, was derived as well as a low perfusion score. Mortality was computed and risk estimated using the Pearson coefficient and log-ranking test. Cox regression analysis was used to identify the predictors of survival.
Results: AHf accounted for 43.6% of all hospitalised heart failure patients, with a total mortality of 67.1%. Hypertension was the commonest cause of AHf. The parameters associated with increased mortality rates included age (r = 5 0.671; p = 5 0.02), presence of atrial fibrillation (r = 5 0.532; p = 5 0.045) and estimated glomerular filtration rate (r = 5 20.486, p = 5 0.04). The majority of patients (54.8%) were in the 'wet and cold' congestion category. The congestion score correlated with mortality. The indices of survival included lower age, lower systolic blood pressure, being literate and lower congestion score.
Conclusion: AHf was common in our cohorts of hospitalised heart failure patients and it was associated with a high mortality rate.
- Title: Race and gender
representation of hypertrophic cardiomyopathy or
long QT syndrome cases in a South African
research setting : review article
Authors: Heradien, M.; Goosen, A.; Moolman-Smook, J.C.; Brink, P.A.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 312-315
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Abstract: We researched hypertrophic cardiomyopathy (HCM) and long QT syndrome (lQTS) as models for studying the pathophysiology of arrhythmias and hypertrophy, and in the process we have had the opportunity to compare local disease profiles with global patterns.
We trawled our database entries over the past 20 years to identify all cases of heart muscle and arrhythmic disease. Among these, we separated the index cases from the rest of their family members, segregating for the relevant heart disease, so that numbers were not biased by family size, and analysed the race and gender composition of the HCM and lQTS sectors.
The majority of HCM index cases (n = 90, 51.1% of HCM index cases) were of mixed ancestry (MA), with white Caucasian ancestry following closely behind with 74 cases (42.0%); only a few black African (n = 9, 5.1%) or indian/Asian (n = 3, 1.7%) cases were seen or referred. The lQTS index cases were almost exclusively white Caucasian (n = 36, 88% of lQTS index cases), with four cases (9.8%) of MA, one (2.4%) of indian / Asian and none of black African descent. These race demographics did not fit the national demographics for South Africa as a whole. in contrast, in both groups, gender biases (slightly more male than female HCM cases, and a 0.4 ratio of males to females in lQTS) previously reported elsewhere appeared to be replicated in our database.
Genetic bias is an unlikely explanation for the skewed demographics in our database; a more likely explanation relates to various missed opportunities to diagnose, missed diagnoses and misdiagnoses, as well as the real population drainage of our main referral centre in the context of a differentiated healthcare system.
- Title: How well do we know the
opioids for providing goodanalgesia?,
Cardiovascular Journal of Africa, 18(5) 2007 :
pp. 261-264 : erratum
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 315
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Abstract: We regret a typographical error in Cardiovasc J Afr 2007; 18(4): 262
- Title: Impact of poverty on
hypertension and cardiovascular disease in
sub-Saharan Africa : review article
Authors: Seedat, Y.K.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 316-320
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Abstract: Sub-Saharan Africa (SSA) has huge amounts of natural resources and a source of strategic minerals. it is not overpopulated compared to the Asian continent, yet the economic conditions have deteriorated alarmingly in recent years. it is the poorest continent and has the lowest per capita income in the world. An analysis of the causes of poverty and its impact on health, particularly cardiovascular diseases (CvD) and hypertension, was carried out and is reported on here.
A 'second-wave epidemic' is currently sweeping through SSA, other developing countries and Eastern Europe, making a comprehensive CvD programme necessary. Social, economic and cultural factors impair the control of hypertension, diabetes, obesity, tobacco use and other risk factors for CvD in SSA. Primary prevention through a population-based, lifestyle-linked programme, as well as cost-effective methods for detection and management are synergistically linked. The existing healthcare infrastructure needs to be orientated to meet the challenge of CvD, while empowering the community through health education.
- Title: Poverty, malnutrition,
underdevelopment and cardiovascular disease : a
South African perspective : review article
Authors: Vorster, H.H.; Kruger, A.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 321-324
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Abstract: This article explores possible mechanisms to explain the known relationships between poverty, undernutrition, underdevelopment and cardiovascular disease (CvD) in developing countries. Poverty is a multidimensional concept. it is both a cause and consequence of undernutrition. The article shows how malnutrition during pregnancy could lead to low birth-weight babies, who are not only at increased risk of mental and physical underdevelopment, but also 'programmed' to be at increased risk of CvD and other noncommunicable diseases in adult life. The underdevelopment leads to decreased 'human capital and competence' with an inability to create food security and an enabling environment for self and family to escape poverty and undernutrition in the next generation.
It is accepted that a lack of education and knowledge in the poor for primary prevention of CvD through healthy eating patterns and lifestyles, as well as limited access to healthcare services for secondary prevention and treatment contribute to CvD. This article postulates that the link between poverty and CvD in South Africa can be explained by the high prevalence of undernutrition in one- to nineyear- old children (9% underweight, 23% stunted and 3% wasted), the high prevalence of overweight and obesity in adults (54.5% in white men and 58.5% in African women) as well as the negative trends in nutrient intakes when Africans (the population group with the largest numbers of poor people) urbanise, acculturate and adopt westernised eating patterns that will increase CvD risk.
In conclusion, we plead for a holistic, integrated but transdisciplinary and multisectorial approach to break the vicious circle of poverty and undernutrition for the longterm prevention of CvD.
- Title: A multicentre, open-label,
observational local study to evaluate the
low-density lipoprotein cholesterol-lowering
effect of ezetimibe as prescribed in daily
routine practice in the South African population
: cardiovascular topic
Authors: Raal, Frederick; Schamroth, Colin; Patel, Jai; Becker, Piet
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 325-329
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Abstract: Objective: The study examined the efficacy, safety and tolerability of co-administering the cholesterol absorption inhibitor, ezetimibe 10 mg with ongoing statin therapy in hypercholesterolaemic patients.
Patients and methods: In this multicentre, open-label, observational study, hypercholesterolaemic patients (from 44 South African speciality practices) on statin therapy were screened and after meeting the inclusion criteria, all received ezetimibe (10 mg/day) in addition to their ongoing statin therapy for four weeks.
Results: In 358 patients, ezetimibe co-administered with ongoing statin therapy significantly reduced the low-density lipoprotein cholesterol (LDL-C) level by an additional 21.9% in the total population. In the secondary-prevention patients (category 1 cardiovascular risk according to ESC guidelines adopted for South Africa), an additional 20.4% reduction was observed, and a 25.5% additional reduction for the primary-prevention patients (category 2 cardiovascular risk according to ESC guidelines adopted for South Africa). These results were consistent across gender, race, age, statin brand and dose subgroups. Ezetimibe co-administered with ongoing statin therapy also increased the number of patients reaching their LDL-C goals according to their risk category (2.5 mmol/l for category 1 patients and 3.0 mmol/l for category 2 patients). Ezetimibe-plus-statin therapy was well tolerated, with a good safety profile.
Conclusion: Ezetimibe co-administered with ongoing statin therapy consistently produced significant additional improvements in lDl-C levels and goal attainment. This was observed for the whole population as well as for the two risk categories. The addition of ezetimibe to ongoing statin therapy may be considered for patients not achieving their LDL-C goals on conventional statin therapy.
- Title: Focus on metformin - a major
cardiovascular medication : 'diabesity - the
biggest epidemic in human history' :
cardiovascular prescriber
Authors: Straughan, John L.
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 331-333
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Abstract: Diabetes mellitus is a major progressive, inflammatory and degenerative cardiovascular disease and 80% of deaths in persons with diabetes are attributed to cardiovascular repercussions, particularly ischaemic heart disease. Insulin resistance and insulin inadequacy are prominent underlying dysfunctions.
- Title: Multiple impacts of
rimonabant on cardiometabolic risk and safety
addressed at ESC congress, Vienna : drug trends
in cardiology
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 336-337
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Abstract: The multiple impacts of rimonabant in reducing overall cardiometablic risk are exciting and offer a novel approach to lowering cardiovascular risk in patients with abdominal obesity, dyslipidaemia and type 2 diabetes.
- Title: Renal and stroke protection
in hypertensive patients at CV risk : drug
trends in cardiology
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 337, 340
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Abstract: Inhibition of the renin-angiotensin system (RAS) by angiotensin receptor blockers (ARBs) has been demonstrated to have renoprotective effects over and above those achieved by blood pressure reduction alone.
- Title: The relationship of lower
heart rate to mortality and the benefits of
exclusive heart rate reduction in ischaemia :
drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 338, 340
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Abstract: The importance of managing heart rate to limit or prevent myocardial ischaemia was stressed by Prof Kim Fox of the Royal Brompton Hospital at a special symposium for delegates attending the recent ESC congress in Vienna.
- Title: ADVANCE trial of great
importance in preventing cardiovascular deaths
in type 2 diabetes : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 343-344
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Abstract: The results of the ADVANCE trial, the largest trial centred on blood pressure lowering and the prevention of adverse event in type 2 diabetic patients have shown that the combination of perindopril / indapamide (Coversyl Plus), when added to existing treatments, significantly lowers cardiovascular mortality and extends renal protection in these patients.
- Title: Advancing the science of
aspirin in primary prevention of vascular events
: drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 18, Issue 5, Sep / Oct
Published: 2007
Pages: 347348
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Abstract: Underutilisation of aspirin, the most well-researched and cost-effective therapy in preventive cardiovascular medicine, will come under increased scrutiny as the Bayer Healthcare-sponsored ARRIVE study gathers momentum across the globe.
