CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 21, ISSUE 1, JANUARY 2011
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- Title: Do inhibitors of the
renin-angiotensin system prevent chronic kidney
disease? : editorial
Authors: Rayner, Brian
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: The world is facing an epidemic of chronic kidney disease (CKD) and in South Africa, death rates from end-stage renal disease (ESRD) have risen by 68% from 1999 to 2006. The major drivers of this epidemic are type 2 diabetes (T2D) and / or hypertension. All major guidelines recommend ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for the prevention of CKD. Recently, two important studies have reported no benefit on renal outcome in patients at high cardiovascular risk or in patients with type 1 diabetes receiving renin-angiotensin system (RAS) inhibitors, and commentators have questioned the validity of the guideline recommendations.
To improve our interpretation of studies of renal disease there needs to be a better understanding of renal physiology and 'hard' renal versus surrogate endpoints.
- Title: Holistic Heart Care - SA
Heart Congress 2010
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Holistic Heart Care - SA Heart Congress 2010
Clinical & Interventional Cardiology
Enhancing your day to day care, expanding your horizons
8 -11 August, Sun City, South Africa
- Title: The simplified modification
of diet in renal disease equation as a predictor
of renal function after coronary artery bypass
graft surgery : cardiovascular topics
Authors: Swart, M.J.; Bekker, A.M.; Malan, J.J.; Meiring, A.; Swart, Z.; Joubert, G.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Background : After open-heart surgery, a percentage of patients have impaired renal function. This deterioration is even seen in patients with serum creatinine (s-creatinine) values that fall within the normal laboratory range, therefore s-creatinine is not an accurate reflection of renal function. Glomerular filtration rate (GFR) is a better indication of renal status. GFR can be calculated with the simplified modification of diet in renal disease (MDRD) equation - a formula that takes age, gender, race and s-creatinine level into account. The purpose of this study was to investigate the relationship between estimated GFR pre-operatively and renal impairment post-operatively.
Methods : All patients who had an isolated coronary artery bypass graft (CABG) done by one surgeon in one hospital between January 2005 and October 2007 had their s-creatinine levels determined pre-operatively. Using a computer desktop calculator, the patient's age, gender and race were used together with the s-creatinine value to estimate the GFR. Prior to CABG, all patients were grouped into the five stages of chronic kidney disease. Renal outcome post-operatively was compared with the estimated pre-operative GFR.
Results : Nineteen per cent of the 451 patients had chronic kidney disease pre-operatively, as defined by the National Kidney Foundation, according to their estimated GFR. Twenty-three per cent of these patients had renal impairment after surgery. Of the patients with reasonable renal function pre-operatively only 4% had further deterioration of renal function. Mortality did not differ significantly, but patients with postoperative renal impairment stayed in hospital on average 2.4 days longer than those who had no renal impairment post-operatively.
Conclusions : Patients with chronic kidney disease before CABG have a six times greater chance of developing further renal impairment post-operatively than those with reasonable renal function beforehand. There is therefore a significant relationship between estimated GFR before CABG and deterioration of kidney function after surgery. The GFR, as calculated with the simplified MDRD, is a predictor of the risk of having renal dysfunction after CABG.
- Title: Tracking of lipids in
schoolchildren : a four-year follow-up,
population-based study in Sousse (Tunisia) :
cardiovascular topics
Authors: Harrabi, I.; Maatoug, J.; Gaha, R.; Limam, K.; Essoussi, A.S.; Ghannem, H.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Objective : Dyslipidaemia, which is now seen as one of the most important cardiovascular risk factors, is becoming more common in the younger population. The aim of this study was to assess the efficacy of tracking serum lipid levels over a four-year period in an urban population of schoolchildren.
Methods : The study began in 1999 with a cohort of 789 schoolchildren. Four years later this group was resurveyed and a further 452 adolescent were recruited to the study.
Results : The percentages of boys who were initially in the extreme quartile for total cholesterol (TC), low-density lipoprotein (LDL) cholesterol and triglycerides were 42.5, 54.8 and 40.4%, respectively. Similarly, the percentages of girls in the extreme quartile were 62.7, 53.8 and 38.2%. Four years later, both the boys and girls were still in the extreme quartile for these parameters. Therefore, the best predictor of follow-up level for each of the serum lipoprotein cholesterol fractions was the corresponding baseline level. Interestingly, the next best predictor in most of the groups was change in body mass index (∆BMI) and smoking status.
Conclusion : Prevention of coronary heart diseases in adults must begin early on in childhood, and should be driven by health education towards achieving a healthy lifestyle.
- Title: The effect of ambient
temperature on blood pressure in a rural West
African adult population : a cross-sectional
study : cardiovascular topics
Authors: Kunutsor, Setor K.; Powles, John W.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Introduction : Associations between ambient temperature and blood pressure have been demonstrated in countries where the temperature varies between the seasons. This phenomenon has been overlooked in blood pressure surveys in sub-Saharan Africa. We assessed the effect of ambient temperature on blood pressure in an adult population in a West African country.
Methods : A cross-sectional survey was carried out on a rural Ghanaian population, investigating the effect of ambient temperature on blood pressure in 574 randomly sampled adults aged between 18 and 65 years.
Results : There was a significant inverse relationship between ambient temperature and systolic (SBP) (p < 0.019) and diastolic blood pressure (DBP) (p < 0.036). SBP fell by 5 mmHg per 10°C rise in ambient temperature.
Conclusion : Higher ambient temperatures are associated with lower blood pressures. To enhance comparability of data from epidemiological surveys, ambient temperature should be recorded for each blood pressure reading and findings standardised to a fixed ambient temperature.
- Title: Relationship between left
ventricular geometric pattern and systolic and
diastolic function in treated Nigerian
hypertensives : cardiovascular topics
Authors: Akintunde, Adeseye A.; Familoni, Oluranti B.; Akinwusi, Patience O.; Opadijo, O. George
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Introduction : Despite a high worldwide prevalence of left ventricular hypertrophy among black patients, the association of a specific left ventricular geometric pattern with left ventricular dysfunction is rare. The aim of this study was to explore the possibility of such an association in Nigerian hypertensives.
Methods : This was a retrospective study consisting of 188 treated hypertensives. Echocardiography was used to allocate the patients to the following four groups : normal geometric pattern, concentric remodelling, eccentric hypertrophy and concentric hypertrophy.
Results : The mean age of the study population was 55.95 ± 10.71 years. There were 75 females (39.9%). Concentric hypertrophy occurred in 72 (38.3%) patients and concentric remodelling in 53 (28.2%). Only 30 (16%) had a normal left ventricular geometric pattern. Hypertensive subjects with eccentric hypertrophy had the lowest ejection fraction, fractional fibre shortening and left ventricular ejection time but these did not reach statistical significance. The mean left atrial dimension was highest in the subjects with eccentric hypertrophy.
Conclusion : In this study population of treated Nigerian hypertensives, concentric remodelling and hypertrophy were the predominant left ventricular geometrical patterns.
- Title: Tribute to Prof Tshimbi
Mathivha : in memoriam
Authors: Ker, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: The news of Prof Tshimbi's untimely death shocked all who were closely associated with her and also the wider cardiology and medical community.
- Title: A prevalence of
cardiometabolic risk factors among a rural
Yoruba south-western Nigerian population : a
population-based survey : cardiovascular topics
Authors: Oladapo, O.O.; Salako, L.; Sodiq, O.; Shoyinka, K.; Adedapo, K.; Falase, A.O.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Background : It has been hypothesised that rural sub-Saharan Africa is at an early stage of epidemiological transition from communicable to non-communicable diseases (NCD). Limited information exists about the prevalence of cardiometabolic risk factors and the burden of cardiovascular disease (CVD) in the adult Nigerian population, especially in the rural setting.
Objectives : The aim of this study was to assess and describe the prevalence of several cardiometabolic risk factors in the sub-Saharan adult population of a rural Yoruba community, living in south-western Nigeria.
Methods : The study was a descriptive, cross-sectional, random-sample survey. Participants were visited at home by trained nurses and community health extension workers (CHEW) who administered a questionnaire, took the relevant history, carried out clinical examinations and measurements and took samples for laboratory tests. They were supervised by primary healthcare physicians serving the community. The variables recorded comprised clinical history, CVD risk factors including blood pressure (BP), body mass index (BMI), waist circumference, blood sugar and serum lipid levels, cigarette use, and dietary habits. The participants included 2 000 healthy adults aged 18 to 64 years who had been living in the area for more than three years.
Results : The average age was 42.1 ± 21.6, with 43.7% (873) being males and 56.3% (1127) females; 20.8% were hypertensive with BP ≥ 140/90 mmHg, 42.3% of the men and 36.8% of the women had BP ≥ 130/85 mmHg; 2.5% had diabetes, 1.9% had hypertriglycerideaemia, 43.1% had low HDL-C, 3.9% had general obesity, 14.7% had abdominal obesity, 3.2% were physically inactive, and 1.7% smoked cigarettes. Overall, 12.9% of the subjects were found to have at least one CVD risk factor. Using the Adult Treatment Panel (ATP) III criteria, 2.1% of men and 2.7% of women in the study population had at least three of the criteria, the commonest being HDL-C < 40 mg/dl in men or < 50 mg/dl in women, followed by BP ≥ 130/85 mmHg, then waist circumference > 88 cm in women or > 102 cm in men, followed by blood glucose ≥ 110 mg/dl.
Conclusion : The results obtained from this study strongly suggest a high prevalence of cardiometabolic risk factors in this rural population and that the epidemiological transition is not restricted to the urban population. This serves as a wake-up call for action in the planning of health services for the management of CVD and other chronic NCDs.
- Title: Cardiac abnormalities and
facial anthropometric measurements in children
from the Free State and Northern Cape provinces
of South Africa with chromosome 22q11.2
microdeletion : cardiovascular topics
Authors: Brown, S.C.; Henderson, B.D.; Buys, D.A.; Theron, M.; Long, M.A.; Smit, F.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Introduction : Microdeletions of chromosome 22 are common and have a prevalence of at least 1/4 000. Cardiac abnormalities, abnormal facial features and palatal abnormalities are frequently present in these patients.
Aim : To describe the cardiac lesions and selected measurable facial features in children from the Free State and Northern Cape presenting at the Cardiology Unit of the Universitas Academic Hospital complex in Bloemfontein.
Methods : This was a prospective study in which patients with abnormal facial characteristics were tested using a fluorescence in situ hybridisation (FISH) probe for the 22q11.2 microdeletion. Forty children tested positive for the microdeletion. All patients underwent an echocardiogram and where possible, facial anthropometric measurements were performed.
Results : The median age at diagnosis was 3.6 years (range 0.04 years, i.e. 2 weeks to 16.2 years). Tetralogy with or without pulmonary atresia was diagnosed in 43% (n = 17) of the children and truncus arteriosus in 20% (n = 8). A right-sided aortic arch was present in 43% (n = 17) of the patients. Mid-facial height was slightly longer (median z = 1.0; range -0.5 to 3.3) and width narrower (median z = -1.4; range -2.2 to 0.1) than normal. Ear height and width were notably small compared to normal, with median z-scores = -3.3 (range -4.8 to -2.6) and z = -2.4 (range -3.4 to -1.4), respectively.
Conclusions : Microdeletions of chromosome 22q11 are present in children from the Free State and Northern Cape. Conotruncal cyanotic heart lesions, especially tetralogy with or without pulmonary atresia and truncus arteriosus were the most frequent congenital cardiac diagnoses. A right-sided aortic arch was also commonly present in these children. Facial features varied and small ears were the most noteworthy anthropometric feature. A right-sided aortic arch with or without a congenital cardiac lesion, a long, narrow mid-face and small ears should alert the physician to the possibility of a microdeletion on the long arm of chromosome 22.
- Title: The effect of
hypoxia-inducible factor 1-alpha on
hypoxia-induced apoptosis in primary neonatal
rat ventricular myocytes : cardiovascular topics
Authors: Zhou, Yan-Fang; Zheng, Xiao-Wei; Zhang, Guo-Hui; Zong, Zhi-Hong; Qi, Guo-Xian
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Aim : To study the role of hypoxia-inducible factor 1-alpha (HIF-1ʅ) on hypoxia-induced apoptosis in primary neonatal rat ventricular myocytes.
Methods : Primary neonatal rat ventricular myocytes were exposed to hypoxia for 24 hours. HIF-1α activity was suppressed by treating the cells with 3-(5'-hydroxymethyl-2'-furyl)-1-benzyl indazole (YC-1). The degree of cell apoptosis was assessed by Hoechst 33258 DNA staining. The levels of HIF-1α and the pro-apoptotic proteins Bnip3, Bax and Bad were measured with western blotting.
Results : On exposure to hypoxia, there was an increase in the expression levels of HIF-1α, and the pro-apoptotic protein Bnip3 was upregulated. Suppression of HIF-1α activity by YC-1 treatment was followed by blockade of hypoxia-induced apoptosis and Bnip3 expression; however, the changes in the levels of Bax and Bad expression were unclear.
Conclusion : Acute hypoxia enhanced primary neonatal rat ventricular myocyte apoptosis through the activation of HIF-1α and a mechanism that perhaps involved Bnip3. Targeting HIF-1α may be a new strategy for reducing the degree of hypoxia-induced apoptosis in ventricular myocytes.
- Title: Is fenofibrate a cost-saving
treatment for middle-aged individuals with type
2 diabetes? A South African private-sector
perspective : cardiovascular topics
Authors: Wessels, Francois
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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DOI: 10.5830/CVJA-2010-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-001
Abstract: Introduction : This project was based on the FIELD trial. It is a localisation of the study by Carrington and Stewart. The aim of the original study was to determine the impact of fenofibrate therapy on healthcare costs of middle-aged patients with type 2 diabetes at high risk of future cardiovascular events.
Methods : The methodology used in the Carrington article was adopted for this study. The clinical foundation for the analysis was derived from the findings of the FIELD study.
All costs were sourced from electronic databases obtained from private-sector South African funders of healthcare. Event costs for the cardiovascular events were determined and added to the treatment costs for the individual treatment arms. The cost saving was determined as the difference between the event costs saved and the additional treatment costs associated with fenofibrate treatment. All costs were reported as 2008 ZAR and a discount rate of 10% was used. The study adopted a South African private-sector funder perspective.
Results : If the same approach is followed as in the Carrington and Stewart study, a cost saving of 18% results. This is the difference between the total costs associated with the placebo and fenofibrate arms, respectively (R3 480 471 compared to R2 858 598 per 1 000 patient years for the placebo and fenofibrate arms, respectively). The total costs were determined as the sum of associated event costs and treatment costs for each of the comparators.
Conclusions : Based on this exploratory analysis, it seems that Lipanthyl® treatment in middle-aged patients resulted in a cost saving due to the prevention of cardiovascular events when it was used in the treatment of type 2 diabetics, as in the FIELD study. It should therefore be considered to be cost effective, even when just the cardiovascular risk reduction effect is considered.
- Title: Persistently elevated CKMB
and negative troponin T in a patient at
ischaemic risk with chest pain : case report
Authors: Schulenburg, D.; De Lange, W.; Van Jaarsveld, H.; Kuyl, J.M.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Analytical interference in laboratory assays is not only unpredictable but also an underestimated problem. Not recognising these interferences can lead to misdiagnosis and mismanagement of patients. We present a case of a patient with chest pain and ischaemic risk factors with incongruent biochemical results. These results were discovered to be due to the presence of macro-creatine kinase (macro-CK) in vivo interfering with the CKMB activity assay.
- Title: Insulin glargine and the risk
of cancer
Authors: Ahmed, F.A.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: The concerns about a possible link between the use of Lantus (glargine) insulin and an increased risk of cancer were raised in the German study of around 127 000 insulin-treated patients in an insurance database. The research identified a statistically significant link between patients who had used Lantus insulin and those who had been diagnosed with cancer.
- Title: Omega-3 intake in patients
with coronary artery disease : focus on recent
studies : your life and your heart
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Despite the recommendations of the American Heart Association (AHA) and other expert groups on the value of added intake of omega-3 polyunsaturated fatty acids (ω-3 PUFA) in the secondary prevention of CAD, either from the diet (oily fish - herring, mackerel, sardines) or from fish-oil supplements which contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), these safe lifestyle or medication therapies are still under-prescribed.
- Title: Treating hypertensive
patients with coronary artery disease : renewed
interest in INVEST : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: The INVEST study, a very large study of 22 576 hypertensive patients with coronary artery disease (CAD) has recently been reviewed in the context of more recent studies, such as ASCOT and ACCOMPLISH, all of which focused on the use of a calcium channel blocker-led (CBB) strategy in combination with an ACE inhibitor to reduce cardiovascular events.
- Title: Watch these dates
Save these dates
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Watch these dates
Save these dates
- Title: The ultimate anticoagulants?
: drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Two new anticoagulants that can be administered orally are poised to change the face of anticoagulation as we know it. Rivaroxaban and dabigatran (neither available in South Africa as yet) have both shown positive results in clinical trials. At the congress of the South African Society of Thrombosis and Haemostasis, held in Johannesburg on 22 November 2009, Profs Sylvia Haas and Ajay Kakkar presented the evidence for rivaroxaban and dabigatran, respectively.
- Title: Stop press focus on RE-COVER
study : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: The milestone results of the RE-COVER™ study show a novel oral, direct thrombin inhibitor dabigatran to be as effective as well-controlled warfarin, with less bleeding, in the treatment of acute venous thromboembolism (VTE).
- Title: 24-hour powerful blood
pressure lowering - essential for target organ
protection : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Circadian blood pressure rhythm is controlled by intracellular molecular clocks, which allow the body to prepare for anticipated stimuli, the morning blood pressure surge helping to meet the challenges of the day while the nocturnal blood pressure fall sets the system for a period of rest.
- Title: 10th PASCAR Congress & Annual
General Meeting - Kampala, Uganda
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: 10th PASCAR Congress & Annual General Meeting - Kampala, Uganda
- Title: More than 50% reduction in
ischaemic stroke with rosuvastatin in the
JUPITER study : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 1, Jan / Feb
Published: 2010
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Abstract: Treatment with rosuvastatin resulted in a 51% reduction in the incidence of ischaemic stroke, a component of the primary endpoint in both men and women in the JUPITER study. In addition, there was no difference in the rates of haemorrhagic stroke between the rosuvastatin-treated and placebo arms.
