CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 21, ISSUE 5, SEP 2011
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- Title: The growing disparity between
clinical trial complexity and investigator
compensation : editorial
Authors: Burgess, L.J.; Sulzer, N.U.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: The issue of investigator compensation in clinical trials is a contentious one, with opinions varying widely between academic researchers, clinical trialists and pharmaceutical companies. Many academic researchers maintain that clinical trial budgets are excessive. Clinical trialists are usually of the opinion that the study budgets are inadequate considering the many potential safety issues, the continuous monitoring of patients and the many 'hidden costs' involved in clinical trials. Pharmaceutical companies and clinical research organisations (CROs) are invariably of the opinion that their study budgets are appropriate.
- Title: Effect of systemic
hypertension on right ventricular morphology and
function : an echocardiographic study :
cardiovascular topics
Authors: Akintunde, A.A.; Akinwusi, P.O.; Familoni, O.B.; Opadijo, O.G.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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DOI: 10.5830/CVJA-2010-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-013
Abstract: Background : Hypertension is an important cardiovascular risk factor worldwide. It is associated with left ventricular hypertrophy (LVH). Both diastolic and systolic dysfunction may occur in hypertensive heart disease. The ventricles are structurally and functionally interdependent on each other. This was an echocardiographic study intended to describe the impact of left ventricular pressure overload and hypertrophy due to hypertension on right ventricular morphology and function.
Methods : One hundred subjects with systemic hypertension and 50 age- and gender-matched normotensive control subjects were used for this study. Two-dimensional (2-D), M-mode and Doppler echocardiographic studies were done to evaluate the structure and function of both ventricles. Data analysis was done using the SPSS 16.0 (Chicago, Ill). Statistical significance was taken as p < 0.05.
Results : Age and gender were comparable between the two groups. Hypertensive subjects had significantly increased left ventricular end-diastolic dimensions, posterior wall thickness, interventricular septal thickness, left atrial dimensions and left ventricular mass and index. The mitral valve E/A ratio was reduced among hypertensive subjects when compared to normal controls (1.15 ± 0.75 vs 1.44 ± 0.31, respectively; p < 0.05). A similar pattern was found in the tricuspid E/A ratio (1.14 ± 0.36 vs 1.29 ± 0.30, respectively; p < 0.05). Hypertensive subjects also had reduced right ventricular internal dimensions (20.7 ± 8.0 vs 23.1 ± 3.1 mm, respectively; p < 0.001) but similar peak pulmonary systolic velocity. The mitral e/a ratio correlated well with the tricuspid e/a ratio.
Conclusion : Systemic hypertension is associated with right ventricular morphological and functional abnormalities. Right ventricular diastolic dysfunction may be an early clue to hypertensive heart disease.
- Title: Pharma Dynamics launch
innovative Patient Assist
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Pharma Dynamics has launched the Patient Assist Programme aimed at assisting self-employed or employed South Africans without medical aid to purchase affordable medicines. Ease of registration for this service and a quality basket of medicines available under the Pharma Dynamics label may help to reduce disparities in access to chronic medication in particular.
- Title: Effect of the haeme
oxygenase-1/endogenous carbon monoxide system on
atherosclerotic plaque
formation in rabbits : cardiovascular topics
Authors: Liu, Da-Nan; Fang, Ying; Wu, Li-Rong; Liu, Xing-De; Li, Ping; He, Zuo-Yun
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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DOI: 10.5830/CVJA-2010-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-015
Abstract: Objective : To investigate the effect of the haeme oxygenase-1/carbon monoxide (HO-1/CO) system on atherosclerotic plaque formation and its possible mechanism.
Methods : For 12 weeks, rabbits were given a 1.5% cholesterol diet (Ch group, n = 8) or a 1.5% cholesterol diet plus an HO-1 inducer, haemin (Hm group, n = 8), or an HO-1 inhibitor, zinc protoporphyrin IX (Znpp-IX, Zn group, n = 8) by intraperitoneal injection.
Results : Compared with the normal control group (C group, n = 8), serum levels of lipids and oxidised low-density lipoproteins (ox-LDL) increased significantly in all experimental groups (p < 0.01). However, no significant differences were observed among the three experimental groups (p > 0.01). Compared with the control group, aortic nitric oxide (NO) production and nitric oxide synthase (cNOS) activity decreased markedly, whereas carbon monoxide (CO) production and HO-1 activity increased markedly in the Ch group (p < 0.01). This was associated with an increase in the area of aortic plaque of 54.00 ± 4.16%. Compared with the Ch group, CO production and HO-1 activity increased markedly, while aortic HO activity and CO production decreased significantly in the Hm group. The area of aortic plaque was significantly reduced in the Hm group (17.88 ± 3.01%), whereas the area of aortic plaque was significantly increased in the Zn group (61.13 ± 3.50%). Compared with the Ch group, aortic endothlin-1 expression in the Hm group reduced significantly, while in the Zn group it was significantly higher than in the Ch group (p < 0.01).
Conclusion : The HO-1/CO system plays an inhibitory role in atherosclerotic plaque formation. This role was not mediated by regulating serum lipids and ox-LDL, but was related to the reciprocal relationship between the HO-1/CO and NOS/NO systems in atherosclerosis and the down-regulated expression of endothlin-1 (ET-1), which inhibits the proliferation of vascular smooth muscle cells.
- Title: Letter to the Editor
Authors: Iturralde, Mario P.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Commenting on the article 'Cerebral embolism following thrombolytic therapy for acute myocardial infarction: the second reported case' by M Bostan, et al., I note that the captions for Figs 1 and 2 are reversed. I would also like to comment on the description of the second brain CT performed on the patient presented in this case report.
- Title: Risk factors associated with
intermediate and long-term mortality following
vascular surgery in South African patients :
cardiovascular topics
Authors: Biccard, B.M.; Nepaul, S.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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DOI: 10.5830/CVJA-2010-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-016
Abstract: There are few data on predictors of mortality following vascular surgery in South African patients. While in the developed world, peri-operative risk factors are also associated with intermediate-term survival, it is likely that the weighting and even the clinical risk factors may be different in South African patients due to the epidemiology of cardiovascular disease in developing countries. The aim of this study was therefore to determine risk factors associated with intermediate and long-term mortality in South African vascular surgical patients.
Design : A retrospective cohort study was conducted. Intermediate and long-term survival was determined by subsequent hospital visits or admissions. For patients who did not return to the hospital, the patient or patient's next of kin was contacted telephonically. The outcome of the patient, and the time to the outcome following the surgical procedure were recorded. Bivariate and multivariate analysis was conducted using Cox regression analysis to determine predictors of intermediate-term mortality.
Results : Only hypertension and diabetes were associated with intermediate and long-term mortality at the bivariate level of analysis with p < 0.10. There was no co-linearity between hypertension and diabetes. Hypertension was the only predictor of intermediate and long-term survival retained in the multivariate model (hazard ratio 3.86, 95% confidence interval 0.83-15.4, p = 0.086).
Conclusion : In contrast to developed-world observations, peri-operative clinical risk indices were not associated with intermediate and long-term survival in South African vascular surgical patients. Instead, two risk factors that were identified in the South African National Burden of Disease study were associated with mortality. It appears that a 'western lifestyle' (and the presence of associated risk factors) may be more important predictors of intermediate and long-term mortality than peri-operative risk predictors of cardiac events in South African vascular surgical patients. This study highlights an important public health issue for the South African population where the most important determinants of mortality are continued exposure to risk factors (such as hypertension and diabetes) in the community, with little modification of these risk factors through primary health surveillance and management, even after surgical admission for pathology known to be associated with these risk factors.
- Title: Dates to diarise
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Dates to diarise
- Title: Coping and metabolic syndrome
indicators in urban black South African men :
the SABPA study : cardiovascular topics
Authors: Du Plessis, A.; Malan, L.; Malan, N.T.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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DOI: 10.5830/CVJA-2010-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-024
Abstract: Urbanisation is associated with obesity, hypertension and development of the metabolic syndrome (MS). We aimed to assess the use of different coping styles and their influence on increases in MS indicators and target end-organ damage (TOD) in urban black African men. A sample of 53 men was classified as clear high active (AC, n = 30) or passive coping (PC, n = 23) responders, using the Amirkhan African validated coping style indicator. Blood pressure (BP) was recorded with an aneroid sphygmomanometer and waist circumference (WC) was determined. Carotid intima-media thickness (CIMT) and microalbuminuria were analysed to determine TOD.
Fasting serum and eight-hour urine samples revealed elevated MS indicators in AC men. Strong associations existed between MS indicators and TOD in AC but not PC men. To conclude, only BP and seeking social support were positively associated with TOD in urban PC African men, while in urban AC African men, most MS indicators were positively associated with TOD, i.e. sub-clinical atherosclerosis and renal impairment.
- Title: The reliability of chest
radiographs in predicting left atrial
enlargement : cardiovascular topics
Authors: Quinton, S.J.; Ker, J.A.; Rheeder, P.; Deffur, A.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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DOI: 10.5830/CVJA-2010-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-028
Abstract: Introduction : Estimates of left atrial size in patients with suspected cardiac disease play an important role in predicting prognosis and events, as well as treatment decisions. Two methods are commonly used to estimate left atrial size : chest radiography and cardiac ultrasound. This study aims to determine the test characteristics by comparing the use of radiographs to cardiac ultrasound (the gold-standard test).
Methods : Data from patients older than 18 years admitted to Steve Biko Academic Hospital during 2000-2003 who had both chest radiographs and cardiac ultrasound were included in this cross-sectional, retrospective analysis. Chest radiographs were classified into three quality classes, and the sub-carinal angle (SCA) and sub-angle distance (SAD) were measured twice in all available radiographs by two observers. Intra- and inter-observer variability (three methods) as well as the predictive value of the carinal angle and sub-angle distance measurements were determined using logistic regression (with left atrial enlargement - determined by ultrasound as comparator).
Results : Data for 159 patients were available (154 cardiac ultrasounds and 178 chest radiographs). Intra-observer variability for chest radiograph measurements was low with almost perfect concordance (p = 0.000). Inter-observer variability was higher for supine radiographs. Using logistic regression, a linear model was identified which was statistically significant only for erect radiographs. While goodness-of-fit analysis showed that the model fits the data, performance characteristics were poor, with high sensitivity and low specificity, and an area under the ROC curve of 0.62-0.63, depending on type of radiograph and measurement (SCA or SAD). Linearity in the logit of the dependent variable was assessed, and found to be present at the extremes of SCA measurements for the supine radiograph data and in the first three quartiles for erect radiograph data. A nonlinear model determined by fractional polynomial analysis did not perform significantly better than the original linear model. Cut-off values for the SCA of 72° and 84° (erect and supine radiographs, respectively) were found to give the best compromise between sensitivity and specificity. The corresponding cut-off values for SAD were 24.1 and 26.9 mm.
Conclusion : Assessment of either SCA or SAD to determine left atrial size was equivalent and repeatable, both with the same observer and between two observers (less so for supine radiographs). While this measure was precise, it was found not to be very accurate. Therefore, chest radiographs are not reliable in predicting left atrial enlargement.
- Title: The grapefruit : an old wine
in a new glass? Metabolic and cardiovascular
perspectives : review article
Authors: Owira, Peter M.O.; Ojewole, John A.O.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Grapefruit is a popular, tasty and nutritive fruit enjoyed globally. Biomedical evidence in the last 10 years has, however, shown that consumption of grapefruit or its juice is associated with drug interactions, which, in some cases, have been fatal. Grapefruit-induced drug interactions are unique in that the cytochrome P450 enzyme CYP3A4, which metabolises over 60% of commonly prescribed drugs as well as other drug transporter proteins such as P-glycoprotein and organic cation transporter proteins, which are all expressed in the intestines, are involved. However, the extent to which grapefruit-drug interactions impact on clinical settings has not been fully determined, probably because many cases are not reported.
It has recently emerged that grapefruit, by virtue of its rich flavonoid content, is beneficial in the management of degenerative diseases such as diabetes and cardiovascular disorders. This potentially explosive subject is reviewed here.
- Title: Congenital absence of the
left circumflex coronary artery and an unusually
dominant course of the right coronary artery :
case report
Authors: Baskurt, M.; Okcun, B.; Caglar, I.M.; Ozkan, A.A.; Ersanli, M.; Gurmen, T.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Congenital absence of the left circumflex artery (LCX) is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report on a 55-year-old female with atypical chest pain. Routine coronary angiography showed a normal left anterior descending coronary artery (LAD), no LCX and a dominant right coronary artery (RCA), which continued beyond the crux, running the full course of the LCX and terminating in the left atrial branch. Neither aortography nor pulmonary angiography showed a separate ostium for the LCX. There were no atherosclerotic lesions in the coronary arteries, or ischaemia on stress myocardial perfusion imaging. Multi-detector row computed tomography (MDCT) was performed to confirm the diagnosis.
- Title: Update on smoking cessation
techniques : your life and your heart
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: 'While public attitudes to smoking have changed radically, medical approaches are often outdated and need to be reviewed to resolve tobacco addiction in a strategic and sensitive manner.' Dr Andrew Pipe of the Heart Institute, University of Ottawa, Canada presented this view in a series of lectures to South African clinicians and physicians at the recent SA Heart Congress.
- Title: Smoking legislation has
forced people to consider quitting smoking :
Nicorette® SA Smoking Survey 2010 : your life
and your heart
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: The second annual Nicorette® South African Smoking Survey has once again reflected several smoke screens on South Africa's habits, trends and behaviours with regard to smoking. The survey revealed that the smoking legislation that came into effect last year (such as restricting people from smoking in public areas) has had a positive impact on encouraging people to stop smoking. Across the board, smokers, non-smokers and ex-smokers are all feeling the impact of legislation, with 56% of ex-smokers (up 22% from last year) agreeing with the rulings, along with smokers at 44% (40% last year) and non-smokers recording 48% (up 21% from last year).
- Title: Reaching target LDL
cholesterol has become more affordable with
launch of ezetimibe / simvastatin combination in
South Africa : special report
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: An affordable addition to the clinician's choice of LDL cholesterol-lowering agents has become available in South Africa. Ashley Pearce, CEO of Merck Sharpe & Dohme, South Africa, and president of the Pharmaceutical Industry Association of South Africa (PIASA) emphasised the need to increase accessibility to innovative medicines for chronic diseases in South Africa.
- Title: Osteoporosis : a
cardiovascular risk factor equivalent to type 2
diabetes : drug trends in cardiology
Authors: Wagenaar, Peter
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: An increasing body of research is showing a link between osteoporosis and cardiovascular disease. The associations are complex and, in some cases, not yet fully understood, but the clinical implications are that healthcare professionals need to consider their osteoporosis patients as having as high a risk for heart disease as those with type 2 diabetes mellitus.
- Title: Dangers of switching
anti-hypertension medication : focus on 2010
South African Heart Congress : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Physicians should discourage switching between anti-hypertension medications and should encourage both the patient and the funder to stick with the successfully up-titrated medication.
- Title: The J-shaped curve : fact or
fiction? : focus on 2010 South African Heart
Congress : drug trends in cardiology
Authors: Meredith, Peter
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Current conventional wisdom suggests that when it comes to good blood pressure control, the lower the better. However, because a pressure of zero over zero is incompatible with life, there would appear to be a J-shaped curve and therefore there must be a point at which lower is not necessarily better.
- Title: Anti-thrombotic trials in
atrial fibrillation, the RELY study : focus on
2010 South African Heart Congress : drug trends
in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: 'The strength of the RELY study of dabigatran in stroke prevention resides in two critical factors; (1) the scientific integrity of the study despite being unblinded to warfarin, and (2) the wide range of patients at risk for stroke studied.'
This view was expressed by the co-principal investigator of the study, Prof Michael Ezekowitz in an interview with the Cardiovascular Journal of Africa at the 2010 South African Heart Congress in August at Sun City.
- Title: New ESC guidelines and data
on dabigatran : focus on 2010 ESC Congress :
drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: In a major symposium on atrial fibrillation (AF), Prof John Camm, head of the Department of Cardiac and Vascular Sciences at St Georges, University of London, pointed out that atrial fibrillation cases are set to double as populations age. 'One in four adults 40 years of age will develop atrial fibrillation in their lifetime. The consequences are tragic and devastating, with a five-fold increase in the risk of having a stroke', he said. Stroke is also more likely to be severe and fatal in these patients; those who survive face persistent neurological deficits, persistent disability and poorer functional performance.
- Title: Effective single-drug
approach is welcomed for deep-vein thrombosis
treatment : focus on 2010 ESC Congress : drug
trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Results from the EINSTIEN-DVT trial were announced at the recent ESC 2010 congress, showing the therapeutic equivalence of rivaroxaban (15 mg twice daily for three weeks, followed by 20 mg once daily) to current standard therapy in treating and preventing further venous thrombotic events (VTE).
- Title: SHIFTING the burden of heart
failure : focus on 2010 ESC Congress : drug
trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: 'The results of the SHIfT study, announced this week at the European Society of Cardiology (ESC) 2010 congress in Stockholm, are likely to change the clinical treatment of chronic heart failure as they provide the first positive results for many years in this difficult field of treatment. The great interest in the outcome of this study was evident from the large number of delegates attending this hot-line session on the first day of the congress.
- Title: South African experts' views
on SHIfT : focus on 2010 ESC Congress : drug
trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Prof Jeffrey Borer, head of the Department of Medicine, State University of New York, Downstate Medical Centre
Dr Tony Dalby, Milpark Hospital, Johannesburg
Prof DP Naidoo, head of Cardiology, University of KwaZulu-Natal
Prof Karen Sliwa, chairperson of the Heart Failure Society of South Africa
- Title: Low-dose omega-3 fatty acids
in margarines prove disappointing as secondary
prevention : focus on 2010 ESC Congress : drug
trends in cardiology
From: Cardiovascular Journal of Africa, Vol 21, Issue 5, Sep / Oct
Published: 2010
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Abstract: Lower doses of ω-3 fatty acids, given in the form of enriched margarines, did not reduce the overall rate of major cardiovascular events following myocardial infarction, according to results from the multicentre Alpha Omega trial. However, there were borderline significant reductions among post-MI sub-groups, including diabetic patients and women receiving alpha-linolenic acid (ALA) supplements, said principal investigator Daan Kromhout from Wageningen University, the Netherlands, in a hot-line session at the ESC.
