CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
AFRICA
343
Editorial
Reflections on a range of cardiovascular issues
Articles in this issue range from epidemiology and determinants
of risk factors for non-communicable diseases, namely, the
prevalence of hypertension in Nigeria (Murthy
et al.
, page 344),
to obesity in South African woman (Micklesfield
et al
., page
369) and risk determination of cardiovascular events in persons
with diabetes mellitus (Kengne, page 376). Interesting cardiac
perfusion abnormalities are addressed in three articles (Tasolar
et al.
, Celik
et al
. and Chang
et al
., pages 355, 357, e12),
which are complimented by an article on congenital coronary
anomalies (Karabay
et al
., page 351) as detected by CT-scanning.
Furthermore, two ways of creating a shunt for renal dialysis
purposes using the basilica vein is discussed by Ozcan
et al
.
(page 364).
Murthy
et al
. in a well-designed survey of blindness and
visual impairment in Nigeria, piggy-backed hypertension onto
the study. They found a prevalence of hypertension of 44.9% in
persons over 40 years, which varied across ‘ethnic’ groups, the
Kanuri group having the highest prevalence of 77.5%.
This begs the question of ethnicity, culture and race, the
latter being historically of significant concern in South Africa,
and brought to the fore by Micklesfield
et al
. in a review on
factors determining obesity in black South African women.
These concepts overlap, however, and there do not appear to be
clear definitions. The South Africa government classifies four
racial groups, namely, black, white, coloured (mixed ancestry)
and Indian.
Nevertheless, black African women in South Africa have an
obesity prevalence of 31.8%, which is the highest in sub-Saharan
Africa. Micklesfield and co-workers discuss the role of various
factors, such as socio-cultural, behavioural, maternal and early
life, socio-economic status, education, physical activity (or lack
thereof), gender, urbanisation, eating behaviour and body image.
Genetics, so fashionable currently, certainly does not appear to
be a major determinant of obesity.
Kengne grapples with risk prediction in diabetes mellitus
(DM); risk prediction that will be valid globally. He describes the
ADVANCE (Action in Diabetes and Vascular disease: PreterAx
and DiamicroN MR Controlled Evaluation) study, with which
he was intimately involved. Diabetes mellitus is not just another
risk factor to be added to other cardiovascular risk factors for
cardiovascular disease (CVD), but is, rather, a condition with a
gradient of influences. Therefore, a need for DM-specific risk
determination is necessary.
The ADVANCE study was a multi-centre study of persons
with DM and therefore CVD risk, which led to a prediction
model that has been both internally and externally validated.
Formulae, such as those derived from the Framingham project,
tend to overestimate risk in persons with DM. A calculator for
calculating CVD risk in DM is available online (
.
advanceriskengine.com/).
Two groups from Turkey (Tasolar
et al
. and Celik
et al.
)
address the phenomenon of slow coronary flow, an angiographic
finding characterised by delayed distal vessel opacification in the
absence of significant epicardial coronary disease. One article is
about the role of endothelial nitric oxide synthase levels and the
response to exercise, while the other is on the role of vitamin E
and antioxidant activity in this phenomenon.
The case study of Chang
et al
., published online, is about
Kounis syndrome, defined by either cardiogenic shock or an
acute coronary syndrome due to vaso-activity triggered by the
release of inflammatory mediators following an allergic insult.
So, overall, this edition of the journal has an interesting mix
of articles with which to conclude 2013. Best wishes for the year
to come.
PAUL A BRINK, MB ChB, PhD,
Department of Internal Medicine, Faculty of Health Sciences,
University of Stellenbosch and Tygerberg Hospital, Tygerberg
The Director of Clinics Cardive Publishing, Prof Paul Brink
and the editorial team thank the authors, reviewers and all
others who contributed to our journal during 2013.
May peace, joy, hope and happiness be yours this
holiday season and throughout the new year.
Thank you
