CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
AFRICA
147
From the Editor’s Desk
I am delighted to have been appointed Editor-in-Chief of the
Cardiovascular Journal of Africa
and believe it appropriate
in this first issue in which I am involved to pay tribute to my
predecessors, to acknowledge my previous error and express my
hope that I can continue the traditions of the Journal.
When the late Professor Andries Brink approached me as a
newly appointed head of Cardiology at the University of Cape
Town and Groote Schuur Hospital in the late 1980s with his
innovative proposal for a uniquely South African cardiology
journal, I was not enthusiastic. I responded with youthful
arrogance and ignorance that ‘there were more than enough
journals and we did not need another one’. How wrong that was!
Professor Andries Brink forged ahead, despite widespread
scepticism, founded the
Cardiovascular Journal of South Africa
and under his guidance and rigorous scholarship it became
established and recognised as a repository for publications of
quality, initially mainly from South Africa, but with increasing
numbers from other countries. When Professor Andries Brink
passed away, his son Professor Paul Brink single-handedly
continued to edit and direct the Journal. I consider that the
highpoint of its 25-year growth trajectory was the acceptance
of the Journal as the official journal of the Pan-African Society
of Cardiology (PASCAR) and its change of name to the current
one of the
Cardiovascular Journal of Africa
.
In 2014 it is difficult for those who did not personally
experience the events of the decades prior to 1994 tounderstandor
appreciate exactly how important the changes and developments
post 1994 have been. In the 1980s, academic, clinical and
scientific contact between South African cardiologists and our
colleagues in most of the rest of Africa was negligible. South
Africans faced academic boycotts from countries both within
and without Africa. Travel to African countries for South
Africans was extraordinarily difficult and it was equally difficult,
if not more so, for colleagues from other African countries to
visit South Africa. How wonderful to have experienced how
things have changed for the better!
Today there is vigorous interchange and interaction, with
collegial participation at continental meetings, exchanges of
trainees, and a generous willingness to share expertise throughout
the continent. Very importantly, multicentre co-operative research
into the diseases of Africa has been instituted, and hopefully in
the near future, new insights facilitating the management of
patients with diseases that are common in Africa will become
available. Other multicentre epidemiological investigations and
registries on the impact of conditions not previously investigated
in depth in Africa, such as coronary artery disease and atrial
fibrillation, have been remarkably successful. The Journal has
been involved directly or indirectly in much of this.
The two Professors Brink, Andries and Paul, deserve
recognition for their major contributions to clinical medicine,
cardiology and cardiovascular science, but very importantly
also, for their role in helping to develop and grow a continental
publishing initiative that is enhancing patient care, medical
training, and cardiovascular research in Africa.
In this editorial I have tried to highlight some items of
particular interest to me in the current issue. This is not
comprehensive and inevitably driven by personal preference.
Many states in Africa lack reliable information on health
and illness issues, which would allow planners to allocate scarce
resources to areas of need, and healthcare practitioners to
examine and improve outputs. There are new and very helpful
efforts to correct this problem. In this issue Bonny and colleagues
(page 176) provide an overview of sudden cardiac death in Africa
and an ambitious proposal to collect reliable information. Chin
(page 151) provides an editorial comment summarising the
problem and potential solutions. The outcome of the project
will be eagerly awaited. In a similar vein, Brun and colleagues
(page 159) examine a large number of patients at risk of venous
thromboembolism and demonstrate under-use of recommended
prophylactic anticoagulation. These two initiatives are both
multicentre studies involving sites from many different African
countries and it is heartening to see such co-operation, which can
only bode well for the future.
In a prospective cohort study, Borkum and co-workers (page
153) examined ambulatory blood pressure and renal function in
asymptomatic HIV-positive patients. The prevalence of chronic
kidney disease was lower than anticipated and HIV infection
was associated with an ambulatory non-dipping status, which
suggests an underlying dysregulation of the cardiovascular
system. In the short term, anti-retroviral therapy did not seem
to improve loss of circadian rhythm. A non-dipping pattern is
an established entity with clinical implications, and is associated
with higher cardiovascular morbidity and mortality rates. The
high prevalence of non-dippers in the HIV-infected group in this
study supports data from other countries. How this non-dipping
pattern will impact on long-term mortality and morbidity in
HIV-positive patients remains to be established.
With the increasing and widespread use of new imaging
modalities, we are learning more about cardiac function and
involvement in systemic diseases. An article from Turkey (page
168) describes echocardiographic abnormalities in patients
with rheumatoid arthritis and the influence of treatment on
those abnormalities. Interestingly for me, the old-fashioned but
evergreen ECG also reflected some of the changes. Cardiac
imaging is further highlighted in a review of cardiac magnetic
resonance imaging by Scholtz and others (page 185). This
reports the clinical utility of this exciting modality.
The letter from Schamroth (page 192) regarding the adverse
effects of the Noakes diet on lipids is of considerable interest
and concern, given several such anecdotal verbal reports from
colleagues around South Africa.
PATRICK COMMERFORD, MB ChB, FCP (SA), FACC,
Professor Emeritus, Senior Scholar, Cardiac Clinic,
Department of Medicine, University of Cape Town
