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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015
AFRICA
3
From the Editor’s Desk
Healthcare professionals often label patients as ‘non-compliant’
when prescribed therapies seem to fail to be effective. This is
often used as a derogatory term of criticism of patient behaviour,
as though patients are personally liable for their lack of response
and continued ill health. Those of us who have experienced
having been prescribed long-term medication, requiring multiple
daily doses, will readily admit to the difficulty of complying fully
with complex regimens despite the best will in the world. The
article by Osamor in this issue (page 29) explores the importance
of social support in the management of a chronic disease in
Africa and confirms the importance of such support in ensuring
compliance with prescribed medication. Given the evidence
from elsewhere that familial and social support is of importance
in lessening the likelihood of developing cardiovascular disease
and increasing the likelihood of compliance with treatment,
the results are not surprising, and are important for those
teaching medicine and planning treatment programmes in
Africa. Hopefully the results will stimulate further African
research in this important area.
Coronary artery bypass grafting (CABG) has produced
excellent symptomatic relief from angina for many patients
and enhanced survival in selected sub-groups. Symptomatic
relief is inevitably time-limited by durability of the venous
conduits. When symptoms recur due to vein graft failure
and a percutaneous intervention is not feasible, patients and
clinicians face a difficult dilemma, particularly if there is a
patent left internal thoracic artery anastomosis to the left
anterior descending coronary artery that may be jeopardised
at the time of repeat median sternotomy. Such patients are
inevitably older with multiple co-morbidities. Duvan and
colleagues (page 25) report their experience with redo off-pump
CABG via a posterolateral thoracotomy to access branches of
the circumflex coronary artery. This report serves as a timely
reminder of an alternative revascularisation strategy that may
well be acceptable to both patients and referring cardiologists
when severe symptoms persist despite optimal medical therapy.
The precise relationship between obesity and coronary disease
remains unclear. Zand-Parsa and colleagues (page 13) add
a new level of complexity by demonstrating that obesity, as
determined by waist-to-hip ratio (WHR), was correlated with
severity of coronary artery disease by two independent scoring
systems, whereas body mass index (BMI) was not. Clinicians
will be aware of considerable ethnic variation in patterns of
distribution of adipose tissue and this is not always considered
in comparisons of BMI and WHR. It may, in part, account for
some discrepancies, and the establishment of regional norms
may be necessary.
Laboratory experimental work by Burma (page 4), using
pre-constricted internal mammary artery (IMA) rings in a tissue
bath, showed that leptin caused relaxation of these arterial
segments. These findings led the authors to raise the intriguing
hypothesis that obese subjects who had a left IMA bypass graft
would actually have better (anterior wall) myocardial perfusion
compared to non-obese subjects. The risks and benefits of
obesity in patients with coronary disease are far from settled!
PJ Commerford
Editor-in-Chief
Professor PJ Commerford