CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 4, July/August 2022 AFRICA 219 Houehanou C, et al. Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. Lancet Diabetes Endocrinol 2016; 4(11): 903–912. 165. Rheeder P, Morris-Paxton AA, Ewing R-MG, Woods D. The noncommunicable disease outcomes of primary healthcare screening in two rural subdistricts of the Eastern Cape Province, South Africa. Afr J Prim Health Care Fam Med 2017; 9(1). 166. Bailey SL, Ayles H, Beyers N, Godfrey-Faussett P, Muyoyeta M, du Toit E, et al. Diabetes mellitus in Zambia and the Western Cape province of South Africa: Prevalence, risk factors, diagnosis and management. Diabetes Res Clin Prac 2016; 118: 1–11. 167. Adedokun AO, Ter Goon D, Owolabi EO, Adeniyi OV, Ajayi AI. Prevalence, awareness, and determinants of type 2 diabetes mellitus among commercial taxi drivers in Buffalo City Metropolitan Municipality South Africa: A cross-sectional survey. Medicine 2019; 98(9): e14652. 168. Hird TR, Pirie FJ, Esterhuizen TM, O’Leary B, McCarthy MI, Young EH, et al. Burden of diabetes and first evidence for the utility of HbA1c for diagnosis and detection of diabetes in urban black South Africans: The Durban Diabetes Study. PLoS One 2016; 11(8): e0161966. 169. Malan L, Hamer M, Schlaich MP, Lambert GW, Ziemssen T, Reimann M, et al. Defensive active coping facilitates chronic hyperglycaemia and endothelial dysfunction in African men: The SABPA study. Int J Cardiol 2013; 168(2): 999–1005. 170. Peltzer K, Phaswana-Mafuya N, Pengpid S. Rural–urban health disparities among older adults in South Africa. Afr J Pri Health Care Fam Med 2019; 11(1). 171. Quashie NT, D’Este C, Agrawal S, Naidoo N, Kowal P. Prevalence of angina and co-morbid conditions among older adults in six low- and middle-income countries: Evidence from SAGE Wave 1. Int J Cardiol 2019; 285: 140–146. 172. Stubbs B, Vancampfort D, Veronese N, Schofield P, Lin P-Y, Tseng P-T, et al. Multimorbidity and perceived stress: a population-based crosssectional study among older adults across six low- and middle-income countries. Maturitas 2018; 107: 84–91. 173. Werfalli M, Kassanjee R, Kalula S, Kowal P, Phaswana-Mafuya N, Levitt NS. Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data. Glob Health Action 2018; 11(1): 1449924. 174. SEMDSA Society for Endocrinology, Metabolism and Diabetes of South Africa. SEMDSA. Retrieved 2020 Sep 28, from https://www. semdsa.org.za/ 175. NCDCountdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet 2020; 396(10255): 918–934. 176. Dover RVH, Lambert EV. ‘Choice Set’ for health behavior in choiceconstrained settings to frame research and inform policy: examples of food consumption, obesity and food security. Int J Equity Health 2016; 15(1): 48. …continued from page 192 Primary or secondary prevention in patients with CKD? ‘Is this primary prevention in patients with CKD?’ asked Gansevoort. ‘I think that CKD is an ongoing process; everything we do (in these patients) is secondary prevention and that is the reason why they show benefit from aspirin, just as aspirin has shown benefit in all secondary prevention trials. We should not regard CKD as a risk factor; it is the disease.’ Mann countered that, despite having more advanced CKD, with eGFR levels of less than 60 ml/min/1.73 m2, the patients in TIPS-3 still represented a primary prevention population by lacking a history of a cardiovascular disease event. But Mann also agreed that ‘CKD as a risk equivalent of cardiovascular disease was established consistently in several studies’ dating back more than two decades to a report he published in 2001 from the HOPE study. TIPS-3 enrolled 5 712 middle-aged or elderly adults in any of nine countries without a history of cardiovascular disease but with intermediate or high cardiovascular risk based on their INTERHEART Risk Score. The study prospectively randomised patients in a 2 × 2 factorial design to aspirin or placebo, or to a ‘low-dose’ polypill or placebo. The polypill included half doses of three different classes of blood pressure-lowering medications, plus 40 mg of simvastatin. Primary results from TIPS-3 The primary endpoint of TIPS-3, first reported in November 2020, was the combined rate of cardiovascular death, non-fatalmyocardial infarction, non-fatal stroke, heart failure, resuscitated cardiac arrest and arterial re-vascularisation. After a median follow up of 4.6 years, people who took the polypill had a 21% relative reduction in their combined event rate compared with those taking placebo, a difference of borderline significance. Those who received aspirin had a 14% relative risk reduction that was not significant. In an analysis of those who received both active agents compared with those who received neither, the combined regimen linked with a significant 31% relative cut in the combined cardiovascular disease endpoint. The post hoc analysis now reported by Mann focused on the 17% of patients with an eGFR of less than 60 ml/ min/1.73 m2, a subgroup with a 36% prevalence of diabetes and an 84% prevalence of hypertension. In addition to showing a significant 43% relative risk reduction linked with aspirin use in this group, his analysis also showed essentially no effect on the primary endpoint in the remaining study participants with higher levels of renal function. Hints of an additive polypill and aspirin effect Preliminary analysis of those with CKD who received both aspirin and the polypill showed evidence of an ‘additive’ effect of the two interventions, said Mann, which together, produced a significant 63% reduction in the primary endpoint, an outcome he said will be the focus of a future report. Mann also highlighted the cost effectiveness of aspirin in the CKD subgroup, with an estimated cost of about €2 500 to prevent one event. That’s a price tag that’s markedly below the monetary cost of many other agents currently used to prevent cardiovascular disease events, he noted. Source: MedicalBrief 2022
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