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- Volume 16, Issue 5, 2005
Cardiovascular Journal of South Africa - Volume 16, Issue 5, 2005
Volume 16, Issue 5, 2005
Author Brian RaynerSource: Cardiovascular Journal of South Africa 16, pp 244 –245 (2005)More Less
The Anglo-Scandanavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOT-BPLA) was a multi-centre, prospective, randomised, controlled trial in 19 257 patients with hypertension, aged 40-79 years, with at least three other cardiovascular (CVS) risk factors. Patients were assigned to either arnlodipine (5-10 mg), adding perindopril (4-8 mg) as required (arnlodipine-based regimen, n = 9 639), or atenolol (50-100 mg), adding bendroflumethiazide (1.25-2.5 mg) and potassium as required (atenolol-based regimen, n = 9 618). The primary end-point was non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD). Although there was a non-significant 10% reduction in the primary end-point in favour of the arnlodipine-based regimen, the study was prematurely stopped after a median follow up of 5.5 years by the Data and Safety Monitoring Committee, because of clinically important reductions in secondary end-points (Table I).
The contribution of diabetes mellitus per se to the severity of coronary artery disease : cardiovascular topicsSource: Cardiovascular Journal of South Africa 16, pp 246 –248 (2005)More Less
Background : Coronary artery disease (CAD) is the most common chronic, life-threatening illness in many Western countries. The risk factors associated with diabetes mellitus and the metabolic syndrome in diabetics are generally considered more important in the evolution of CAD than the diabetic state itself.
Aim : This study was undertaken to determine the contribution of diabetes mellitus to the characteristics and severity of coronary artery disease among young patients.
Methods : Thirty diabetics (group 1) were selected from a group of young patients (≤ 45 years) with ischaemic heart disease, which was documented angiographically. For this retrospective, case-controlled study, 60 non-diabetic patients with CAD (group 2) were matched for gender, age, LDL level, hypertension, smoking, family history and obesity. These diabetic and non-diabetic groups were compared for different outcomes of coronary artery disease.
Results : Group 1 had a higher incidence of three-vessel coronary involvement (56.7 vs 20%; p < 0.05) and more hospitalisations for ischaemic episodes (4 ± 4.5 vs 2.1 ± 1.8; p < 0.05) than group 2. They also had more previous myocardial infarctions, longer intervals between their first admission and the current hospitalisation, and more common left main coronary artery disease.
Conclusion : Diabetes mellitus contributes significantly to the severity of CAD.
Source: Cardiovascular Journal of South Africa 16, pp 249 –255 (2005)More Less
Objective : The purpose of this study was to assess the prevalence of dyslipidaemia and the correlates of serum lipids and lipoproteins among Congolese subjects with and without arterial hypertension.
Methods : One hundred hypertensive patients attending the outpatient clinics at the University of Kinshasa Hospital, and 100 age- and sex-matched controls recruited among hospital personnel or blood donors entered the case-control study. Their blood pressure (BP), heart rate (HR), body mass index (BMI), waist-to-hip ratio (WHR), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), plasma fibrinogen (only in patients) and fasting glucose, serum uric acid, creatinine and creatinine clearance (erel) were compared using the Student's t-test or Chi-square test as appropriate. Associations between continuous variables were assessed with Pearson correlation coefficients, and correlates of lipids and lipoproteins were determined using multiple linear-regression analysis.
Results : Compared to healthy controls, hypertensive patients had greater BMI (p ≤ 0.05) and WHR (p ≤ 0.01), and higher levels of fasting plasma glucose (p ≤ 0.05), serum uric acid (p ≤ 0.05) and creatinine (p ≤ 0.001). The average TC (4.96 ± 1.18 mmol/l for controls vs 5.01 ± 1.49 mmol/l for hypertensives), LDL-C (3.46 ± 1.16 mmol/l vs 3.36 ± 1.32 mmol/l) and HDL-C (1.19 ± 0.39 mmol/l vs 1.27 ± 0.39 mmol/l) were similar and within the normal ranges, whereas TG in hypertensives (1.03 ± 0.66 mmol/l) were significantly higher (p ≤ 0.05) than in controls (0.85 ± 0.48 mmol/l). Dyslipidaemia was observed in 33 controls (33%) and 40 hypertensive patients (40%). Sixteen controls (16%) and 23 hypertensive patients (23%) had TC ≥ 6.20 mmol/l.
In hypertensive patients, TC (r = 0.24; p < 0.01) and LDL-C (r = 0.20; p ≤ 0.05) were positively correlated to plasma fibrinogen. A positive correlation was also observed between TC and LDL-C (r = 0.91; p < 0.001), HDL-C and CrCl (r = 0.28; p < 0.001), and TG and glucose (r = 0.24; p < 0.01), whereas TG were negatively correlated to HDL-C (r = -0.38; p < 0.001).
In multiple linear-regression analysis, LDL-C, HDL-C, TG and age accounted for 87% (R2) of variation in TC levels; plasma glucose and HDL-C for 19% (R2) of variation in TG levels; and TG and CrCI for only 17% (R2) of variation in HDL-C levels.
Conclusions : The present data indicate that dyslipidaemia affects a substantial proportion of healthy and hypertensive Congolese subjects. Furthermore, hypertension is associated with a cluster of risk factors characteristic of the metabolic syndrome, of which overweight/central obesity could be the cornerstone. Management of arterial hypertension should therefore focus both on lowering high blood pressure and correcting associated lipid disorders.
Effect of resistance training on cardiorespiratory endurance and coronary artery disease risk : cardiovascular topicsSource: Cardiovascular Journal of South Africa 16, pp 256 –259 (2005)More Less
Coronary artery disease (CAD) represents a major medical problem in Western society and is a considerable cause of morbidity and mortality in South Africa. In recent years, epidemiologists have made extensive efforts to define the most common risk factors for CAD and propose preventative measures to limit the spread of the disease. Despite the increasing realisation of the importance of resistance training, the literature has focused primarily on aerobic modes of exercise and their effects on risk for CAD. The aim of this study was to determine whether resistance training could alter cardio-respiratory endurance (VO2max), and thus reduce CAD risk.
A quantitative, experimental, comparative research design incorporating a pre-test, a treatment period and a post-test was used. Twenty-eight untrained male volunteers were age matched (mean age: 28 years and seven months) and randomly assigned to either a non-exercising control group (n = 15) or a resistance-training group (n = 13). The study demonstrated no statistically significant change in VO2max for the control group from their pre-test (25.097 ml/kg/min) to their post-test (23.778 ml/kg/min) (p = 0.201). However, resistance training significantly (p ≤ 0.01) increased the VO2max from 26.674 ml/kg/min to 30.981 ml/kg/min (p = 0.004). Additionally, the difference between the pre- and post-test of the control and training group, respectively, demonstrated that the control group's mean VO2max was significantly lower than that of the resistance-training group (p = 0.001).
Although not all studies have demonstrated significant increases in VO2max following resistance training, the results of this study showed that eight weeks of resistance training were sufficient to result in a significant improvement in VO2max. This suggests that an exercise programme that includes resistance training results in a composite of physical and physiological improvements necessary to impact favourably on risk for CAD.
Endotoxin-independent white cell cytokine production in haemodynamically stable patients with idiopathic dilated cardiomyopathy : cardiovascular topicsSource: Cardiovascular Journal of South Africa 16, pp 260 –265 (2005)More Less
Introduction : In heart failure, increased circulating white cell tumour necrosis factor-α production could be attributed to elevated plasma endotoxin concentrations or an increase in white cell sensitivity to endotoxin.
Aims : To ascertain whether, in patients with IDC, circulating white cell TNF-α production is also mediated through endotoxin-independent mechanisms.
Methods : Whole blood production of TNF-α, both with and without the presence of an endotoxin stimulus, was evaluated in 89 controls and in 60 patients with IDC in New York Heart Association functional class I, II or III heart failure and without evidence of oedema, reduced peripheral perfusion or elevated plasma endotoxin concentrations. Circulating concentrations of selected pro- and anti-inflammatory factors were also measured.
Results : In patients compared to controls, IgG (p < 0.01) (IgG1 and IgG3), but not IgM concentrations were elevated, and plasma TNF-α and TGF-β concentrations were raised (p < 0.001, p < 0.02 respectively). In addition, endotoxin-free cultured whole blood TNF-α production (p < 0.0005) was increased. Against a role for endotoxin-mediated pre-activation of white cells in patients, the sensitivity of white cells to endotoxin, as determined from the excitatory endotoxin concentration producing 50% maximal TNF-α production was unchanged. Moreover, in favour of non-endotoxin-mediated white cell activation, the calcineurin inhibitor, cyclosporin-A, which did not alter endotoxin-induced TNF-α production, decreased TNF-α produced by unstimulated cultured cells in patients to values not significantly greater than those in controls.
Conclusions : We concluded that circulating white cell cytokine over-production can occur through both endotoxin-dependent and -independent mechanisms in IDC.
Plasminogen activator inhibitor type 1 (PAI-1) and platelet glycoprotein IIIa (PGIIIa) polymorphisms in young Asian Indians with acute myocardial infarction : cardiovascular topicsSource: Cardiovascular Journal of South Africa 16, pp 266 –270 (2005)More Less
Background : The relationship between polymorphisms in the genes for plasminogen activator inhibitor type 1(PAI-1) and platelet glycoprotein IIIa (PGIIIa), clinical and environmental features, and the risk of premature coronary heart disease (CHD) in Asian Indian subjects living in South Africa, has been investigated.
Methods : The prevalence of the PAI-1 promoter 4G/5G and the PGIIIa PIA1A2 polymorphisms was examined in 195 unrelated Asian Indian patients (≤ 45 years) who presented with myocardial infarction (MI). Results were compared with those from 107 unaffected siblings (18-45 years) and 300 healthy age- and race-matched control subjects.
Results : Overall, neither the PAI-1 4G/5G nor the PGIIIa PIA1A2 polymorphism demonstrated an independent risk for MI. No synergistic effect was observed between these two polymorphisms when analysed together. There was a marginal association between the 4G allele of the PAI-1 gene and the risk of MI in individuals who smoked compared with non-smokers (26 vs 11%; p = 0.028; OR 2.74; 95% CI 1.04-8.47). The PGIIIa PIA2 allele was, however, strongly associated with a previous history of MI (17 vs 6%; p = 0.004; OR 3.00; 95% CI 1.38-6.46), as well as the severity of disease as determined by angiography (single/double- vs triple-vessel disease: 3% vs 15%; p = 0.020; OR 0.19; 95% CI 0.02-0.92).
Conclusion : In young Asian Indians who smoke, the PAI-1 4G allele is a mild risk factor for the development of MI. The PGIIIa PIA2 allele constitutes a significant risk for individuals who have a previous history of MI, as well as serving as an indicator for the severity of CHD.
ASCOT - blood pressure arm confirms efficacy of amlodipine/perindopril (Norvasc® / Coversyl®) regimen : drug trendsSource: Cardiovascular Journal of South Africa 16, pp 271 –275 (2005)More Less
This large study, initiated in 1997 against the background of the wide usage of atenolol (beta-blocker) and thiazide diuretic, has shown the benefit of newer agents (amlodipine and perindopril) in the treatment of hypertensive patients with cardiovascular risk. The results of the study were announced at the European Society of Cardiology Congress held in Stockholm recently.
Trend towards prolonged survival in bisoprolol-first (Concor®) for heart-failure trial (CIBIS III) : drug trendsSource: Cardiovascular Journal of South Africa 16 (2005)More Less
In the first large prospective study undertaken to contrast the early introduction of beta-blockers in comparison to ACE inhibitors in mild to moderate heart failure, the β1 selective beta-blocker, bisoprolol (Concor®), administered once daily for six months prior to combined therapy, resulted in a trend towards prolonged survival, although true significance was not reached.
Comments from South African cardiologists attending the European Society of Cardiology Congress : drug trendsSource: Cardiovascular Journal of South Africa 16, pp 278 –279 (2005)More Less
Source: Cardiovascular Journal of South Africa 16, pp 282 –283 (2005)More Less
The importance of reaching LDL cholesterol (LDL-C) treatment goals in patients with established cardiovascular disease and in asymptomatic individuals at particularly high risk was re-emphasised at a specialist symposium presented at the ESC on 3 September 2005 in Stockholm.
Opportunities to improve risk factor control in type 2 diabetes and reduce cardiovascular events : drug trendsSource: Cardiovascular Journal of South Africa 16, pp 283 –284 (2005)More Less
'Type 2 diabetic patients still have a higher incidence of cardiovascular events despite the risk reduction achieved by improved control of hyperglycaemia, blood pressure and lipid levels', noted Dr Larry Distiller of the Centre for Diabetes and Endocrinology, Houghton.
Additional benefits of RAS blockade in the treatment of black hypertensives using valsartan/hydrochlorothiazide combination : drug trendsSource: Cardiovascular Journal of South Africa 16 (2005)More Less
A recent trial comparing the non-inferiority of valsartan/hydrochlorothiazide to amlodipine in the treatment of black Americans provides valuable data for the physician wishing to extend the benefits of RAS blockade (reduced progression of kidney disease, diminished new-onset diabetes and congestive heart failure) to their hypertensive black patients.
PROactive study shows reduced heart attacks and strokes in type 2 diabetics on pioglitazone HCI (Actos®) therapy : drug trendsSource: Cardiovascular Journal of South Africa 16, pp 286 –287 (2005)More Less
The ambitious PROactive study, initiated in 2001, is the first prospective, randomised, double-blind, placebo-controlled trial of an oral glucose-lowering medication's ability to significantly improve cardiovascular outcomes over 2.5 years of therapy in type 2 diabetics. The study added pioglitazone to the treatment of type 2 diabetics who were already receiving standard-care therapy including dietary modification, glucose lowering (using metformin, sulphonylureas and insulin), blood pressure regulation, lipid lowering and antithrombotic agents, according to the 1999 IDF (European) guidelines.
Two- and three-drug therapy with candesartan cilexetil (Atacand®) successful in patients with severe hypertension : drug trendsSource: Cardiovascular Journal of South Africa 16 (2005)More Less
A recent double-blind study of the treatment of hypertensive patients whose blood pressure remained above target on two-drug combinations, showed that a strategy of adding candesartan cilexetil (Atacand®) or of switching to candesartan and hydrochlorothiazide produced further reductions in blood pressure while maintaining tolerability. In addition, the results showed a trend in favour of the three-drug, standard-dose approach, compared to the two-drug, high-dose approach.
Source: Cardiovascular Journal of South Africa 16, pp 289 –290 (2005)More Less
Introduced at the European Society of Cardiology in September 2005 as an interesting and exciting new approach to the medical treatment of angina, Prof. Kim Fox of the Royal Brompton Hospital, London, welcomed the advent of ivabradine, the first new molecule since the introduction of calcium channel blockers (CCB) in the 1970s for the treatment of angina.
Source: Cardiovascular Journal of South Africa 16 (2005)More Less
The PREAMI study (Perindopril and Remodeling in Elderly with Acute Myocardial Infarction), undertaken to address the lack of information concerning the use of ACE inhibitors in post-myocardial infarction patients with normal ejection fraction and older than 65 years of age, shows that perindopril (8 mg) is very effective in preventing cardiac remodeling and is well-tolerated in these patients.
Source: Cardiovascular Journal of South Africa 16 (2005)More Less
The South African Medicines Control Council (MCC) has approved the removal of the boxed warning from Pharma Dynamics' Amloc package insert. The nullified warning stated that the 'substitutability or interchangeability of Amloc with other amlodipine-containing products has not been established'.
Increased integrated primary care needed for cardiovascular disease prevention in South Africa : drug trendsSource: Cardiovascular Journal of South Africa 16 (2005)More Less