SA Journal of Diabetes & Vascular Disease: Vol 1, Issue 1, March 2004

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SAJDVD: VOLUME 1, ISSUE 1, MARCH 2004

Title: Diabetes at the forefront of cardiovascular risks : editorial
Authors: Opie, Lionel H.
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.3-4
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Title: Diabetes mellitus in South African Indians : editorial
Authors: Seedat, Y.K.
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.5-7
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Title: Can type 2 diabetes be prevented? : editorial
Authors: Distiller, Larry A.
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.8-9
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Title: Homocysteine : how does this relate to diabetes and vascular disease? : editorial
Authors: Delport, Rhena
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.10-12
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Abstract: The purpose of this review is to explore the relationship between homocysteine and vascular disease in diabetes mellitus (DM). Elevated plasma total homocysteine (tHcy) concentrations are consistently related to the presence of vascular disease in epidemiological studies. Hyperhomocysteinemia is induced by genetic defects of the enzymes and deficiencies of the vitamins that regulate the metabolism of methionine. Renal function also plays an important role in regulating plasma tHcy concentrations. The impairment of renal function appears to be the principal modulator of plasma tHcy concentrations in DM. It is not clear at present whether the relationship between homocysteine and vascular disease in DM is a causal relationship, or whether hyperhomocysteinemia is an epiphenomenon. The metabolism of homocysteine and possible mechanisms for vascular effect are discussed. Findings of relevant studies concerning the association between homocysteine and vascular disease in diabetics and non-diabetics are presented.
Title: Implications from hypertension outcome trials for the management of patients with hypertension and diabetes : review
Authors: Brown, Morris J.
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.15-21
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Abstract: The UKPDS highlighted the importance of blood pressure control in patients with type 2 diabetes. In this review I draw on data from the INSIGHT and other recent outcome trials in hypertension which provide clear evidence that it is the achievement of good control of blood pressure, irrespective of the initial choice of drug, that is the major determinant of outcome. The INSIGHT trial provides hard evidence of how resistant to treatment patients with diabetes really are. In this review I offer a theoretical and practical solution in the form of a stepwise algorithm using multiple therapies.
Title: The management of acute myocardial infarction in patients with diabetes mellitus : review
Authors: Williams, Ian L.; Noronha, Brian; Zaman, Azfar G.
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.22-27
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Abstract: Diabetic subjects are more likely to experience a myocardial infarction and have worse outcomes compared to non-diabetic subjects. The underlying pathophysiology of the atherosclerotic process is not significantly different in diabetic subjects, but the prothrombotic and procoagulant state with which diabetes is associated is thought to contribute to the higher incidence of and worse prognosis after myocardial infarction. Difficulties of re-establishing vessel patency by thrombolytic or mechanical means contribute to the high morbidity and mortality. The diffuse nature of arterial disease with accompanying metabolic derangement contribute to impaired compensatory mechanisms, increased infarct size and a disproportionately more substantial impairment of left ventricular function. The newer adjuvant antithrombotic and anticoagulant agents have particular roles in management therefore and careful modulation of glucose metabolism in the acute and follow-up phase of an infarct may favourably influence outcome.
Title: Optimising treatment of hypertension to prevent cardiovascular complications in type 2 diabetes : current topics in diabetes care
Authors: Daly, Caroline; Purcell, Henry
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.28-30
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Abstract: Diabetes is associated with an increased risk of cardiovascular disease which is amplified in the presence of hypertension. Tight control of blood pressure (BP) reduces cardiovascular events in patients with type 2 diabetes. It has been suggested that drugs which interrupt the renin-angiotensin system (RAS) may be superior to other classes of antihypertensive agents. This review assesses the evidence for this suggestion, focusing on recently reported trials including ALLHAT, ANBP2, LIFE, and SCOPE. The evidence suggests that antihypertensive agents which interrupt the RAS offer benefits for diabetic patients with multiple cardiovascular risk factors.
Title: Should BP targets be lower in diabetic patients with microalbuminuria or nephropathy? : current topics in diabetes care
Authors: Kaiser, Thomas; Florack, Christiane; Stephan, Uta; Sawicki, Peter T.
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.31-34
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Abstract: oes antihypertensive treatment in normotensive patients with diabetic nephropathy alter the progression of kidney failure? We have evaluated studies of renal function which either assessed the effects of different therapeutic blood pressure (BP) goals, or the effects of antihypertensive therapy within the normotensive BP range. Need for renal replacement therapy was regarded as the most valid end point for assessment of deterioration of nephropathy, and change in the glomerular filtration rate (GFR) was regarded as a valid surrogate parameter. Five randomised controlled trials (RCTs) which included normotensive and hypertensive type 1 and type 2 diabetic patients have investigated the effect of lowering of BP within the normotensive range, or from hypertensive values to within the normotensive range. Albumin excretion in urine decreased in the groups randomised to lower BP values, but none of the trials demonstrated any beneficial effect of this intervention on the progression of kidney failure as assessed by the course of GFR. In conclusion, in diabetic patients with microalbuminuria or overt nephropathy, there is no evidence in the literature from RCTs for a beneficial effect of lowering BP within the normotensive range on the risk of kidney replacement therapy or on the loss of glomerular function.
Title: Initiating antiplatelet therapy in diabetes : a primary care organisation view : current topics in diabetes care
Authors: Morrell, Jonathan
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.37-41
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Abstract: Antiplatelet therapy has a role in the primary and secondary prevention of serious vascular events, especially in high-risk patients, including people with diabetes. This review considers the evidence and guideline recommendations for initiating antiplatelet therapy in people with diabetes with and without vascular disease. It concludes that, for diabetic patients with coronary heart disease, stroke or peripheral vascular disease, an antiplatelet agent (e.g. aspirin 75 mg per day or clopidogrel 75 mg per day) should be given routinely and continued in the long term. For diabetic patients with acute coronary syndromes, the addition of clopidogrel (75 mg daily) to usual therapy should be considered. For primary prevention, aspirin (75 mg) should be considered for all diabetic patients with well controlled hypertension and a > 20% risk of developing coronary disease over 10 years.
Title: Candesartan CHARMs in heart failure : CV deaths, hospital admissions and cases of new-onset diabetes reduced : drug trends in diabetes and vascular disease
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.42
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Title: Intensive lipid lowering 'freezes' atherosclerosis : drug trends in diabetes and vascular disease
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.44
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Title: Pioglitazone monotherapy approved in Europe : drug trends in diabetes and vascular disease
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.46
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Title: Improved risk profile with pioglitazone (Actos) : drug trends in diabetes and vascular disease
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.46
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Title: Patient preference for ED drugs studied : drug trends in diabetes and vascular disease
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.47
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Title: DIRECting the fight against vision impairment in diabetes : drug trends in diabetes and vascular disease
From: South African Journal of Diabetes and Vascular Disease, Vol 1, Issue 1, Mar / Apr
Published: 2004
Pages: p.48
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