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VOLUME 12 NUMBER 1 • JULY 2015
3
SA JOURNAL OF DIABETES & VASCULAR DISEASE
From the Editor’s Desk
From the Editor’s Desk
T
here is probably no more important topic for discussion than
the effect of lifestyle and diet on our health. The impact of
lifestyle is hugely underestimated by the general public and
is, in my view, by far the biggest contributor to non-communicable
disease today. ‘You are what you eat’ is an old statement that still
holds true.
We, the human race, have lost the plot when it comes to diet,
and our over-consumption of high-calorie and nutritionally poor-
quality food is endangering our health. The food industry, driven
by profit not health, and supported by the advertising industry, has
largely contributed to this problem.
This is very topical currently, and has recently been revived by
Prof Tim Noakes. It was with excitement that I read the review
by the legendary Prof Lionel Opie (page 5) on the topic of diet
and cardiovascular disease. This is a must read for every healthcare
professional who is questioned daily about the Banting and Noakes
diets. The review gives a balanced and scientific opinion on the
different diets and the best options.
Of concern to me is the large number of people who follow
their own version of these diets, unsupervised, with potentially
hazardous consequences. Strong evidence supports the
association between low-density lipoprotein cholesterol (LDL-C)
and cardiovascular disease, and if a diet increases LDL-C levels, it
will very likely increase the risk of cardiovascular disease.
Prospective studies comparing these diets in a large number of
people are urgently needed, to look at surrogate cardiovascular
markers as well as cardiovascular endpoints. Such studies would be
challenging because of people’s inability to stick to a specific diet.
Pop and co-workers (page 8) discuss non-conventional
cardiovascular risk factors that could be used to estimate
cardiovascular risk in women. They highlight many options and
discuss the validity of these risk factors.
A novel approach to peripheral neuropathy is discussed in a very
interesting article by Seewoodhary and others (page 12), using
stem cell transplants. This appears promising, but is unlikely to be
a therapeutic option for diabetic neuropathy in the near future,
and will probably be a very costly option. There are currently not
enough human data to support this mode of therapy.
In a study called the Dyslipidaemia International Study
(DYSIS), Raal and colleagues (page 21) assessed cholesterol
therapy in South African patients in private practice. In total,
1 029 patients were included in the study, and it was shown that
more than 50% of patients did not reach their LDL-C targets
and over 70% were at high cardiovascular risk. Many patients in
South Africa experience persistent dyslipidaemia despite statin
treatment, and further measures are needed to reduce the burden
of cardiovascular disease in our population.
In another observational study assessing lipid control on home
soil, Rapeport and co-workers (page 30) also reported sub-optimal
lipid control in 2 996 patients (52%) from the private and public
sectors. They reported important gender and ethnic differences
and reinforced control of risk factors.
Controlling lipid levels in high-risk patients is a fairly easy
intervention and many potent statins are available at a fair price.
However, drug side effects are sometimes a stumbling block to
achieving our goals. We need to improve on the numbers of
patients reaching target levels in order to lower cardiovascular risk
in our patients, especially in the diabetic subgroup, where glucose
targets are much more difficult to achieve. Target control of glucose
levels is much lower than 50% in diabetic patients, but we know
that lipid control gives much better cardiovascular protection and
therefore this should be a priority, as it is achievable.
Correspondence to: Dr Landi Lombard
Netcare Kuilsriver Hospital, Cape Town
Tel: +27 (0)21 900-6350
e-mail:
lclombard@mweb.co.zaS Afr J Diabetes Vasc Dis
2015;
12
: 3
Image courtesy of Stuart Miles at FreeDigitalPhotos.net