VOLUME 20 NUMBER 2 • NOVEMBER 2023 23 SA JOURNAL OF DIABETES & VASCULAR DISEASE FROM THE EDITOR’S DESK From the Editor’s Desk Correspondence to: FA Mahomed Head of Internal Medicine, Madadeni Hospital Newcastle, KwaZulu-Natal Continued on page 28 CALSAR 5/80 mg, 5/160 mg, 10/160 mg. Each tablet contains amlodipine/valsartan 5/80 mg, 5/160 mg, 10/160 mg respectively. S3 A51/7.1.3/1106, 1107, 1108. For full prescribing information, refer to the professional information approved by SAHPRA, March 2021. CRB958/08/2022. CUSTOMER CARE LINE +27 21 707 7000 www.pharmadynamics.co.za | | | DILIGENT WORKERS BIOEQUIVALENT TO THE ORIGINATOR VALSARTAN/AMLODIPINE CONVENIENTLY PACKED IN 30 TABLETS Painkillers linked to heart failure in type 2 diabetes: Danish study Patients with type 2 diabetes (T2D) who use short-term nonsteroidal anti-inflammatory drugs (NSAIDs) have a greater risk of being hospitalised for heart failure, particularly older patients with poorly controlled diabetes, according to a Danish registry study. Among more than 300 000 patients with T2D, short-term use of NSAIDs was linked to a relative 43% increased risk of a first-time heart failure hospitalisation in the subsequent 28 days (OR: 1.43, 95% CI: 1.27–1.63), reported Dr Anders Holt of Copenhagen University Hospital-Herlev Gentofte in Hellerup, Denmark, and colleagues. The most at-risk subgroups were patients 80 years and older (OR: 1.78, 95% CI: 1.39–2.28), those poorly managed as evidenced by elevated HbA1c levels and no or only one anti-diabetic drug (OR: 1.68, 95% CI: 1.00–2.88), and new NSAID users without previous prescriptions (OR: 2.71, 95% CI: 1.78–4.23). ‘Individual risk assessment is advised if prescribing NSAIDs for patients with T2D,’ the researchers wrote in the Journal of the American College of Cardiology. NSAIDs have previously been linked to heart failure risk, doubling the risk of hospitalisations in one study, in a post-myocardial infarction population. Implications While the findings in T2D might not be surprising, they are worrying, given the widespread use of NSAIDs, according to an accompanying editorial by Dr Hassan Khan of Norton Healthcare in Kentucky, and Dr Setor Kunutsor, of the University of Leicester in England. This issue covers mainly cardiac issues, ranging from coronary arterial bypass grafting (CABG) outcomes to cardiovascular benefits of the latest diabetes drugs, the role of exercise in diabetes and arrythmias. CABG superiority over percutaneous coronary intervention (PCI) in diabetes has been shown in many studies. Early complications of CABG are bleeding, arrythmias and rehospitalisation.1 Yücel and Özgöl (page 24) studied early renal outcomes after CABG and found early adverse renal complications in patients with diabetes and low cardiac ejection fraction. Diabetes remainsamajorglobal riskfactor for cardiovasculardeath,2 and there is a great need to have drugs that treat hyperglycaemia and have cardiovascular benefit. Maney and Hanmonth (page 29) review the cardiovascular benefits of new diabetes drugs: sodiumglucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors. The Diabetes News section stresses the importance of exercise in people living with diabetes (page 34). Exercise plays an important role in preventing obesity and diabetes,3 and also in improving diabetes control.4 Even modest exercise has benefit. This section also discusses the potential mechanisms of increased risk of arrhythmia in patients with diabetes (page 36). There appears to be a reduced risk of atria fibrillation in well-controlled diabetes and with treatment with the newer diabetes drugs. Atrial fibrillation is the commonest arrhythmia and requires rate control, anticoagulation and cardioversion strategies. This may require drugs or complex ablation interventions.5 References 1. Fearon WF, Zimmermann FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, et al. Fractional flow reserve – guided PCI as compared with coronary bypass surgery. N Engl J Med 2022; 386(2): 128–137. 2. Magnussen C, Ojeda FM, Leong DP, Alegre-Diaz J, Amouyel P, et al. Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med 2023; 389 (14): 1273–1285. 3. Hannon TS, Arslanian SA. Obesity in adolescents. N Engl J Med 2023; 389(3): 251–261. 4. Lundgren JR, Janus C, Jensen SBK, Juhl CR, Olsen LM, Christensen RM, et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med 2021; 384(18): 1719–1730. 5. Michaud GF, Stevenson WG. (2021). Atrial Fibrillation. N Engl J Med 2021; 384: 353–361.
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