VOLUME 21 NUMBER 1 • November 2024 3 SA JOURNAL OF DIABETES & VASCULAR DISEASE From the Editor’s Desk From the Editor’s Desk In this issue, the following topics are discussed: carotid intima–media thickness and cardiovascular risk factors and outcomes in coronary artery bypass grafting (CABG) in central South Africa, effectiveness of a femoral vascular closure device with percutaneous angiography, the use of the triglyceride– glucose index in cardiovascular disease in premature coronary artery disease, and cardiovascular disease risk-factor control and outcomes in patients with major depressive disorder and type 2 diabetes. Mokoena et al. (page 4) examined the correlation between intima–media thickness (IMT) and cardiovascular risk factors and outcomes with CABG in the Free State Province of South Africa. The researchers found no correlation with outcomes but some correlation with cardiovascular risk factors. IMT could be a useful marker for cardiovascular disease because it is non-invasive and easy to measure with an ultrasound probe.1 While Mokoena et al. showed no correlation with outcomes, this could have been due to a small sample size. Other studies have shown a correlation with cardiovascular disease outcomes with CABG2 but used different outcomes and definitions of IMT. Measurement of IMT is not clear-cut: a measurement of 1 mm was used by Ham et al.,3 whereas 1.5 mm and another measure, degree of stenosis, was used by Polak et al.4 Variability in operator experience may also be a factor. A more recent study shows that a combined IMT measurement (measuring both the common carotid and internal carotid arteries) may be the best measurement to use.5 Papoutsis et al., from Athens, Greece (page 10) determined vascular changes and complications after use of a femoral vascular closure device, used at the end of percutaneous angiography to seal the femoral artery. The options for sealing the femoral artery include manual compression, use of a collagen sealant and use of a vascular device, among others. Choice depends on a number of factors and availability.6 Papoutsis and colleagues showed that the device they used was safe to use and had minimal complications. Yang et al., from Gansu Province, China (page 16) assessed the use of the triglyceride–glucose index for assessing cardiovascular outcomes in premature coronary artery disease (premature defined as less than 55 years in males and less than 60 years in females). The measurement is cheap and easy to do. It uses fasting levels of triglycerides and glucose in the calculation and is shown to be associated with insulin resistance, type 2 diabetes, hypertension and obesity. It correlates to cardiovascular risk at all ages.7 This study found a correlation in younger patients and may be a useful addition in the clinical arena when assessing cardiovascular risk in these patients. Naidoo et al., from Johannesburg, South Africa (page 22) determined the effect of major depressive disorder (MDD) on cardiovascular risk factors and outcomes in patients with type 2 diabetes. A number of psychiatric conditions are associated with adverse cardiac outcomes. MDD is common in the general population and has clearly been shown to be associated with a number of poor cardiac outcomes and increased overall mortality.8 Naidoo and colleagues found poorer cardiac riskfactor control and more frequent admissions and re-admissions for macrovascular outcomes, even in their managed-care setting. The diagnosis of depression remains an important clinical issue when assessing risk for cardiovascular disease and impact on care. References 1. Øygarden H. Carotid intima–media thickness and prediction of cardiovascular disease. J Am Heart Assoc 2017; 6(1): 1–3. 2. Ham SY, Song JW, Shim JK, Soh S, Kim HJ, Kwak YL. Prognostic role of carotid intima–media thickness in off-pump coronary artery bypass surgery. Sci Rep 2018; 8(1): 1–8. 3. Ham SY, Song JW, Shim JK, Soh S, Kim HJ, Kwak YL. Prognostic role of carotid intima–media thickness in off-pump coronary artery bypass surgery. Sci Rep 2018; 8(1): 1–8. 4. Polak JF, Szklo M, Kronmal RA, Burke GL, Shea S, Zavodni AEH, O’Leary DH. The value of carotid artery plaque and intima–media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis. J Am Heart Assoc 2013; 2(2): 1–10. 5. Ling Y, Wan Y, Barinas-Mitchell E, Fujiyoshi A, Cui H, Maimaiti A, et al. Varying definitions of carotid intima–media thickness and future cardiovascular disease: a systematic review and meta-analysis. J Am Heart Assoc 2023; 12(23). 6. Sartorius B, Behnes M, Ünsal M, Hoffmann U, Lang S, Mashayekhi K, et al. Arterial access-site complications after use of a vascular closure device related to puncture height. BMC Cardiovasc Disord 2017; 17(1): 1–8. 7. Hong S, Han K, Park CY. The triglyceride glucose index is a simple and lowcost marker associated with atherosclerotic cardiovascular disease: a populationbased study. BMC Med 2020; 18(1): 1–8. 8. Krittanawong C, Maitra NS, Qadeer YK, Wang Z, Fogg S, Storch EA, et al. Association of depression and cardiovascular disease. Am J Med 2023; 136(9): 881–895. Correspondence to: FA Mahomed Head of Internal Medicine, Madadeni Hospital Newcastle, KwaZulu-Natal
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