SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 8 NUMBER 3 • SEPTEMBER 2011
103
M
ost professionals reading this Journal will be struggling with
the ever-increasing number of patients with diabetes who
consult us daily. These days I seldom see patients without
this challenging illness, which is probably more of a cardiovascular
risk factor than a disease, as suggested by our Journal’s title. In this
edition, the focus is on cardiovascular protection in special subgroups
and includes some interesting articles.
In a Medical Research Council (MRC)
1
assessment of the burden
of disease attributable to diabetes in South Africa, the research
showed that 14% of ischaemic heart disease, 10% of stroke and
12% of hypertensive and renal disease is directly attributable to
diabetes. The investigation used South African community studies
on diabetes in various population groups to assess risk in terms of a
World Health Organisation risk-assessment protocol. We also know
that ischaemic heart disease, stroke, hypertension and renal disease
are increasing in prevalence.
Clinicians are aware that the presence of diabetes is regarded
as a cardiovascular risk equivalent, ranking equally with smoking,
hypertension and raised cholesterol levels, as has been shown by
Steven Haffner
et al
.
2,3
In a recent study of long-surviving patients
with type 1 diabetes who had developed the metabolic syndrome,
undertaken in Johannesburg at the CDE, intima–media thicknesses
were used to assess their cardiovascular risk. This clinical study
showed that those patientswho developed features of themetabolic
syndrome had greater carotid artery intima–media thicknesses as a
result. By inference, they are at higher risk of atherosclerosis and
possibly cardiovascular disease.
4
Interestingly, a recent study
5
on South Africans, regarding diet
and cardiovascular health, has shown than the South African
population has a better understanding of the cardiac risks of high
cholesterol levels, high blood pressure and diabetes than of the
risks related to being overweight. Obesity, however, is currently a
worldwide crisis (including in South Africa) and will be followed
by increasing diabetes and cardiovascular burden, overwhelming
our healthcare capabilities. We need much more public education
around the issue of overweight and obesity, and its role in adversely
affecting cardiovascular health.
In this issue, a review on HIV and diabetes by Wilson is long
overdue and puts into perspective the complex interactions of
the disease and the treatments used. It is unfortunate that the
increasing diabetes risk in HIV patients is partially a reflection of our
treatment success and increased drug availability/usage.
Achieving Best Practice provides valuable practical advice on
how to avoid weight gain during smoking cessation and focuses
on lifestyle recommendations. It also discusses the value of nicotine
replacement and pharmacotherapy.
Also, in ADA Watch, our special report on the American Diabetes
Correspondence to: Dr Landi Lombard
Netcare Kuilsrivier Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2011;
8
: 103
Cardiovascular protection in special populations
LANDI LOMBARD
Association meeting in June, intensive lifestyle and early intensive
dietary interventions (page 130) show diabetes ‘remission’ in 11%
of these overweight and obese patients.
An interesting article from Turkey, assessing the future
cardiovascular risk in pregnant womenwith gestational diabetes and
impaired glucose tolerance, using mean platelet volume, provides
useful information on current and future thrombosis risk. This is a
novel concept and could become a measurable cardiovascular risk
factor in the future (page 109).
The risk of thrombosis takes us to the issue of aspirin treatment
in diabetic patients, which is dealt with in the patient information
leaflet. This has dramatically changed recently due to new data and
is not as clear-cut as it was previously.
For many years, all diabetic patients were put on aspirin therapy
as primary prevention. However, recent research on aspirin in
both Europe and Japan has shown that aspirin (81–162 mg daily)
should be recommended for diabetic patients with a 10% and
higher-decade risk for a cardiovascular event, while those below
5% should not be given a daily aspirin dose. Those in the 5–10%,
10-year risk group need to be individualised, and we will probably
be doing more risk-score assessments in the future.
6,7
As clinicians,
we need to be alert to this nuance in aspirin usage and that the old
approach of aspirin for all diabetics was too simplistic.
Cardiovascular risk in diabetic patients also relates to glucose
control and we hope the article on patient glucose self-monitoring
will be of value to the diabetes care team. This discusses new
developments and gives some guidance on glucose testing in type
2 diabetes. It includes international guidelines as well as individual
views.
I would like to end this editorial on a personal note, because this
is my first edition as corresponding editor. I hope I can serve this
journal and its growing number of readers as well as the previous
editors did. I’m looking forward to an interesting journey, supported
by an excellent team at the
South African Journal of Diabetes and
Vascular Disease
.
References
Bradshaw D, Norman R, Lewin S, Cairncross E,
1.
et al
. Estimating the burden of
diseases attributable to diabetes in South Africa in 2000.
S Afr Med J
2007;
97
(8
Pt 2): 700–706.
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary
2.
heart disease in subjects with type 2 diabetes and in nondiabetic subjects with
and without prior myocardial infarction.
N Engl J Med
1998;
339
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Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. San Antonio Heart
3.
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San Antonio Heart Study.
Circulation
2004;
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: 1251–1257.
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4.
syndrome on atherosclerotic risk in relatively long-surviving patients with type 1
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5.
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6.
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7.
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