INVEST study warns on too-low BP in diabetic patients with CAD

The INVEST (INternational VErapamil SR-Trandolapril) study, a very large international study of hypertensive patients, has shown that patients with type 2 diabetes and coronary artery disease do not benefit from tightening systolic blood pressure levels to below 130 mmHg, and this may in some cases be harmful.

Comparison of ivabradine plus beta-blockers versus beta -blocker therapy only

A study of patients with stable angina and moderate left ventricular systolic dysfunction has shown that the addition of ivabradine to bisoprolol produced additional anti-anginal and anti-ischaemic effects that were not achieved with up-titration of bisoprolol. This indicative study is of importance to clinicians as they are frequently faced with patients on beta-blockers who are not able to tolerate the full target dose, as defined from evidencebased clinical trials.

Reduced blood pressure variability in ASCOT-BPLA trial favours use of amlodipine/perindopril combination to reduce stroke risk

Lower within-individual visit-to-visit variability in blood pressure readings in the amlodipine/perindopril combination treatment arm of the ASCOT study has been shown to account for the more effective stroke reduction rate with this combination compared to atenolol and diuretic-based therapies, despite overall similar blood pressure lowering.

ACCORD LIPID study results strengthen guideline approach of adding fenofibrate to therapy of dyslipidaemic type 2 diabetic patients

Type 2 diabetic patients treated with statins but still experiencing elevated serum levels of triglycerides (2.3 mmol/l or higher) and low HDL cholesterol (0.8 mmol/l or lower), a pre-specified subgroup, benefited from the addition of fenofibrate to their treatment regimen. Risk of cardiovascular events was reduced by 31% in those patients, translating to a need-to-treat 20 patients for five years to prevent one cardiovascular event.

Strategies for heart disease in sub-Saharan Africa

The commonest forms of heart disease in sub-Saharan Africa are chronic rheumatic heart disease, dilated cardiomyopathy, pulmonary heart disease, infectious forms of heart disease including chronic, constrictive and infective endocarditis, genetic forms of heart disease and arrhythmias. Malnutrition, with cardiac manifestations such as beriberi, and alcoholism also play a part. Ischaemic heart disease in sub-Saharan Africa at present affects mainly the small, Westernised white population. Heart disease is a less important cause of morbidity and mortality than many other infectious diseases but is likely to escalate in the next generation(s). The changing demographic picture dictates the way in which funds for research, prevention and treatment must be channelled to best advantage. A concerted effort must be made by cardiologists of African countries to arrest the advance of heart disease, and a declaration outlining these strategies has been endorsed by the Pan-African Society of Cardiology (PASCAR).

Maternal copper supplementation protects the neonatal rat lung against the adverse effects of maternal nicotine exposure

Maternal nicotine exposure interferes with the extracellular formation of the connective tissue framework of the neonatal lung, a process that is dependent on copper-dependent lysyl oxidase. It has been shown that, during the phase of lung development associated with alveolarization, maternal nicotine exposure resulted in a reduction in the copper content and thus conceivably in the activity of lysyl oxidase of the neonatal lung. Therefore the aims of this study were (a) to determine the effects of maternal nicotine exposure during gestation and lactation on neonatal lung development, and (b) to establish whether maternal copper supplementation during gestation and lactation prevented the effect of maternal nicotine exposure on neonatal lung development. Pregnant rats were randomly divided into four groups: the control group received saline; the second group received 1 mg nicotine (kg bodyweight)(-1) day(-1) subcutaneously; the third group received 1 mg copper (kg bodyweight)(-1) day(-1); and the fourth group received both nicotine and copper in the same quantities as the previous two groups. Lung tissue of 14- and 42-day-old rat pups were processed for light microscopy. Maternal nicotine exposure during gestation and lactation resulted in (a) decreased alveolar number, (b) reduced internal surface area and (c) increased alveolar volume. Copper supplementation during gestation and lactation prevented the adverse effects of maternal nicotine exposure during gestation and lactation on the development of the alveolar region of the rat lung.

The effect of dietary protein on the mineral status of vervet monkeys with special reference to the impact of milk solids on calcium excretion

This study assessed the impact of Westernised and traditional African diets on mineral metabolism in general and calcium status in particular in vervet monkeys. Twelve adult male vervet monkeys (Cercopithecus aethiops), with an average weight of 5+/-0.58 kg each, were divided into two groups of six individuals each and fed traditional diets containing largely maize + legumes (17.4%) or Westernised diets containing milk solids (17.2%) as the source of high crude protein for 8 weeks. Blood was taken at 2-week intervals, the animals were weighed, while urine and stool samples were collected over 24 hours. The monkeys on the milk solids diet had diarrhoea for 6 weeks post-dietary intervention, and produced significantly greater quantities (P<0.02) of stool. These animals also produced significantly more urine (P<0.02). There was no difference in the degree of calciuresis of the two groups, but the monkeys on maize + legume proteins absorbed significantly more calcium during weeks two and six (P<0.04). Furthermore, both groups of monkeys showed a significant decline in plasma calcium levels over the experimental period (P<0.001). The diets had no effect on phosphate levels in the plasma or urine. However, both groups of animals absorbed less phosphate (P<0.09). There was an increasing loss of urinary magnesium (P = 0.03) in both groups, with the milk solids group showing lower plasma levels of this element (P = 0.09). However, the milk solids group lost less magnesium through the stool (P<0.03). In addition, the animals on milk solids showed significant natriuresis (P<0.05), while plasma sodium levels in both groups declined over time (P<0.03). Both diets induced a state of urinary potassium loss (P = 0.0003) and decrease in plasma potassium (P<0.0002). Urinary pH and plasma urea were unaffected by the diets, but the monkeys on maize + legumes excreted significantly less (P<0.001) urinary urea. This study indicates that the milk solids diet compromised mineral homeostasis by interfering with gut and renal functioning, while the traditional African diet did not induce these effects.