VOLUME 20 NUMBER 1 • JUNE 2023 3 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 This issue takes a look at the potential cardiac benefit of empagliflozin, the effect of insulin resistance on left ventricular modelling in hypertensives and the benefits of cinnamon in diabetes management. Baris et al., in Gaziantep, Turkey, (page 4) showed that in an animal model, empagliflozin, a selective sodium-glucose transporter-2 (SGLT2) inhibitor, attenuated the QT prolongation associated with amitriptyline use. QT prolongation is associated with negative cardiac outcomes, such as torsade de pointes and sudden cardiac death.1 The authors give a plausible physiological explanation in terms of effect on calcium channels. Many of the common antidepressants may also prolong the QT interval. These medications include selective serotonin reuptake inhibitors (SSRIs), such as citalopram, fluoxetine and venlafaxine. Other antidepressant options, namely bupropion or mirtazapine, may be considered since they carry minimal to no risk of QT prolongation.2 Further studies on empagliflozin in a clinical setting may be warranted. Phanzu et al., in Kinshasa, DRC, (page 9) determined at the effect of hyperinsulinaemia and insulin resistance on left ventricular remodelling. Left ventricular hypertrophy is associated with increased rates of morbidity and mortality. Various elements are important, such as posterior ventricular wall changes, interventricular septal changes and left ventricular mass. This can lead to diastolic and systolic dysfunction, arrythmias and increased ischaemic events.3 The authors tried to tease out whether there is a difference in effect of hyperinsulinaemia versus insulin resistance on cardiac function and what the implications might be. They highlight the early changes in cardiac function and elaborate on possible pathophysiology Cholesterol passport for adolescents to halt the world’s deadliest disease, atherosclerosis The United Nations Declaration of Human Rights that everyone has the right to life could as well be extended to include the right to an ‘elevated cholesterol-free life’, a viewpoint by Dr Andrew Agbaje of the University of Eastern Finland, published in Frontiers in Pediatrics, concludes. Globally, atherosclerotic cardiovascular disease has remained the leading cause of death in the past decades, despite huge advancements in medical treatment. The staggering cost of longterm treatment of atherosclerotic cardiovascular disease forms a significant proportion of annual health expenditure. Based on strong evidence from studies among adults, risk factor assessments for atherosclerotic cardiovascular disease have been established by middle age. However, emerging studies in the paediatric population describe two main problems. Firstly, the likelihood of genetic conditions, which result in extremely high levels of cholesterol from birth with the risk of heart attack and sudden death by age 20 years. Secondly, the prevalence of elevated cholesterol in 20% of adolescents without genetic alterations, which could rise to 25% of young adults within seven years. This second category constitutes the majority of people who progress to developing atherosclerotic cardiovascular disease in mid-adulthood. There is a call to shift to prevention as the gold standard for addressing this deadly disease through the initiation of a universal paediatric lipid screening in the latest European Atherosclerosis Continued on page 16 linking these two factors to their cardiac consequences. Mohan, from the University of KwaZulu-Natal, (page 17) reviewed the use of cinnamon in type 2 diabetes. She documents the history, types, physiological effects and evidence for benefit from cinnamon. Cinnamon can also have a beneficial effect on lipids,4 and therefore modify a cardiovascular risk factor in diabetes. Few comprehensive studies have been done and this deserves further study. Herbs and natural remedies have a fascinating history over thousands of years. References 1. Vandael E, Vandenberk B, Vandenberghe J, Willems R, Foulon V. Risk factors for QTc-prolongation: systematic review of the evidence. Int J Clin Pharm 2017; 39(1): 16–25. 2. https://www.acc.org/latest-in-cardiology/articles/2019/01/04/07/59/current-updatesregarding-antidepressant-prescribing-in-cv-dysfunction. Accessed 28/06/2023. 3. Sayin BY, Oto A. Left ventricular hypertrophy: etiology-based therapeutic options. Cardiol Ther 2022; 11(2): 203–230. 4. Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis. Ann Fam Med 2013; 11(5): 452–459. CARVETREND 6,25, 12,5, 25 mg. Each tablet contains 6,25, 12,5, 25 mg carvedilol respectively. S3 A37/7.1.3/0276, 0277, 0278. NAM NS2 08/7.1.3/0105, 0104, 0103. BOT S2 BOT1101790, 1791, 1792. For full prescribing information, refer to the professional information approved by SAHPRA, 13 December 2019. 1) Panagiotis C Stafylas, Pantelis A Sarafidis. Carvedilol in hypertension treatment. Vascular Health and Risk Management 2008;4(1):23-30. CDA891/09/2022. RESTORE cardiac function ß C A R V E D I L O L 6,25 mg 12,5 mg 25 mg CARVEDILOL: • is indicated twice daily for mild to moderate stable symptomatic congestive heart failure • is indicated once daily for essential mild to moderate hypertension • has no significant metabolic e ects1 CUSTOMER CARE LINE +27 21 707 7000 www.pharmadynamics.co.za
RkJQdWJsaXNoZXIy NDIzNzc=