Lifestyle for cardiovascular prevention. How relevant to the health needs of South Africa?

The concept that the ideal lifestyle changes will improve heath and longevity may only be feasible for the fortunate few who have time, knowledge and energy to devote to this important health issue. I have called the critical five lifestyle factors the “Big Five” to help in spreading the concept.(1) Such mnemonics sound good and we all know of the health benefits but, as the saying goes, “the spirit is willing but the flesh is weak.” What is practical? How do the lifestyle Big Five fit in with the better known Risk Factor concept and the increasing number of guidelines

Digitalis reappraised: Still here today, but gone tomorrow?

Digoxin is one of the oldest of drugs acting on the heart and still one of the most frequently used. While in atrial fibrillation digoxin continues to have a valid role in the control of ventricular rate when added to beta-blockers and calcium antagonists, digoxin for heart failure is no longer a supportable option in view of the negative recent meta-analysis

The five-point heart healthy lifestyle

The “Lifestyle Big-Five” are, in order of importance, nonsmoking, daily exercise for 30 min or more, a body mass index of 25 or less, the ideal diet  and last and least, modest alcohol. This lifestyle is associated with a pattern of maximal freedom from cardiovascular disease, stroke and with improved longevity. The major data supporting the “Lifestyle Big-Five” chiefly come from the results of the Nurses’ Health Study over 26 years and the Health Professionals Study over 20 years, both in the USA. Both these studies are supported by several large European studies including one that by computer randomly recruited a selected population. Apart from the evidence for non-smoking, which is already well-established and well-known, each of the other four components are evaluated in this review, with recommendations for application to patients. SAHeart 2011; 8:154-16

Myocardial intermediary metabolism: with special reference to the isolated, contracting, perfused rat heart

Studies of myocardial metabolism In vivo have been considerably advanced by the introduction of coronary sinus catheterization. By determining the coronary arterio-venous differences of various substrates, Sing and other workers (Goodale, Olson) have been able to describe the overall picture of myocardial metabollism in man and intact experimental animals. This technique dos not, however, allow adequate pinpointing of the precise pathways of cardiac metabolism in health and disease, and Bing concludes a recent review (1958) by advocating further studies using newer techniques such as radio-isotopes in a controlled in vitro system

Wine and heart health: learning from the French paradox

Wine with good food (albeit fatty) is an integral part of the French dietary pattern which is often called the French paradox. We note that among the inherent compounds in wine, especially red, that could confer cardioprotection, are resveratrol and melatonin. However, we do not think that drinking red wine is the sole explanation for the French paradox, whereby a rich high fat diet is associated with a lower than expected incidence of coronary heart disease. Rather, we note differences in French social behaviour – French eating is for refined pleasure and conviviality. ''Food is bought, cooked, and celebrated.'' Gardening with the availability and love of fresh vegetables is common. This lifestyle may be the key to the French paradox which, however, seems to be a passing phenomenon as dietary patterns and passion for gardening change even in France. Recent data suggest that, after all, the French are susceptible to the same rules as are other nations. The true Mediterranean diet pattern, found only in the relatively small geographic part of the South of France, is by contrast low in fat, with little red meat and rich in fish and olive oil. Like the French diet, it emphasises fresh fruit and vegetables and includes modest wine with the meals

Influence of Tumour Necrosis Factor Alpha on the Outcome of Ischaemic Postconditioning in the Presence of Obesity and Diabetes

Obesity and diabetes contribute to cardiovascular disease and alter cytokine profile. The cytokine, tumour necrosis factor alpha (TNFα), activates a protective signalling cascade during ischaemic postconditioning (IPostC). However, most successful clinical studies with IPostC have not included obese and/or diabetic patients. We aimed to investigate the influence of TNFα on the outcome of IPostC in obese or diabetic mice. TNF knockout or wildtype mice were fed for 11 weeks with a high carbohydrate diet (HCD) to induce modest obesity. Diabetes was induced in a separate group by administration of a single intraperitoneal injection of streptozotocin. Hearts were then isolated and subjected to ischaemia (35 min of global ischaemia) followed by 45 min of reperfusion. HCD increased body weight, plasma insulin and leptin levels while the glucose level was unchanged. In streptozotocin-treated mice, blood glucose, plasma leptin and insulin were altered. Control, obese or diabetic mice were protected with IPostC in wiltype animals. In TNF knockout mice, IPostC failed to protect control and diabetic hearts while a slight protection was observed in obese hearts. Our data confirm a bidirectional role for TNFα associated with the severity of concomitant comorbidities and suggest that diabetic and/or modestly obese patients may still benefit from IPostC

Warfarin in non-valvular atrial fibrillation

The development of novel oral anticoagulants that are effective alternatives to warfarin in non-valvular atrial fibrillation (AF) is a welcome advance. However, a variety of unresolved problems with their use, and not least with their cost, make it important to re-evaluate the use of warfarin as it will likely remain the anticoagulant of choice in South African patients with non-valvular AF for the foreseeable future. In this article, we review the correct clinical use of warfarin. Guidance is provided on commencing warfarin treatment, maintenance dosing, the recommended steps when temporary withdrawal of treatment is necessary, the management of bleeding, and the use of warfarin in chronic kidney disease. Techniques for changing from warfarin to one of the new oral anticoagulants and vice versa are included