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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013
44
AFRICA
Fig. 1.
JUPITER trial endpoint: myocardial infarction, stroke, UA/revascularisa-
tion, cardiovascular death.
‘A
ny infection creates a risk of
myocardial infarction (MI)
because bursts of inflammation
destabilise arterial plaques. A high rate of
infectious diseases resulting in high pre-
vailing C-reactive protein (CRP) levels in
Africa, together with social deprivation,
hypertension, diabetes and renal disease
add to the coronary artery disease (CAD)
risk in these individuals.’ This view was
expressed by Prof Thomas F Lüscher, head
of Cardiology, University of Zurich and
current editor-in-chief of the
European
Heart Journal
.
‘Supportive evidence for this view on
infections comes from studies in patients
with long-term rheumatoid arthritis,
1
where treating these patients
with simvastatin improved
vascular function considerably.
This vascular benefit can also
be attributable to reduced
levels of CRP and other
inflammatory cytokines’, Prof
Lüscher pointed out.
Low-density
lipoprotein
(LDL) cholesterol is the main
target for addressing the lipid-
related risk of cardiovascular
events, with added benefit to
be derived from also address-
ing CRP levels. ‘The potential
benefit of targeting high-den-
sity lipoprotein (HDL) choles-
terol has also been investigated
Patients in Africa with a high risk of coronary artery disease (CAD) often have elevated levels of C-reactive
protein due to inflammation caused by infections. Additionally, this underlying inflammation produces significant
platelet dysfunction in people who have the added complication of diabetes. Each of these complications and their
therapeutic consequences were discussed by a distinguished faculty at a symposium titled:
Unmasking cardiovascular
complications: what are we missing?
6th World Congress
Paediatric Cardiology and Cardiac Surgery
Cape Town, February 2013
Satellite symposium
Consequences of underlying infection
complicate CVD management in Africa
Jupiter . . . highlighted the value of
lowering LDL cholesterol and CRP levels
“
”
in many trials; most of them have however
been negative’, Prof Lüscher said.
By contrast, the evidence for lowering
LDL cholesterol is consistent, and the
message for both primary and secondary
prevention is ‘the lower the LDL level, the
better the outcome’.
‘Also at the level of the coronary
plaque, lowering LDL cholesterol levels
as far as possible achieves better results.
This was clearly shown in the ASTEROID
trial with rosuvastatin where intensive
therapy led to an actual regression of
atherosclerosis’, he explained.
JUPITER, the most important trial of
lipids in primary prevention, also high-
lighted the value of lowering LDL choles-
terol and CRP levels. In this trial, 17 000
men and women were randomly assigned
to rosuvastatin 20 mg or placebo and fol-
lowed up for up to five years until the
occurrence of a myocardial infarction,
stroke, cardiovascular-related hospital
admission or cardiovascular death. Partici-
pants in the trial had low-to-normal LDL
cholesterol levels (3.4 mmol/l) and raised
CRP levels of 2 mg/l or higher.
2
‘There was a marked reduction in
cardiovascular events in patients receiving
rosuvastatin therapy and the size of this
reduction was more than expected from
the statistical modelling’, Prof Luscher
said (Fig. 1).
‘The JUPITERdatahavealsoproved tobe
invaluable in the interpretation
of the recent finding that statin
therapy can increase patient’s
overall risk of diabetes’, Prof
Luscher said, referring to the
recently published evaluation
which showed that among the
primary-prevention patients
included in the JUPITER
study, the cardiovascular and
mortality benefits of statin
therapy far exceeded the
diabetes hazard, even in study
participants who were at high
risk of developing diabetes.
3
Nevertheless, plasma glucose
level needs to be monitored in
patients on statin treatment.