CEPHEUS SA : a South African survey on the undertreatment of hypercholesterolaemia : cardiovascular topics

Abstract

AimThe aim of the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) was to evaluate the current use and efficacy of lipid-lowering drugs (LLDs), and to identify possible patient and physician characteristics associated with failure, if any, to achieve low-density lipoprotein cholesterol (LDL-C) targets.MethodsThe survey was conducted in 69 study centres in South Africa and recruited consecutive consenting patients who had been prescribed LLDs for at least three months. One visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Physicians and patients completed questionnaires regarding their knowledge, awareness and perceptions of hypercholesterolaemia and the treatment thereof.ResultsOf the 3 001 patients recruited, 2 996 were included in the final analyses. The mean age was 59.4 years, and 47.5% were female. Only 60.5 and 52.3% of patients on LLDs for at least three months achieved the LDL-C target recommended by the NCEP ATP III/2004 updated NCEP ATP III and the Fourth JETF/South African guidelines, respectively. Being male, older than 40 years, falling into the lower-risk categories, compliance with the medication regimen, and patient knowledge that the LDL-C goal had been reached, were associated with the highest probability of attaining LDL-C goals.ConclusionThe results of this survey highlight the sub-optimal lipid control achieved in many South African patients taking lipid-lowering therapy.

Undertreatment of dyslipidemia: from the Arabian Gulf to the USA. Time to solve this problem!

“…These two conditions, among others, increase CVD risk and there is an absolute necessity to effectively treat all CVD risk factors, among which is dyslipidemia. Similar data are reported by the CEPHEUS South Africa Study 6 , the CEPHEUS Pan-Asia Study 7 , the CEPHEUS Centralized Pan-European Study 8 and other European Countries 9 as well as the OLYMPIC and the metabolic syndrome Greece (n ¼ 10,000) studies 10,11 , a study from the UK (n ¼ 117,840) 12 and a study from the US National Health and Nutrition Examination Survey 13 . The recent Euroaspire IV 14 included high risk individuals (coronary patients) from 26 countries 14 .…”

Suboptimal Control of Lipid Levels: Results from 29 Countries Participating in the Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS)

“…In total, 29 countries were included, and patient and physician characteristics associated with failure to attain recommended LDL-C levels were also assessed [20][21][22][23][24][25][26][27][28] . Here we have consolidated the global results and analyzed LLD use and LDL-C goal attainment worldwide.…”

“…Patients were considered to be at very high CV risk if they had established CHD and severe and persistent CV risk factors, high CV risk if they had established CHD or CHD risk equivalents (i.e., abdominal aortic aneurysm, diabetes mellitus, peripheral vascular disease, symptomatic carotid artery disease or chronic kidney disease) or a 10-year Framingham absolute risk score ≥ 140/90 mmHg or current use of antihypertensive medication), any CV history, and presence of metabolic syndrome. Patients with metabolic syndrome were those with three or more of the following: fasting plasma triglyceride levels of at least 1.7 mmol/L (150 mg/dL), high-density lipoprotein cholesterol (HDL-C) levels 1.0 mmol/L (40 mg/dL) for men and 1.3 mmol/L (50 mg/dL) for women, blood pressure at least 130/85 mmHg, a fasting plasma glucose level of at least 5.6 mmol/L (100 mg/dL), and enlarged waist circumference (the definition of enlarged waist circumference varied across the regional CEPHEUS studies [20][21][22][23][24][25][26][27][28] ; for this statistical analysis, it was defined as a waist circumference of at least 90 cm for men and at least 80 cm for women). Examination by the physician was limited to measurement of height, weight, waist circumference, and blood pressure.…”

“…Epidemiological studies have shown that elevated serum lipid and low-density lipoprotein 568 CEPHEUS studies were conducted in 29 countries across Asia (Hong Kong, Indonesia, Malaysia, Philippines, South Korea, Taiwan, Thailand, and Vietnam) 23,26) , Western Europe (Belgium, Finland, France, Greece, Ireland, Luxembourg, Netherlands, and Turkey) 22,27,28) , Eastern Europe (Bulgaria, Poland, and Russia) 20) , the Middle East (United Arab Emirates, Bahrain, Jordan, Kuwait, Oman, Qatar, and Saudi Arabia) 21,25) , and Africa (Algeria, Egypt. and South Africa) 24) . In each country, the study protocol was reviewed and approved by the Institutional Review Board and Ethics Committee governing each participating center.…”

Quality and efficiency of statin prescribing across countries with a special focus on South Africa; findings and future implications

“…However, higher doses of atorvastatin were prescribed (Table 1) (2). In a more recent study conducted in South Africa by Raal and colleagues, 48% of patients did not reach target low-density lipoprotein cholesterol (LDL-C) levels (32). Any underdosing needs to be addressed as this significantly increases patients' risk of developing or progressing their cardiovascular disease with reduced cardioprotection (33).…”