Management of low-density lipoprotein cholesterol levels in South Africa: the International ChoLesterol management Practice Study (ICLPS)

Abstract

The International Cholesterol Management Practice Study (ICLPS) South Africa investigated achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline low-density lipoprotein cholesterol (LDL-C) targets in real-world clinical practice. Demographic data, clinical characteristics, cardiovascular risk factors, lipidmodifying medications, lipid values and investigator's assessment of cardiovascular risk were recorded for 396 patients on stable lipid-modifying therapy. Most (98.7%) patients received statins; 25.1% of statin-treated patients were receiving highintensity statins. Overall, 41.4% of patients achieved their LDL-C target; among 354 (89.4%) patients in whom cardiovascular disease risk, based on ESC Systematic Coronary Risk Estimation (SCORE) was calculated, achievement rate was 14.3% for moderate-risk (n = 7), 59.3% for high-risk (n = 123) and 32.3% for very high-risk patients (n = 223). Half of Asian (54.7%) and black African (53.2%) patients were at LDL-C target compared with 29.8% of European/Caucasian and 27.3% of 'other' patients. Improved guideline adherence and greater use of combination therapy may increase LDL-C goal achievement.

Dyslipidaemia pattern and prevalence among type 2 diabetes mellitus patients on lipid-lowering therapy at a tertiary hospital in central South Africa

“…In one multi-centre study of over 7 000 participants in Europe, only 45 % of the participants with atherogenic dyslipidaemia were on lipid-lowering therapy [ 20 ]. In another SA study that evaluated the achievement of LDL-C targets in patients on lipid-lowering therapy in clinical practice, only 41.4 % of patients achieved their LDL-C target [ 21 ]. In the European study, approximately 27 % [ 20 ] and in the SA study 64 % [ 21 ] of the participants had T2DM.…”

“…In another SA study that evaluated the achievement of LDL-C targets in patients on lipid-lowering therapy in clinical practice, only 41.4 % of patients achieved their LDL-C target [ 21 ]. In the European study, approximately 27 % [ 20 ] and in the SA study 64 % [ 21 ] of the participants had T2DM. A previous report assessing lipid goal attainment in patients on lipid-lowering therapy in central SA was done in the private sector and included patients with and without DM [ 21 ].…”

Pattern of dyslipidaemia in relation to statin use in patients with type 2 diabetes mellitus attending a tertiary care hospital

“…In the South African context, the prevalence of uncontrolled dyslipidaemia is reflected in studies done in the private sector only, 20 and in both the public and private sectors. 21,22 In these studies, the prevalence of uncontrolled LDL-C ranged from 47.7% to 58.6%.…”

“…Concerns for safety, toxicity and side effects, as well as ethnicity and lower socio-economic status, have been cited as patient factors for poor statin adherence. [20][21][22] In the public sector the lack of drug availability, due to formulary restrictions and at times stock shortage, is a common problem while staff shortage in large diabetic clinics impairs the holistic management of diabetic dyslipidaemia.…”

Guideline-directed low-density lipoprotein management in high-risk ischemic stroke or transient ischemic attack admissions in China from 2015 to 2019

“…In our study, significant gaps were found between guideline recommendations and real-world clinical practice. Previous studies also reported significant gaps between evidence-based medicine and real-world clinical practice (18)(19)(20)(21) lower than those in the Get-With-The-Guidelines-Stroke Registry several years ago with 51.3% for <2.6 mmol/L and 19.8% for <1.8 mmol/L (18). Encouragingly, however, temporal trend analysis showed there is an increasing trend for the attainment rates of LDL-C <2.6 mmol/L, LDL-C <1.8 mmol/L, LDL-C <1.4 mmol/L and prescription of cholesterol-lowering agents at discharge, though the increase was only marginal.…”