Prevalence of lipid abnormalities and cholesterol target value attainment in Egyptian patients presenting with an acute coronary syndrome

Abstract

BackgroundEffective management of hyperlipidemia is of utmost importance for prevention of recurring cardiovascular events after an acute coronary syndrome (ACS). Indeed, guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL for such patients. The Dyslipidemia International Study II (DYSIS II) – Egypt was initiated in order to quantify the prevalence and extent of hyperlipidemia in patients presenting with an ACS in Egypt.MethodsIn this prospective, observational study, we documented patients presenting with an ACS at either of two participating centers in Egypt between November 2013 and September 2014. Individuals were included if they were over 18 years of age, had a full lipid profile available (recorded within 24 h of admission), and had either been taking lipid-lowering therapy (LLT) for ≥3 months at time of enrollment or had not taken LLT. Data regarding lipid levels and LLT were recorded on admission to hospital and at follow-up 4 months later.ResultsOf the 199 patients hospitalized for an ACS that were enrolled, 147 were on LLT at admission. Mean LDL-C at admission was 127.1 mg/dL, and was not significantly different between users and non-users of LLT. Only 4.0% of patients had an LDL-C level of <70 mg/dL, with the median distance to this target being 61.0 mg/dL. For the patients with LDL-C information available at both admission and follow-up, LDL-C target attainment rose from 2.8% to 5.6%. Most of the LLT-treated patients received statin monotherapy (98.6% at admission and 97.3% at follow-up), with the mean daily statin dose (normalized to atorvastatin) increasing from admission (30 mg/day) to follow-up (42 mg/day).ConclusionsDYSIS II revealed alarming LDL-C goal attainment, with none of the patients with follow-up information available reaching the target of LDL-C <70 mg/dL, either at hospital admission or 4 months after their ACS event. Improvements in guideline adherence are urgently needed for reducing the burden of cardiovascular disease in Egypt. Strategies include the effective use of statins at high doses, or combination with other agents recommended by guidelines.

A semi-systematic review on hypertension and dyslipidemia care in Egypt—highlighting evidence gaps and recommendations for better patient outcomes

“…According to the DYSlipidemia International Study (DYSIS)-Egypt, one-third of the patients who received chronic statin treatment had control in LDL-C levels [ 21 ]. In the DYSIS II study, 73.9% of patients with ACS received treatment for dyslipidemia, whereas the proportion of patients who achieved target LDL-C levels varied within different risk categories, with 5.1% at very high risk, 27.3% at high risk, 32.3% at moderate risk, and 14.3% at low risk [ 22 ]. No study provided data on diagnosis of dyslipidemia in the Egyptian population.…”

“…However, there was a possibility of recall bias, which is commonly seen in survey studies. Similarly, the proportion of patients treated (74%) was relatively higher when analyzed in a small cohort of patients suffering from ACS [ 22 ], which may not be representative of the overall Egyptian population.…”

“…The management of hypertension in Egypt was affected by multiple factors such as an inconsistent approach adopted by the physicians to measure blood pressure, inadequate treatment, lower number of patients achieving target blood pressure, lower awareness of hypertension among patients, limited use of risk assessment tools to identify high-risk patients, patient noncompliance to treatment, lack of preventive centers, and absence of national registries for CVD risk factors [ 5 , 17 – 20 ]. On the other hand, despite higher awareness regarding dyslipidemia, patients were severely undertreated and were unable to reach the target lipid levels while on treatment in Egypt [ 21 , 22 ]. In addition, there was a lack of appropriate programs for the prevention and timely detection of these two CVD risk factors [ 23 ].…”

Association between CYP3A4/CYP3A5 genetic polymorphisms and treatment outcomes of atorvastatin worldwide: is there enough research on the Egyptian population?

“…Hydroxymethyl glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) are the primary pharmacotherapy for dyslipidemia [ 21 ]. Statin monotherapy is the lipid-lowering pharmacologic treatment used among Egyptians, with atorvastatin as the most commonly prescribed statin in Egypt [ 22 ]. Responses to statins show apparent interpersonal deviations [ 21 ].…”