VOLUME 8 NUMBER 4 • NOVEMBER 2011
155
SA JOURNAL OF DIABETES & VASCULAR DISEASE
SPECIAL REPORT
South African patients with diabetes are under-treated for
hypercholesterolaemia
T
he recently published South African CEPHEUS study has
shown that 46% of patients with diabetes who are treated
for hypercholesterolaemia do not reach their targets for low-
density lipoprotein cholesterol (LDL-C).
1
This non-interventional
study known as CEPHEUS (CEntralised Pan-South African survey
on tHE Under-treatment of hypercholeSterolaemia) was conducted
between November 2009 and April 2010 in 69 South African study
centres and evaluated patients who had received cholesterol-low-
ering therapy for at least three months.
A total of 3 001 patients consented to participate in the survey
with only five patients not being entered into the final data set. The
study was a single-visit non-interventional study, but also included
a doctor and patient questionnaire.
The doctor questionnaire was completed prior to patient recruit-
ment. It evaluated the attending doctor’s views on the manage-
ment of hypercholesterolaemia as seen in his/her patients, and the
overall attitude to diagnosis and treatment according to dyslipidae-
mia guidelines.
The patient questionnaire was completed before the investiga-
tor assessed the patient. It evaluated the patient’s awareness and
perceptions of hypercholesterolaemia, his/her understanding of the
lipid-lowering drug (LLD) regimen and compliance with treatment.
Survey of in-treatment hypercholesterolaemia highlights the need for intensified
treatment in diabetes
J AALBERS
Major centres in Johannesburg, Cape Town, Durban and Bloem-
fontein led the study, with AstraZeneca sponsorship and assistance
in the study design. Quintiles, a contract research organisation, pro-
vided data management support.
CEPHEUS study methods
For each patient, the investigator completed a patient record form,
which included information on the patient’s demographics, current
LLD treatment and reason for initiating LLD treatment. The investi-
gator also recorded the presence of known cardiovascular risk fac-
tors such as smoking, diabetes, family history of premature CHD
(defined as definite myocardial infarction or sudden death before 55
years of age in father or other male first-degree relative, or before
65 years of age in mother or other female first-degree relative),
arterial hypertension (defined as blood pressure ≥ 140/≥ 90 mmHg
or current use of antihypertensive medication) and cardiovascular
medical history.
Physical examination by the investigator was limited to measure-
ment of height, weight, waist circumference and blood pressure. A
fasting blood sample was drawn to evaluate the serum lipid profile
[including measurement of apolipoprotein (Apo) AI and Apo B] and
glucose levels.
It is important to note that this study deliberately attempted to
ensure the inclusion of patients of all racial groups, with Caucasians
being in the minority (46.2%) (Table 1). The proportion of patients
achieving LDL-C target was analysed using target values from mul-
tiple guidelines to allow for easy comparison with similar surveys
conducted in other countries (Table 2).
Results of lipid-lowering therapy in diabetes patients
Only slightly more than half (54.4%) of the diabetes patients
reached a target LDL-C of less than 2.5 mmol/l. HbA
1c
level was
also measured in all patients and mean HbA
1c
in the diabetics was
8.33%, indicating that many diabetics have inadequate glycaemic
control. The mean fasting plasma glucose (FPG) in the diabetes
Table 1.
Summary of demographics and patient characteristics at baseline
Study cohort
Patient characteristics
n
= 2 996 (%)
Age (years)
59.4 (11.4)
Gender
Male
1572 (52.5)
Female
1424 (47.5)
Ethnic group
Caucasian
1385 (46.2)
Non-Caucasian
1611 (53.8)
Black
510 (17.0)
Mixed ancestry
481 (16.1)
Indian
576 (19.2)
Asian
44 (1.5)
BMI (kg/m
2
)
30.0 (6.0)
Waist circumference (cm)
101.0 (14.1)
SBP (mmHg)
133.2 (17.7)
DBP (mmHg)
80.2 (9.9)
Current smoker
445 (14.9)
Diagnosed diabetes
1411 (47.1)
Undiagnosed diabetes
71 (2.4)
Diabetes and history of coronary heart disease
494 (16.5)
Table 2.
LDL-C goal-achievement targets
Risk category
NCEP ATP III/
2004 NCEP
ATP III
European
JEFT IV
South
African
High risk
Current goal (mmol/l)
< 2.6
< 2.5
< 2.5
Optional goal (mmol/l)
< 1.8
< 2.0
–
Medium/low risk
Current goal (mmol/l)
< 3.4
< 3.0
< 3.0
