156
VOLUME 8 NUMBER 4 • NOVEMBER 2011
SPECIAL REPORT
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Key take-home messages
• In South Africa, only 50% of diabetes patients reached the
target LDL-C of < 2.5 mmol/l.
• Lipid levels are often not checked and medication adjusted
following the initial prescription.
• Patients who reported high treatment adherence were more
likely to reach target.
• Patients in the 55–70-year age range were more likely to
reach target than those under 40, likely due to better adher-
ence.
• Many diabetics require high-dose statins or combination
lipid-lowering therapy to reach LDL-C targets.
Table 4.
Patients on statins achieving the LDL-C goals
Atorvastatin Fluvastatin
Lovastatin Pravastatin Rosuvastatin Simvastatin
(
n
= 866)
(
n
= 10)
(
n
= 4)
(
n
= 43)
(
n
= 371)
(
n
= 1 526)
Mean dosage (mg)
20.6
44.0
17.5
23.6
14.7
21.7
Controlled LDL-C NCEP* (%)
62
60
25
44
71
59
Controlled LDL-C Eu/SA* (%)
53
30
25
33
61
52
*Chi-square test;
p
< 0.05
Table 3.
Patients achieving the LDL-C goals recommended by the
guidelines.
European/South
African guidelines
Patient characteristics
n (%)
Overall survey
1557 (52.3)
Age (years)
< 40
52 (36.1)
40–54
382 (48.5)
55–69
822 (54.5)
≥ 70
301 (56.2)
Gender
Male
854 (54.7)
Female
706 (49.6)
Body mass index (kg/m
2
)
Normal weight (< 25 kg/m
2
)
293 (51.3)
Overweight (25–29 kg/m
2
)
584 (54.0)
Obese (≥ 30 kg/m
2
)
678 (51.4)
Coronary heart disease
532 (50.4)
Peripheral artery disease
69 (47.3)
Cerebrovascular atherosclerotic disease
81 (52.3)
Current smoker
213 (48.2)
Diabetes
764 (54.4)
Arterial hypertension
1136 (53.4)
Family history of premature
391 (45.3)
cardiovascular disease
Type of prevention
Primary prevention
722 (54.8)
Secondary prevention
437 (50.6)
Diabetes mellitus
364 (54.6)
Familial hypercholesterolaemia
34 (26.4)
Metabolic syndrome
(Alberti et al. 2009)
1031 (50.9)
Type of therapy
Statin monotherapy
1485 (53.0)
Fibrates monotherapy
7 (28.0)
Combination therapy
53 (43.8)
Risk category
High risk
1086 (50.2)
Medium/low risk
471 (57.9)
patients was correspondingly high at 8.16 mmol/l. Only 50% of
patients with the metabolic syndrome reached their LDL-C goal of
less than 2.5 mmol/l (Table 3).
One of the most important lessons for clinical practice from this
study is that lipid-lowering therapy was frequently left unaltered,
with a total of 63% of patients still on the same agent and dose
that they started on. Table 4 lists goal achievement on and the
mean dosage according to the statin prescribed.
The physician survey showed that most doctors used the South
African guidelines. Their failure to treat to target may have been
due to additional concerns about drug toxicity, drug formulary con-
straints, and failure to check lipid levels once LLDs had been started
and to titrate LLD dosage when required.
Patients showed a good understanding of the need to take their
medication, particularly among patients who had had previous car-
diovascular events.
Julia Aalbers, Special Assignments Editor
Reference
Raal F, Schamroth C, Blom D, Marx J, Rajput M, Haus M,
1.
et al
. CEPHEUS SA:
a South African survey on the under-treatment of hypercholesterolaemia.
Cardiovasc J Afr
2011;
22
(5): 234–242. Advance published, September 2011.
