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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019
18
AFRICA
despite the availability of local and international dyslipidaemia
management guidelines with well-publicised LDL-C targets.
Fewer than half of patients (41.4%) were at or below their
LDL-C target, and target achievement rates were lower (32.3%)
for those patients at very high cardiovascular risk and moderate
risk (14.3%). These results are consistent with the overall findings
of the ICLPS study, which demonstrated that lipid management
remains suboptimal in countries outside of Western Europe.
15
Similar rates of LDL-C goal achievement (
∼
50%) were
reported for previous studies conducted in South Africa,
13,14
demonstrating a lack of improvement in dyslipidaemia
management over recent years. Factors that may contribute
to low LDL-C goal achievement rates include prescription of
inadequate statin doses, use of moderate- or low-potency statins,
Table 1. Demographics, presenting characteristics and medical history of the study population overall and by cardiovascular risk level
Variables
Total
(
n
=
396)
Risk level
Low
(
n
=
1)
Moderate
(
n
=
7)
High
(
n
=
123)
Very high
(
n
=
223)
Not assessable
a
(
n
=
42)
Demographics
Age (years), mean (SD)
60.0 (10.2)
43.0
43.4 (13.9)
57.8 (10.0)
62.4 (9.1)
56.9 (11.2)
Men,
n
(%)
223 (56.3)
1 (100.0)
6 (85.7)
52 (42.3)
142 (63.7)
22 (52.4)
Ethnicity,
n
(%)
Asian/South Asian/Indian
98 (24.7)
0 (0.0)
2 (28.6)
34 (27.6)
59 (26.5)
3 (7.1)
Black African
96 (24.2)
0 (0.0)
1 (14.3)
46 (37.4)
32 (14.3)
17 (40.5)
Caucasian/European
144 (36.4)
1 (100.0)
4 (57.1)
26 (21.1)
94 (42.2)
19 (45.2)
Other
58 (14.6)
0 (0.0)
0 (0.0)
17 (13.8)
38 (17.0)
3 (7.1)
Residence location,
n
(%)
Urban/suburban
367 (92.7)
0 (0.0)
6 (85.7)
117 (95.1)
208 (93.3)
36 (85.7)
Rural
29 (7.3)
1 (100.0)
1 (14.3)
6 (4.9)
15 (6.7)
6 (14.3)
Educational level,
n
(%)
Illiterate
7/391 (1.8)
0 (0.0)
0 (0.0)
3 (2.5)
1 (0.5)
3 (7.1)
Primary
67/391 (17.1)
0 (0.0)
0 (0.0)
24 (19.8)
34 (15.5)
9 (21.4)
Secondary
197/391 (50.4)
0 (0.0)
5 (71.4)
59 (48.8)
117 (53.2)
16 (38.1)
University/higher
120/391 (30.7)
1 (100.0)
2 (28.6)
35 (28.9)
68 (30.9)
14 (33.3)
Private health insurance,
n
(%)
Yes
279 (70.5)
1 (100.0)
7 (100.0)
85 (69.1)
161 (72.2)
25 (59.5)
No
117 (29.5)
0 (0.0)
0 (0.0)
38 (30.9)
62 (27.8)
17 (40.5)
Insurance includes drug reimbursement,
n
or
n
/
n
(%)
301/368 (81.8)
1 (100.0)
5 (71.4)
97/113 (85.8) 174/216 (80.6)
24/31 (77.4)
Employment status,
n
(%)
Full time
159 (40.2)
1 (100.0)
5 (71.4)
56 (45.5)
74 (33.2)
23 (54.8)
Part time
13 (3.3)
0 (0.0)
0 (0.0)
3 (2.4)
9 (4.0)
1 (2.4)
Not employed/retired
224 (56.6)
0 (0.0)
2 (28.6)
64 (52.0)
140 (62.8)
18 (42.9)
Presenting characteristics
BMI,
n
or
n/n
(%)
25 to
<
30 kg/m
2
145/395 (36.7)
1 (100.0)
3 (42.9)
37 (30.1)
91/222 (41.0)
13 (31.0)
≥
30 kg/m
2
199/395 (50.4)
0 (0.0)
2 (28.6)
71 (57.7)
101/222 (45.5)
25 (59.5)
Metabolic syndrome (ATP III),
n
or
n/n
(%)
205/380 (53.9)
0 (0.0)
1 (14.3)
62/121 (57.2) 125/210 (59.5)
17/41 (41.5)
Physical inactivity,
b
n
(%)
227 (57.3)
1 (100.0)
3 (42.9)
65 (52.8)
134 (60.1)
24 (57.1)
Current smoker,
c
n
(%)
53 (13.4)
0 (0.0)
0 (0.0)
13 (10.6)
39 (17.5)
1 (2.4)
Regular alcohol consumption,
n
(%)
87 (22.0)
1 (100.0)
2 (28.6)
20 (16.3)
56 (25.1)
8 (19.0)
SBP
≥
140 mmHg and/or DBP
≥
90 mmHg,
n
(%)
196 (49.5)
0 (0.0)
3 (42.9)
56 (45.5)
120 (53.8)
17 (40.5)
Diabetes mellitus (type 1 or 2),
n
(%)
258 (65.2)
0 (0.0)
0 (0.0)
109 (88.6)
149 (66.8)
0 (0.0)
Diabetes mellitus (type 2),
n
or
n
/
n
(%)
253/395 (64.1)
0 (0.0)
0 (0.0)
106 (86.2)
147/222 (66.2)
0 (0)
Dyslipidaemia (diagnosis or history) (physician defined),
n
(%)
390 (98.5)
1 (100.0)
7 (100.0)
122 (99.2)
219 (98.2)
41 (97.6)
Family history of CVD,
d
n
(%)
151 (38.1)
1 (100.0)
3 (42.9)
30 (24.4)
100 (44.8)
17 (40.5)
Hypertension (diagnosed/history of),
n
(%)
322 (81.3)
0 (0.0)
2 (28.6)
99 (80.5)
190 (85.2)
31 (73.8)
Familial hypercholesterolaemia,
e
n
/
n
(%)
8/130 (6.2)
0 (0.0)
0/6 (0.0)
1/56(1.8)
7/67 (10.4)
NA
Medical history
CAD (documented),
n
(%)
135 (34.1)
0 (0.0)
0 (0.0)
0 (0.0)
135 (60.5)
0 (0.0)
ACS/MI,
n
(%)
88 (22.2)
0 (0.0)
0 (0.0)
0 (0.0)
88 (39.5)
0 (0.0)
Stroke (any),
n
(%)
15 (3.8)
0 (0.0)
0 (0.0)
0 (0.0)
15 (6.7)
0 (0.0)
Peripheral artery disease,
n
(%)
18 (4.5)
0 (0.0)
0 (0.0)
0 (0.0)
18 (8.1)
0 (0.0)
Congestive heart failure,
n
(%)
13 (3.3)
0 (0.0)
0 (0.0)
1 (0.8)
12 (5.4)
0 (0.0)
Chronic kidney disease (GFR
<
60 ml/min/1.73 m
2
),
n
(%)
27 (6.8)
0 (0.0)
0 (0.0)
0 (0.0)
27 (12.1)
0 (0.0)
ACS: acute coronary syndrome; ATP: Adult Treatment Panel; BMI: body mass index; CAD: coronary artery disease; CVD: cardiovascular disease; DBP: diastolic
blood pressure; GFR: glomerular filtration rate; MI: myocardial infarction; NA: not available; SBP: systolic blood pressure; SD: standard deviation.
a
Patients without a serious pathology, classifying them as very high or high cardiovascular risk, and in whom the SCORE could not be calculated owing to missing data.
b
Subject is not regularly involved in moderate (walking/cycling/gardening) or strenuous exercise (jogging/football/vigorous swimming) for
≥
four hours each week.
c
Individuals who smoked any tobacco in the previous 12 months or who quit during past year.
d
Coronary and/or vascular disease
<
55 years of age in male and
<
60 years in female first-degree relatives.
e
Dutch Lipid Clinics criteria: definite or probable.