CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 5, September/October 2011
AFRICA
237
Most were male (80.2%) and general practitioners/primary care
practitioners (GP/PCP) (66.3%); only 12.9% were cardiologists,
6.9% endocrinologists and 13.9% other specialist physicians.
Most investigators (
n
=
96; 95.0%) use guidelines to estab-
lish individual target cholesterol levels, with the National
South African guidelines and the NCEP ATP III guidelines
(Framingham) being the most frequently used by 50.0% and
35.9% of investigators, respectively (Fig. 1). Other less-used
guidelines were: Joint European guideline (SCORE) (
n
=
22;
23.9%), individual practice guidelines (
n
=
12; 13.0%), funder
formularies (
n
=
10; 10.9%), other guidelines (
n
=
6, 6.5%) and
local healthcare authority guidelines (
n
=
4; 4.3%) (Fig. 2).
Lipid values and attainment of guideline targets
The overall mean plasma lipid and glucose values are presented
in Table 3. The mean values of total cholesterol and LDL-C were
4.88 mmol/l and 2.73 mmol/l, respectively (Table 3).
Target attainment according to the NCEP/2004
NCEP ATP III guidelines
Overall, 60.5% (
n
=
1 801) of patients with no missing data (
n
=
2 976) were at target LDL-C goals as recommended by NCEP
ATP III/2004 NCEP ATP III guidelines (Table 4).
Fig. 1. Use of guidelines to establish individual target
cholesterol levels.
100
80
60
40
20
0
Yes
No
% of investigators
95.0
5.0
Guideline used
Fig. 2. Guidelines used to establish cholesterol targets.
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Guideline used
% of investigators
23.9
35.9
50.0
4.3
13.0 10.9
6.5
SCORE
FRAMINGHAM South African
Local healthcare
authority
Individual practice
guidelines
Funder formularies
Other
TABLE 3 SUMMARY OF LABORATORY RESULTS
Test
Study cohort (
n
=
2996)
Mean (SD)
Total cholesterol (mmol/l)
4.88 (1.24)
Triglycerides (mmol/l)
1.90 (1.71)
HDL-C (mmol/l)
1.31 (0.39)
LDL-C (mmol/l)
2.73 (1.01)
Non-HDL-C (mmol/l)
3.58 (1.22)
Apo A1 (g/l)
1.39 (0.31)
Apo B (g/l)
0.87 (0.27)
Apo B/Apo A1 ratio
0.70 (0.30)
Glucose (mmol/l)
6.63 (2.95)
With diagnosed diabetes (
n
=
1 411)
8.16 (3.59)
HbA
1c
(%)
7.11 (1.96)
With diagnosed diabetes (
n
=
1 411)
8.33 (2.19)
SD: standard deviation, HDL-C: high-density lipoprotein cholesterol,
LDL-C: low-density lipoprotein cholesterol, ApoA1: apolipoprotein
A1, ApoB: apolipoprotein B, HbA
1c
: haemoglobin A
1c
.
Non-HDL-C (mmol/l): [total cholesterol (mmol/l) – HDL-C (mmol/l)].
TABLE 4 PATIENTSACHIEVINGTHE LDL-C GOALS
RECOMMENDED BY THE DIFFERENT GUIDELINES
NCEP ATP III/
2004 NCEP
ATP, n (%)
European/
South African
guidelines
n (%)
Overall survey
1801 (60.5) 1557 (52.3)
Age (years)
<
40
61 (42.4)
52 (36.1)
40–54
441 (56.0)
382 (48.5)
55–69
941 (62.4)
822 (54.5)
≥
70
358 (66.8)
301 (56.2)
Gender
Male
992 (63.6)
854 (54.7)
Female
809 (57.1)
706 (49.6)
Body mass index (kg/m
2
)
Normal weight (
<
25 kg/m
2
)
352 (61.6)
293 (51.3)
Overweight (25–29 kg/m
2
)
667 (61.7)
584 (54.0)
Obese (
≥
30 kg/m
2
)
780 (59.1)
678 (51.4)
Coronary heart disease
591 (56.0)
532 (50.4)
Peripheral artery disease
77 (52.7)
69 (47.3)
Cerebrovascular atherosclerotic disease
91 (58.7)
81 (52.3)
Current smoker
234 (52.9)
213 (48.2)
Diabetes
837 (59.6)
764 (54.4)
Arterial hypertension
1290 (60.6) 1136 (53.4)
Family history of premature
cardiovascular disease
462 (53.5)
391 (45.3)
Type of prevention
Primary prevention
882 (67.0)
722 (54.8)
Secondary prevention
492 (56.9)
437 (50.6)
Diabetes mellitus
388 (58.2)
364 (54.6)
Familial hypercholesterolaemia
39 (30.2)
34 (26.4)
Metabolic syndrome
(Alberti
et al
. 2009)
1177 (58.2) 1031 (50.9)
Type of therapy
Statin monotherapy
1720 (61.3) 1485 (53.0)
Fibrates monotherapy
9 (36.0)
7 (28.0)
Combination therapy
59 (48.8)
53 (43.8)
Risk category
High risk
1201 (55.5) 1086 (50.2)
Medium/low risk
600 (73.8)
471 (57.9)
