CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 5, September/October 2011
238
AFRICA
The level of achievement of LDL-C targets improves as the
patient ages (
<
40 years: 42.4%; 40 to
<
55 years: 56.0%; 55 to
<
70 years: 62.4%;
≥
70 years: 66.8%). More males (63.6%)
reached the LDL-C goals than females (57.1%). Achievement
of LDL-C goals was not affected by BMI, with the respective
at-goal rates of 61.6% in normal-weight patients, 61.7% in over-
weight and 59.1% in obese patients.
Stratification according to LLD showed that 61.3% of
patients on statin monotherapy, 48.8% on combination therapy
and 36.0% on monotherapy with fibrates achieved their LDL-C
goals. In patients on statin therapy, more achieved their goals
on the more potent statins (Rosuvastatin and Atorvastatin)
compared to those on the less potent statins (Table 5).
Differences were noted in the achievement of LDL-C goals in
different ethnic groups, withAsians showing the highest achieve-
ment (65.9%), followed by Caucasians (64.9%), blacks (63.3%),
Indians (55.5%), and the mixed-ancestry (50.6%) group.
The percentage of patients who attained the LDL-C goal
was highest among primary-prevention patients (67.0%), simi-
lar among patients treated for diabetes mellitus (58.2%) and
in secondary prevention after a cardiovascular event (56.9%),
but lowest among patients with familial hypercholesterolaemia
(30.2%). Only 58.2% of patients with the metabolic syndrome
achieved the LDL-C goal, while 65.5% of patients without the
metabolic syndrome achieved the LDL-C goal.
Target attainment according to the Fourth JETF/
South African guidelines
Only 52.3% (
n
=
1 557) of patients with no missing data (
n
=
2 976) reached the LDL-C goals recommended by the Fourth
JETF/South African guidelines (Table 4). The percentage of
patients reaching the LDL-C goals was higher in male patients
(54.7%) than in females (49.6%). Younger patients achieved
LDL-C goals less frequently, with only 36.1% of patients under
40 years and 48.5% of patients aged 40 to 54 years reaching the
LDL-C goal, while 54.5 and 56.2% reached goal in the 55 to 69
years and
≥
70 years categories, respectively.
A similar percentage of patients reaching the LDL-C goals
was observed in normal-weight (51.3%), overweight (54.0%)
and obese (51.4%) patients. The percentage of LDL-C goal
achievers was slightly lower in patients with CHD (50.4%) than
in those without CHD (53.4%), and similar in patients with
(52.3%) and without (52.3%) CAD.
Conversely, more patients without peripheral arterial disease
(PAD) (52.6%) reached the LDL-C goals versus patients with
PAD (47.3%). Fewer patients with a family history of premature
CVD (45.3%) reached the LDL-C goal versus those without a
family history of premature CVD (55.2%). More patients with
diagnosed diabetes (
n
=
1 411; 54.4%) achieved the LDL-C goal
than patients with probable undiagnosed diabetes based on a
single fasting glucose of
>
7 mmol/l (
n
=
71; 40.8%).
More patients on statin monotherapy (53.0%) or combina-
tion therapy (43.8%) reached their LDL-C goal, compared with
patients on monotherapy with fibrates (28.0%). Differences
were noted in the achievement of LDL-C goals in different
ethnic groups, with Asians showing the highest achievement
(59.1%), followed by blacks (58.0%), Caucasians (54.5%),
Indians (49.4%), and the mixed-ancestry (43.1%) group.
More patients who were non-smokers (53.0%) achieved
LDL-C goals than patients who were smokers (48.2%). The
percentage of patients who were at the LDL-C recommended
level was 54.9% for those in primary prevention, 54.6% for
those in secondary prevention and 26.4% for those with familial
hypercholesterolaemia.
The percentage of patients with the metabolic syndrome who
achieved their LDL-C goal was 50.9%. When stratified accord-
ing to LLD, 53.0% of patients on monotherapy with statins,
53.0% of patients on combined therapy, and 28.0% of patients
on monotherapy with fibrates achieved their LDL-C goals. The
percentage of patients at the LDL-C goal recommended by the
Fourth JETF/South African guidelines in different sub-popula-
tions is also summarised in Table 4.
Determinants for attainment of the NCEP and
Fourth JETF/South African guidelines targets
A total of 72.2% of patients were still on the same LLD as when
first prescribed lipid-lowering pharmacotherapy; 63.5% of all
patients were still taking the initial starting dose, while the dose
had been increased in 8.7% of patients. In 23.2% of patients the
LLD had changed once or twice, while in 4.6% of patients the
LLD had changed several times (Fig. 3).
A total of 63.5% of patients were still on the same LLD as
when first prescribed lipid-lowering pharmacotherapy; 63.5%
of all patients were still taking the initial starting dose, while the
dose had been increased in 8.7% of patients. In 4.6% of patients,
the LLD had been changed several times.
Patient predictors that significantly influenced achieving of
LDL-C goals recommended by the NCEP ATP III/2004 updated
NCEP ATP III guidelines included being older in age; male
gender; being a non-smoker; not having familial hypercholester-
olaemia; being in the medium/low-risk category rather than high
risk; and compliance with treatment, including compliance after
cholesterol had returned to normal levels (Fig. 4).
Predictors that significantly influenced being at the LDL-C
goal according to the Fourth JETF/South African guidelines
included being older in age, male gender, having diagnosed
diabetes, not having a family history of premature CVD, being
medium/low risk rather than in the high-risk category, and
compliance with treatment, including compliance after choles-
terol returned to normal.
TABLE 5. PATIENTS ON STATINSACHIEVINGTHE LDL-C GOALS
Atorvastatin
(
n
=
866)
Fluvastatin
(
n
=
10)
Lovastatin
(
n
=
4)
Pravastatin
(
n
=
43)
Rosuvastatin
(
n
=
371)
Simvastatin
(
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
