CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 5, September/October 2011
240
AFRICA
LLDs. Poor goal attainment may result from many factors.
Patient factors may include inadequate lifestyle modifica-
tion, sub-optimal adherence to medication and poor long-term
persistence with therapy. Many of these factors are modified or
determined by the patient’s attitude to taking medication (e.g.
concerns about safety and toxicity) and the perceived benefit
of lipid-lowering medication, which tends to be highest in those
with previous cardiovascular events. High out-of-pocket costs
may also affect adherence negatively.
Physician factors may include unawareness of lipid targets,
unwillingness to treat to target due to concerns about drug
toxicity, drug formulary constraints, and failure to check lipid
levels once LLDs have been started, and to titrate LLD dosage
if required. Patients with severe genetic dyslipidaemias such
as familial hypercholesterolaemia frequently do not reach lipid
goals, as currently available LLDs are not sufficiently potent.
Some patients may be unable to tolerate high doses of LLDs and
therefore fail to reach goal.
Poor lipid goal attainment therefore is a complex problem
that cannot be resolved by a single across-the-board intervention.
Physician education and incentivisation may address some of
the physician-related factors leading to poor lipid control, while
patient-related factors can only be addressed at an individual
level. Availability and affordability of lipid-lowering medication
remains problematic for both private and public sector patients
in South Africa.
The study was made possible by funding from AstraZeneca. The sponsors
of the study, with input from the steering committee, designed the study.
Quintiles provided data management support, analysed the data, and were
involved in writing the manuscript. All authors were involved in the interpre-
tation of the data, and with the writing and approval of the manuscript. The
sponsor and authors acknowledge the contribution of the investigators who
participated in the study.
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