CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 5, September/October 2011
234
AFRICA
Cardiovascular Topics
CEPHEUS SA: a South African survey on the under-
treatment of hypercholesterolaemia
FREDERICK RAAL, COLIN SCHAMROTH, DIRK BLOM, JAN MARX, MANGOO RAJPUT, MATTHIAS HAUS,
RAZIA HUSSAIN, FATIMA CASSIM, MICHELLE NORTJÉ, GUY VANDENHOVEN, ANNE-MARIE TEMMERMAN
Abstract
Aim:
The aim of the CEntralised Pan-SouthAfrican survey on
tHE Under-treatment of hypercholeSterolaemia (CEPHEUS
SA) was to evaluate the current use and efficacy of lipid-
lowering drugs (LLDs), and to identify possible patient and
physician characteristics associated with failure, if any, to
achieve low-density lipoprotein cholesterol (LDL-C) targets.
Methods:
The survey was conducted in 69 study centres in
South Africa and recruited consecutive consenting patients
who had been prescribed LLDs for at least three months.
One visit was scheduled for data collection, including fast-
ing plasma lipid and glucose levels. Physicians and patients
completed questionnaires regarding their knowledge, aware-
ness and perceptions of hypercholesterolaemia and the treat-
ment thereof.
Results:
Of the 3 001 patients recruited, 2 996 were included
in the final analyses. The mean age was 59.4 years, and 47.5%
were female. Only 60.5 and 52.3% of patients on LLDs for at
least three months achieved the LDL-C target recommended
by the NCEP ATP III/2004 updated NCEP ATP III and the
Fourth JETF/South African guidelines, respectively. Being
Department of Medicine, Charlotte Maxeke Johannesburg
Academic Hospital, Johannesburg, South Africa
FREDERICK JOHAN RAAL, FCP (SA), FRCP, FRCPC, MMED,
PhD,
Milpark Hospital, Johannesburg, South Africa
COLIN SCHAMROTH, MB ChB, MMed
Health Science Faculty, University of Cape Town, Cape
Town, South Africa
DIRK BLOM, MB ChB, MMed, FCP (SA), PhD
Cardiology Research, Universitas Private Hospital,
Bloemfontein, South Africa
JAN MARX, MB ChB, MMed, MB (SA)
RK Khan Hospital, Durban, South Africa
MANGOO RAJPUT, FCP (SA), FRCP (UK)
AstraZeneca, South Africa
MATTHIAS HAUS, MB ChB, MD, DCH, FCFP, Dip Mid COG, FFPM
(RCP)
RAZIA HUSSAIN, MBA
FATIMA CASSIM, BPharm, PCDT, HDip Bus M
MICHELLE NORTJÉ, BPharm
AstraZeneca, Belgium
GUY VANDENHOVEN, MD, PhD
ANNE-MARIE TEMMERMAN, MD
male, older than 40 years, falling into the lower-risk catego-
ries, compliance with the medication regimen, and patient
knowledge that the LDL-C goal had been reached, were asso-
ciated with the highest probability of attaining LDL-C goals.
Conclusion:
The results of this survey highlight the sub-opti-
mal lipid control achieved in many South African patients
taking lipid-lowering therapy.
Keywords:
hypercholesterolaemia, LDL-C, lipid-lowering
drugs, statins, under-treatment
Submitted 31/5/11, accepted 23/8/11
Published online 15/9/11
Cardiovasc J Afr
2011;
22
: 234–240
DOI: 10.5830/CVJA-2011-044
Cardiovascular disease (CVD), of which coronary heart disease
(CHD) is the commonest manifestation, is the leading cause of
mortality in adults in most European countries.
1
Multiple lines of
evidence (epidemiological, clinical and interventional) confirm
that elevated levels of low-density lipoprotein cholesterol (LDL-
C) are associated with increased cardiovascular risk and that
lowering LDL-C reduces cardiovascular risk. This relationship
between LDL-C and cardiovascular risk thus far holds true for
almost all populations investigated.
2–4
Several authorities, such as the Joint European Task Force
(JETF) and the United States (US) National Cholesterol
Educational Program Adult Treatment Panel III (NCEP ATP III)
have developed clinical guidelines for the management of CVD
risk, as there are extensive data showing that modification of risk
factors can delay the development of CHD or prevent recurrent
events in those with CVD at baseline.
5–8
Over time, these guide-
lines have proposed progressively lower targets for the cardio-
vascular risk factors, on the basis of clinical study evidence
demonstrating that cardiovascular risk is reduced further by more
rigorous risk factor control.
5–8
Currently, all guidelines identify LDL-C as the primary target
of cholesterol-lowering therapy, and recommend LDL-C goals
based on the risk category of the individual patient.
7,8
For many
patients who are at low risk for future CVD events, non-pharma-
cological interventions such as diet, exercise and smoking cessa-
tion may be adequate risk-reduction strategies. However, patients
with high cardiovascular risk generally require lipid-lowering
drug therapy to reduce their risk adequately.
Despite the significant increase over the last decade in the
number of patients treated with LLDs, surveys in Europe
9–13
as
