CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
238
AFRICA
Gender and ethnic differences in the control of
hyperlipidaemia and other vascular risk factors:
insights from the CEntralised Pan-South African survey
on tHE Under-treatment of hypercholeSterolaemia
(CEPHEUS SA) study
NAOMI RAPEPORT, COLIN LESLIE SCHAMROTH, DIRK JACOBUS BLOM
Abstract
Aim:
The aim of the CEntralised Pan-South African
survey on tHE Under-treatment of hypercholeSterolaemia
(CEPHEUS SA) was to evaluate the current use and efficacy
of lipid-lowering drugs (LLDs) in urban patients of differ-
ent ethnicity with hyperlipidaemia, and to identify possible
patient characteristics associated with failure to achieve
low-density lipoprotein cholesterol (LDL-C) targets. There
is little published data on LDL-C attainment from develop-
ing countries.
Methods:
The survey was conducted in 69 study centres in
South Africa and recruited consecutive patients who had
been prescribed LLDs for at least three months with no
dose adjustment for six weeks. All patients provided written
consent. One visit was scheduled for data collection, includ-
ing fasting lipid and glucose, and HbA
1c
levels.
Results:
Of the 3 001 patients recruited, 2 996 were included
in the final analyses; 1 385 subjects were of Caucasian origin
(818 male), 510 of African ancestry (168 male), 481 of mixed
ancestry (222 male) and 620 of Asian origin (364 male). Only
60.5% of patients on LLDs for at least three months achieved
the LDL-C targets recommended by the NCEPATP III/2004
updated NCEP ATP III guidelines and 52.3% the fourth
JETF/South African guidelines. African females were on
average younger than females of other ethnic origins, and
had the lowest smoking rates but the highest prevalence of
obesity, hypertension, the metabolic syndrome and diabetes
mellitus (DM), with the worst glycaemic control. Although
women were less likely than men to reach goal [OR 0.65 (CI
0.54–0.77),
p
<
0.001 for NCEP ATP III guidelines and OR
0.76 (CI 0.64–0.91),
p
<
0.003 for fourth JETF guidelines],
women of African ancestry were just as likely not to reach
goal as their Caucasian counterparts.
Conclusion:
The results of this survey highlight the sub-opti-
mal lipid control achieved in many South African patients,
and profile important gender and ethnic differences. Control
of cardiovascular disease risk factors across gender and
ethnic groups remains poor.
Submitted 28/2/13, accepted 7/6/13
Cardiovasc J Afr
2013;
24
: 238–242
DOI: 10.5830/CVJA-2013-043
Elevated serum lipid levels have been identified as one of the
modifiable risk factors in the aetiology of cardiovascular disease
(CVD). The INTERHEART study established that elevated
lipid levels was the greatest contributor to the development
of myocardial infarction worldwide.
1
Multiple studies have
evaluated the control of serum lipid levels in clinical practice but
these studies originate almost exclusively from the developed
nations of North America and Europe.
2-8
Cardiovascular risk-
factor control is poorly studied in developing nations, and in
particular, knowledge of the control of lipid levels is largely
unknown. In the limited published data, there is no specific
information on gender and/or ethnic differences.
9
Different authorities, such as the Joint European Task Force
(JETF) and the United States National Cholesterol Educational
Program Adult Treatment Panel III (NCEP ATP III) have
developed clinical guidelines for the management of CVD
risk, and there are extensive data showing that modification
of risk factors can delay the development of CVD or prevent
recurrent events in those with CVD at baseline.
10-13
Over time,
these guidelines have proposed progressively lower targets for
CVD risk factors on the basis of evidence from clinical studies
demonstrating that cardiovascular risk is further reduced by more
rigorous risk-factor control. Aggressive low-density lipoprotein
cholesterol (LDL-C) lowering remains the cornerstone of lipid
management.
The CEntralised Pan-South African survey on tHE
Undertreatment of hypercholeSterolaemia (CEPHEUS SA)
was initiated to detect and quantify the degree of under-
treatment of hypercholesterolaemia in South Africa, and the
full overall results have been published.
14
This study afforded
us an opportunity to study both gender and ethnic differences in
the prevalence of these CVD risk factors in a developing world
population on drug treatment for elevated serum lipid levels, and
forms the basis of this article.
Methods
CEPHEUS was a non-interventional study conducted in
South Africa between November 2009 and April 2010. To be
representative of the varied population demographics in the
country, 101 investigators in 69 urban study centres were involved
in recruiting patients; 67 were general/primary healthcare
Milpark Hospital, Johannesburg, South Africa
NAOMI RAPEPORT, MB BCh, FCP, FACP,
COLIN LESLIE SCHAMROTH, MB BCh, FCP, MMed
Division of Lipidology, Department of Medicine, University
of Cape Town, South Africa
DIRK JACOBUS BLOM, MB ChB, MMed, FCP (SA), PhD
