CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 6, July 2013
240
AFRICA
coronary artery disease (CAD) was lower than that seen in the
other ethnic groups. The prevalence of CAD was higher in males
than in females in all ethnic groups. Among male participants,
CAD rates were highest in men of Caucasian, Asian and mixed
ancestry. Among the women, the highest prevalence of CAD was
in women of mixed and Asian ancestry. Few African patients
gave a family history of CAD and the percentage of smokers was
also lowest among the African patients. Most patients (95.9%)
were on LLD monotherapy, with this being almost exclusively
(98.9%) statin based.
The on-treatment lipid and FG values are listed in Table 3.
Overall, patients of African ancestry had lower TC, LDL-C, and
non-HDL-C levels and higher FG levels than subjects of other
ethnic groups. In the cohort with DM (Table 2), the African-
ancestry patients had the highest levels of HbA
1c
, both for males
and females.
The primary outcome or percentage of patients reaching
LDL-C targets is given in Table 4. Overall 60.5% of patients
reached goal as per the NCEP ATP II guidelines and 52.3%
according to the JETF guidelines. Differences in attainment of
goal were noted. Patients of mixed ancestry were less likely
to get to either of the two goals, with the exception of mixed-
ancestry males, who had similar not-at-goal percentages as the
male patients of Asian ancestry. Females subjects were less
likely to get to goal, both for the NCEP ATP III [OR 0.65 (CI
0.54–0.77),
p
<
0.001] and JETF [OR 0.76 (CI 0.64–0.91),
p
<
0.003] guidelines. This difference was maintained across the
various ethnic groups.
The secondary outcomes or percentages of patients receiving
LLDs with the metabolic syndrome, and the breakdown of those
receiving LLDs for primary versus secondary prevention is given
in Table 5.
Discussion
The World Health Organisation has indicated that cardiovascular
disease will be the number one cause of mortality in the
developing world by 2020.
15
Subjects with cardiovascular disease
in underdeveloped countries tend to exhibit mortality 10 or more
years before their counterparts from the developed nations.
16
These factors indicate that it is imperative to address all
cardiovascular risk factors aggressively if there is to be any
TABLE 2. CONTROL OF DIABETESAND HYPERTENSION
Condition
Entire study
Caucasian
African
Mixed ancestry
Asian
Male Female Male Female Male Female Male Female Male Female
Diabetic patients
Number
718
690
279
152
118
256
120
139
200
141
Glucose (mmol/l)
7.93
8.44
7.46
8.08
8.12
9.12
8.17
7.86
8.24
8.19
HbA
1c
(%)
7.94
8.73
7.33
7.64
8.66
9.60
8.19
8.52
8.26
8.57
Hypertensive patients
Number
1081 1063
529
367
142
304
170
218
240
174
Systolic blood pressure (mmHg)
134.9 137.3 135.6 135.6 137.3 137.1 136.6 141.9 130.6 135.3
Diastolic blood pressure (mmHg)
81.7
80.8
82.2
79.3
83.8
81.5
81.3
81.2
79.8
80.0
TABLE 3. LABORATORY RESULTS
Laboratory parameters
Entire study
Caucasian
African
Mixed ancestry
Asian
Male Female Male Female Male Female Male Female Male Female
Total cholesterol (mmol/l)
4.72
5.06
4.75
5.26
4.44
4.57
4.78
5.20
4.75
5.13
LDL cholesterol (mmol/l)
2.63
2.85
2.62
2.93
2.44
2.55
2.65
3.01
2.72
2.91
HDL cholesterol (mmol/l)
1.21
1.41
1.25
1.53
1.19
1.31
1.15
1.36
1.19
1.33
Triglycerides (mmol/l)
2.01
1.79
2.03
1.80
1.83
1.55
2.31
1.83
1.88
1.99
Non-HDL cholesterol (mmol/l)
3.51
3.65
3.51
3.73
3.25
3.26
3.63
3.84
3.56
3.80
Glucose (mmol/l)
6.52
6.76
6.0
5.8
7.2
8.1
6.8
6.7
7.1
7.0
Glycosylated haemoglobin (%)
7.34
638
6.31
8.74
7.48
7.91
TABLE 4. ATTAINMENT OF PRIMARY GOAL (%)
Guidelines
Entire study
Caucasian
African
Mixed ancestry
Asian
Male Female Male Female Male Female Male Female Male Female
NCEP ATP III
63.4
56.8
67.3
61.5
68.4
60.8
61.0
41.7
58.7
52.7
EAS/ESC
55.0
49.3
57.5
50.1
62.3
55.8
44.3
42.0
51.6
48.0
TABLE 5. SECONDARY OUTCOMEVARIABLES
Variables
Entire study
Caucasian
African
Mixed ancestry
Asian
Male Female Male Female Male Female Male Female Male Female
Metabolic syndrome (%)
65.2
71.5
62.8
55.7
72.6
88.0
71.2
77.6
63.7
78.1
Primary prevention (%)
40.3
48.7
47.4
66.7
32.7
24.9
32.4
44.0
34.1
45.7
Secondary prevention (including DM) (%)
59.7
51.3
52.6
33.3
67.3
75.1
67.6
56.0
65.9
54.3
