CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
330
AFRICA
Prevalence of dyslipidaemia in statin-treated patients in
South Africa: results of the DYSlipidaemia International
Study (DYSIS)
FREDERICK J RAAL, DIRK J BLOM, SHANIL NAIDOO, PETER BRAMLAGE, PHILIPPE BRUDI
Abstract
Introduction and objectives
: Cardiovascular disease (CVD)
is the leading cause of mortality worldwide and increased
levels of low-density lipoprotein cholesterol (LDL-C) are an
important modifiable risk factor. Statins lower LDL-C levels
and have been shown to reduce CVD risk. Despite the wide-
spread availability of statins, many patients do not reach the
lipid targets recommended by guidelines. We evaluated lipid
goal attainment in statin-treated patients in South Africa
and analysed variables contributing to poor goal attainment
as part of the DYSlipidaemia International Study (DYSIS).
Methods:
This cross-sectional, observational study enrolled
1 029 consecutive South African patients consulting office-
based physicians. Patients were at least 45 years old, had
to be treated with a stable dose of statins for at least three
months and had been fasting for 12 hours. We evaluated
lipid goal attainment and examined variables associated with
residual dyslipidaemia [abnormal levels of LDL-C, high-
density lipoprotein cholesterol (HDL-C) and/or triglycerides
(TG)].
Results:
We found that 50.3% of the patients overall did not
achieve target LDL-C levels and 73.5% of patients were at
very high cardiovascular risk. In addition, 33.7% had low
levels of HDL-C, while 45.3% had elevated TG levels despite
statin therapy. Asian and mixed-ancestry patients but not
black (vs Caucasian ethnicity), as well as obese individuals
in South Africa were more likely to still have dyslipidaemia
involving all three lipid fractions.
Conclusions:
We observed that many patients in SouthAfrica
experienced persistent dyslipidaemia despite statin treat-
ment, supporting the concept that there is a need for more
intensive statin therapy or the development of novel treat-
ment strategies. Measures aimed at combating obesity and
other lifestyle-related risk factors are also vital for effectively
controlling dyslipidaemia and reducing the burden of CVD.
Keywords:
cardiovascular disease (CVD), dyslipidaemia, lipid
abnormalities, statins, low-density lipoprotein cholesterol (LDL-C)
Submitted 16/5/13, accepted 18/9/13
Cardiovasc J Afr
2013;
24
: 330–338
DOI: 10.5830/CVJA-2013-071
Cardiovascular disease (CVD) is the leading cause of mortality
worldwide. In 2008,World Health Organisation (WHO) estimates
suggested that 30% (17.3 million) of all deaths worldwide could
be attributed to CVD.
1
In 2008 and 2009, the two most recent
years for which South African data are available, CVD was
responsible for 13.7 and 14.0% of total deaths, respectively.
2-4
However, CVD mortality rates are expected to rise in South
Africa as unhealthy lifestyle trends associated with urbanisation
spread to the countryside, and the population of people surviving
life-threatening infections continues to grow.
5,6
Well-known risk factors for CVD include age, gender,
dyslipidaemia, tobacco smoking, high blood pressure and
diabetes mellitus (DM). Other lifestyle behaviours such as
excessive alcohol consumption, sedentary lifestyle and poor
diet with resultant obesity further contribute to CVD risk.
7,8
The
WHO 2008 estimates indicated that the prevalence of obesity,
tobacco smoking and physical inactivity in South Africa were
31.3 (
≥
20 years old), 14 and 51.1%, respectively.
9
Furthermore,
in 2010 the prevalence of DM was 4.5% for individuals
≥
15
years old,
10,11
and the WHO estimated the rate of high blood
pressure at 42.2% in 2008.
9
As the prevalence of these risk
factors rise in South Africa,
5
so will the rate of CVD.
The main effect of statins is to lower LDL-C levels and they
are used extensively in both primary and secondary prevention of
CVD.
12-14
Importantly, several large clinical trials have indicated
that for every 1-mmol/l reduction in LDL-C levels there is a 23%
reduction in CVD risk.
15-18
In a further meta-analysis of studies
comparing high and low statin doses, more intensive lowering of
LDL-C (0.51 mmol/l additional reduction) in the high-dose statin
armwas associated with a further 15% reduction in CVD risk.
19
In
the most recently published statin cardiovascular outcomes trial
(JUPITER study: men and women free of overt cardiovascular
disease over the ages of 50 and 60 years, respectively; baseline
LDL-C
<
3.37 mmol/l and high-sensitivity C-reactive protein
of 2 mg/l or more; randomised to rosuvastatin 20 mg/day or
placebo), statin treatment was associated with a 39% reduction
in primary endpoints (myocardial infarction, stroke, admission
to hospital for unstable angina, arterial revascularisation or CV
death) in patients with at least one risk factor for DM.
20
The results of these and other studies have resulted in
treatment guidelines recommending progressively lower LDL-C
Carbohydrate and Lipid Metabolism Research Unit,
Department of Medicine, University of the Witwatersrand,
Johannesburg, South Africa
FREDERICK J RAAL, MBBch, MMed, PhD,
Division of Lipidology, Department of Medicine, University
of Cape Town, Cape Town, South Africa
DIRK J BLOM, MBBCh, MMed, PhD
MSD South Africa, Midrand, South Africa
SHANIL NAIDOO, MB ChB, Dip HIV, MAN (SA), PDM
Institut für Pharmakologie und präventive Medizin, Mahlow,
Germany
PETER BRAMLAGE, MD
Merck, Sharp & Dohme Corp, Whitehouse Station, NJ, USA
PHILIPPE BRUDI, MD
