CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
AFRICA
335
independently associated with LDL-C levels not being at goal.
Having low HDL-C levels was negatively associated with
female gender and increased alcohol consumption, but positively
associated with being treated by a specialist, increased waist
circumference, and presence of DM. Having elevated triglyceride
levels was negatively associated with age above 70 years, but
positively associated with female gender, obesity, history of DM
and peripheral artery disease. The three variables independently
associated with having all three lipid abnormalities were Asian
and mixed-ancestry ethnicity versus Caucasian ethnicity, and
obesity, all of which were positively associated with not reaching
goal (Table 4).
Discussion
In the DYSIS South Africa study we observed marked ethnic
differences in cardiovascular risk profiles and the primary
indication for statin therapy. While about half of Asian and
mixed-ancestry patients had clinically overt CVD, the rate in
black patients was less than 10%. The major indication for statin
therapy in black patients was diabetes, which was present in
71.2% of patients. A family history of premature CVD was very
uncommon (1.8%) in black patients.
These data are reflective of the epidemiological transition,
which the South African black population is currently
undergoing,
6
with increasing urbanisation and transition to a
TABLE 4. FACTORS INDEPENDENTLYASSOCIATEDWITH LDL-C, HDL-CAND TGABNORMALITIES:
RESULTS FROM MULTIPLE REGRESSIONANALYSES (OR, 95% CI)
LDL-C not at target*†
(
≥
1.8/2.5/3.0 mmol/l)
Low HDL-C*
[
<
1.0 (m)/1.2 (w) mmol/l]
Elevated TG*
(
>
1.7 mmol/l)
LDL-C not at target, low
HDL-C, elevated TG*
Age
≥
70 years
ns
ns
0.57 (0.43–0.77)
ns
Female
ns
0.43 (0.32–0.58)
1.33 (1.02–1.74)
ns
Asian vs Caucasian
ns
ns
ns
2.48 (1.19–5.16)
Black vs Caucasian
ns
ns
ns
ns
Mixed ancestry vs Caucasian
2.12 (1.36–3.32)
ns
ns
2.78 (1.50–5.19)
Alcohol consumption
>
2 units/week
ns
0.50 (0.31–0.79)
ns
ns
BMI
≥
30 kg/m
2
(obesity)
ns
ns
1.74 (1.33–2.29)
2.11 (1.27–3.50)
WC
>
102 (m)/
>
88 cm (w)
ns
1.71 (1.26–2.32)
ns
ns
Hypertension
1.55 (1.12–2.13)
ns
ns
ns
Diabetes mellitus
1.36 (1.01–1.82)
1.58 (1.17–2.15)
1.49 (1.12–1.98)
ns
Cerebrovascular disease
1.89 (1.39–2.57)
ns
ns
ns
Peripheral artery disease
ns
ns
2.35 (1.09–5.07)
ns
Specialist (Card/Endo/Dia/Int/Oth)
ns
2.01 (1.46–2.76)
ns
ns
*Models contained the following variables: age, gender, ethnicity, 1st-grade family history of premature CVD, current smoker, sedentary lifestyle, alcohol consumption
>
2 units/
week, BMI
≥
30 kg/m
2
(obesity), waist circumference
>
102 cm in men/
>
88 cm in women, hypertension, diabetes mellitus, coronary heart disease, cerebrovascular disease, heart
failure, peripheral artery disease, RR
≥
140/90 mmHg (systolic/diastolic), 20–40 vs 10 mg/day simvastatin equivalent,
≥
80 vs 10 mg/day simvastatin equivalent, ezetimibe.
Backward selection (alpha = 0.05) was done.
†
Patients with SCORE risk 1–4%: LDL-C
≥
3.0 mmol/l; patients with SCORE risk 5–9%: LDL-C
≥
2.5 mmol/l; patients with CVD, DM, and/or SCORE risk
≥
10%: LDL-C
≥
1.8 mmol/l
Card
=
cardiologist, Endo
=
endocrinologist, Dia
=
diabetologist, Int
=
internist, Oth
=
other speciality, ns
=
not significant (
p
>
0.05), OR
=
odds ratio, CI
=
confidence interval.
No lipid abnormalities
14.4%
(104)
22.9%
(165)
10.8%
(78)
8.3%
(60)
18.0%
(130)
9.0%
(65)
8.2%
(59)
8.4%
(61)
LDL-C not at goal
(
≥
1.8 mmol/l)
Elevated TG
(
≥
1.7 mmol/l)
Low HDL-C
(
<
1.0 male /
<
1.2 female mmol/l)
Fig. 4. Distribution of no, single and multiple combined
lipid abnormalities in non-very high-risk patients (ESC
2011, SCORE
<
10%). TG, triglycerides; HDL-C, high-
density lipoprotein cholesterol; LDL-C, low-density lipo-
protein cholesterol; thresholds for LDL-C are based on
the ESC guidelines (2011): SCORE risk 1–4%: LDL-C
≥
3.0 mmol/l; patients with SCORE risk 5–9%: LDL-C
≥
2.5
mmol/l; patients with CVD, DM, and/or SCORE risk
≥
10%:
LDL-C
≥
1.8 mmol/l.
No lipid abnormalities
14.4%
(104)
22.9%
(165)
10.8%
(78)
8.3%
(60)
18.0%
(130)
9.0%
(65)
8.2%
(59)
8.4%
(61)
LDL-C not at goal
(
≥
1.8 mmol/l)
Elevated TG
(
≥
1.7 mmol/l)
Low HDL-C
(
<
1.0 male /
<
1.2 female mmol/l)
Fig. 5. Distribution of no, single and multiple combined
lipid abnormalities in very high-risk patients (ESC 2011,
SCORE
≥
10%). TG, triglycerides; HDL-C, high-density
lipoprotein cholesterol; LDL-C, low-density lipoprotein
cholesterol; proportions add up to 100.1% because of
rounding; thresholds for LDL-C are based on the ESC
guidelines (2011): SCORE risk 1–4%: LDL-C
≥
3.0 mmol/l;
patients with SCORE risk 5–9%: LDL-C
≥
2.5 mmol/l;
patients with CVD, DM, and/or SCORE risk
≥
10%: LDL-C
≥
1.8 mmol/l.
