CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
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the effects of statins over time in either reducing CVD risk
factors or their ultimate effects in reducing CVD. In addition,
the cross-sectional nature of the study precludes us from drawing
conclusions of temporality based on observed associations. The
study was also only conducted in the private sector and does not
therefore provide any information on the care provided in the
public sector, which accounts for about 80% of patients in South
Africa. As this study was conducted in the private sector, the
ethnic make-up of the DYSIS study cohort is not representative
of the South African population at large.
Furthermore physicians were aware of the study purpose,
possibly making the results prone to a selection bias towards
patients with better-than-average lipid goal attainment. DYSIS by
its design is also unable to provide data on the important public
health question on what proportion of patients with an indication
for lipid-lowering therapy is actually being treated. Analysing
patients that return for follow-up consultation and are still taking
statins is not reflective of the entire statin treatment experience,
as patients discontinuing early and defaulting on follow up are
not captured. However, in spite of these potential limitations, the
data obtained during this cross-sectional, observational study
of South Africa has furthered our knowledge of CV risk and
the factors that contribute to persistent dyslipidaemia in statin-
treated patients.
Conclusions
The DYSIS study for South Africa, like the DYSIS studies in
other countries and regions, indicates that large proportions of
statin-treated patients have persisting lipid abnormalities, which
place them at ongoing risk for CVD. While some observations
with regard to co-morbid conditions and demographics associated
with lipid goal attainment were expected, observations also
demonstrate a decreased likelihood of obtaining lipid goals
among two ethnic minority groups, independent of treatment,
demographics and other co-morbidities. These findings deserve
further attention. As statins remain among the most effective
agents for preventing CVD, the findings of this study emphasise
the necessity for more aggressive therapy in order to achieve
recommended lipid targets, so as to reduce the burden of
cardiovascular disease, which is on the increase not only in South
Africa but worldwide.
The authors thank Dr Claus Jünger and Dr Steffen Schneider, Stiftung
Institut für Herzinfarktforschung, Ludwigshafen, Germany, for performing
the statistical analyses, Dr Myrga Zankel (MSD International) for general
support of the study, and Dr Lori D Bash (Merck, Sharp & Dohme Corp)
for critical content review. We are indebted to all investigators and patients in
South Africa who participated in DYSIS. This study was funded by Sharp &
Dohme Corp, a subsidiary of Merck & Co, Ltd (New Jersey, USA).
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