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VOLUME 12 NUMBER 1 • JULY 2015
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Gender and ethnic differences in the control of hyper-
lipidaemia 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
Correspondence to: Naomi Rapeport
Colin Leslie Schamroth
Milpark Hospital, Johannesburg, South Africa
e-mail:
nrapeport@global.co.zaDirk Jacobus Blom
Division of Lipidology, Department of Medicine, University of Cape Town,
South Africa
Previously published in
Cardiovasc J Afr
2013;
24
(6): 238–242
S Afr J Diabetes Vasc Dis
2015;
12
: 30–34
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 different
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 developing
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,
including fasting lipid and glucose, and HbA1c 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 NCEP ATP 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-
optimal lipid control achieved inmanySouthAfricanpatients,
and profile important gender and ethnic differences. Control
of cardiovascular disease risk factors across gender and
ethnic groups remains poor.
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 practitioners, 13 were cardiologists,
seven endocrinologists, and 14 internists/specialist physicians.
Investigators were drawn from both the public and private sectors.
Public sector sites were located in tertiary level referral hospitals.
Subjects 18 years or older who had been receiving lipid-lowering
drugs (LLDs) for at least three months (without dose adjustments
for at least six weeks) were eligible. Consecutive patients who came