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VOLUME 12 NUMBER 1 • JULY 2015
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
specialist practices. The public sector patients were predominantly
recruited from tertiary-care lipid and diabetes clinics. The majority
of African patients came from the public sector.
Several private-sector centres had practitioners who dealt
predominantly with patients with DM, and this could have further
swayed the emphasis of the results on the diabetic cohort. DM is
often associated with an increase in body mass index and other
anthropometric measures of obesity, and data from a cohort with
a high prevalence of DM may therefore not be reflective of the
general population.
As the veracity of the patient questionnaires was not tested, the
validity of the CVD history may have been inaccurate. Measured
clinical parameters (such as blood pressure) were from a single visit
and methods of measurement were not standardised or checked,
and therefore inaccuracies could have arisen. Causal correlations
were not established, and relationships should therefore be
interpreted with caution.
Conclusion
Management of lipid-lowering treatment in South Africa is sub-
optimal, and in general lags behind control achieved in the more
developed nations. Furthermore, other cardiovascular risk factors are
not receiving due attention and their prevalence in this population
remains high. For any serious impact to be made on the looming
epidemic of cardiovascular disease in the underdeveloped world,
more attention needs to be focused on more aggressive treatment
of dyslipidaemia as well as the other cardiovascular risk factors and,
in particular, diabetes mellitus and obesity.
Acknowledgements
The authors acknowledge the participation of all the investigators who participated in
the study. Ms Michelle Nortje of AstraZeneca Pharmaceuticals was most helpful in the
acquisition of data.
References
1.
Yusuf S, Hawken S, Ounpuu S,
et al
. Effect of potentially modifiable risk factors
associated with myocardial infarction in 52 countries (the INTERHEART study):
case control study.
Lancet
2004;
364
: 937–952.
2.
Kuklina E, Yoon P, Keenan N. Trends in high levels of low-density lipoprotein
cholesterol in the United States, 1999–2006.
J Am Med Assoc
2009;
302
(19):
2104–2110.
3.
Kotseva K, Wood D, De Backer G,
et al
. EUROASPIRE III: a survey on the lifestyle,
risk factors and use of cardioprotective drug therapies in coronary patients from
22 European countries.
J Cardiovasc Risk
2009;
16
: 121–137.
4.
Gitt A, Drexel H, Feely J,
et al
. High prevalence of persistent lipid abnormalities
in high-risk patients treated with statins in Europe and Canada: results of the
Dyslipidemia International Study (abstract).
J Am Coll Cardiol
2009; A372.
5.
Pearson T, Laurora I, Chu H,
et al
. The Lipid Treatment Assessment Project (L-TAP):
a multi-centre survey to evalulate the percentages of dyslipidemic patients
receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol
goals.
Arch Int Med
2000;
160
: 459–467.
6.
Van Ganse E, Laforest L, Alemao E,
et al
. Lipid-modifying therapy and attainment
of cholesterol goals in Europe: the Return on Expenditure Achieved for Lipid
Therapy (REALITY) study.
Curr Med Res Opin
2005;
21
(9): 1389–1399.
7.
Hermans M, Cabenzas M, Strandberg T,
et al
. Centralized Pan-European survey
on the under-treatment of hypercholesterolemia (CEPHEUS): overall findings from
eight countries.
Curr Med Res Opin
2010;
26
(2): 445–454.
8.
Bandegas J, Lopez-Garcia E, Dallongeville J,
et al
. Achievement of treatment goals
for primary prevention of cardiovascular disease in clinical practice across Europe:
the EURIKA study.
Eur Heart J
2011;
32
: 2143–2152.
9.
Ramjeeth A, Butkow N, Raal F,
et al
. The evaluation of low-density lipoprotein
cholesterol goals achieved in patients with established cardiovascular disease
and/or hyperlipidaemia receiving lipid-lowering therapy: the South African
Not-at-Goal study (SA-NAG).
Cardiovasc J Afr
2008;
19
(2): 88–94.
10. De Backer G, Ambrosioni E, Borch-Johnsen K,
et al
. European guidelines on
cardiovascular disease prevention in clinical practice. Third joint task force of
European and other societies on cardiovascular disease prevention in clinical
practice.
Eur Heart J
2003;
24
: 1601–1610.
11. Third report of the National Cholesterol Education Program (NCEP) expert panel
on detection, evaluation and treatment of high blood cholesterol in adults (Adult
Treatment Panel III); final report.
Circulation
2002;
106
: 3143–3421.
12. Graham I, Atar D, Borch-Johnsen K,
et al
. European guidelines on cardiovascular
disease prevention in clinical practice: executive summary. Fourth Joint Task Force
of the European Society of Cardiology and other societies on cardiovascular
disease prevention in clinical practice.
Eur Heart J
2007;
28
: 2375–2414.
13. Grundy S, Cleeman J, Merz C,
et al
. National heart, Lung and Blood Institute:
American College of Cardiology Foundation; American Heart Association.
Implications of recent clinical trials for the National Cholesterol Education
Program Adult Treatment Panel III guidelines.
Circulation
2004;
110
: 227–239.
14. Raal F, Schamroth C, Blom D, Marx J, Rajput M, Haus M,
et al
. CEPHEUS SA: a
South African survey on the undertreatment of hypercholesterolaemia.
Cardiovasc
J Afr
, 2011;
22
(5): 234–240.
15. Beaglehole R, Yach D. Globalisation and the prevention and control of non-
communicable disease: the neglected diseases of adults.
Lancet
2003;
362
(9387):
903–908.
16. Reddy KS. Cardiovascular disease in non-Western countries.
New Engl J Med
2004;
350
(24): 2438–2440.
17. Sliwa K, Lyons JG, Carrington MJ, Lecour S,
et al
. Different lipid profiles according
to ethnicity in the Heart of Soweto study cohort of de novo presentations of heart
disease.
Cardiovasc J Afr
2012;
23
: 389–395.
18. Sliwa K, Wilkinson D, Hanson D,
et al
. Spectrum of heart disease and risk factors
in a black urban population in South Africa (the Heart of Soweto Study): a cohort
study.
Lancet
2008;
371
: 915–922.
19. Steyn K, Sliwa K, Hawken S,
et al
. Risk factors associated with myocardial
infarction in Africa: the INTERHEART Africa study.
Circulation
2005;
112
: 3554–
3561.