BackgroundCardiovascular disease is a major cause of morbidity and mortality; however, the risks associated with this disease can be reduced by targeting circulating low-density lipoprotein cholesterol (LDL-C) with lipid-lowering drugs, as recommended in many treatment guidelines. Their effectiveness for hypercholesterolemia management depends on appropriate use in at-risk patients. Observational studies have shown varying adherence to national and international guidelines on reaching LDL-C treatment goals.MethodsThe Centralized Pan-Middle East Survey on the under-treatment of hypercholesterolemia (CEPHEUS) study observed the current management of hypercholesterolemia in patients on lipid-lowering drugs in seven Middle Eastern countries, and results from 1,043 patients in Egypt are presented here.ResultsOverall, less than 50% of patients achieved their LDL-C treatment goal, with patients at higher risk of a cardiovascular event being less likely to attain their target. Nearly, three-quarters of patients in this study were considered high or very high risk, with only 10% of high-risk patients reaching their treatment goal.ConclusionsManagement of hypercholesterolemia in Egypt is comparatively worse than the average for similar countries in the region, and many patients with high risk of CVD are not being effectively treated. Initiatives to improve physicians’ management of these patients and patient compliance to treatment are urgently needed.FundingAstraZeneca, Cairo, Egypt.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-014-0031-x) contains supplementary material, which is available to authorized users.

IntroductionAs part of the CEPHEUS study, CEPHEUS I was conducted in 2010 and 2011 in Cairo and then the CEPHEUS II study was carried out in Alexandria and Delta Regions in Egypt between April 2014 and August 2015 to determine the proportion of dyslipidemic patients on lipid-lowering treatment reaching LDL-C treatment goals.MethodsWe conducted an open-label, observational, multicenter, cross-sectional survey where 90 investigators enrolled 1127 patients receiving lipid-lowering drugs for at least 3 months. After signing informed consent forms, the study questionnaires were completed by patients and investigators. Blood samples were taken for laboratory investigations. Patients with missing LDL-C data were excluded from the analysis and results from 896 patients were analyzed according to European Atherosclerosis Society and EAS/ESC 2011 guidelines.ResultsOut of 896 patients enrolled based on the risk stratification of EAS/ESC 2011 guidelines, 12.4% were classified as low risk, 20.0% as moderate risk, 2.5% as high risk, and 65.2% as very high risk. Achievement goals were 84.7, 44.7, 18.2, and 22.3% for low-risk, moderate-risk, high-risk, and very high risk patients, respectively, with an overall achievement goal of 34.4%. The study population included 50.2% diabetes, 64.4% hypertension, 54.9% metabolic syndrome, 32.2% family history of cardiovascular disease, 23.1% smokers, and 33.8% secondary prevention. Lipid-lowering agents were prescribed as a monotherapy to 90.1% and in combination in 9.9% with goal achievements of 34 and 38%, respectively (p > 0.05). Statins were prescribed to 86.9% of patients. The most frequent prescribed statins were rosuvastatin (47.1%) and atorvastatin (36.0%), followed by simvastatin (9.2%). Treatment goal was achieved in 34.2, 36.0, and 31.7% for rosuvastatin, atorvastatin, and simvastatin, respectively, with no significant difference in achievement goals (p > 0.05).ConclusionsHypercholesterolemia is still not being effectively managed in many at-risk patients in Egypt. The majority of patients enrolled in the study were being actively treated with lipid-lowering medications yet the percentage goal achievement was less when compared to CEPHEUS results.

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