Centralized Pan-Middle East Survey on the Under-Treatment of Hypercholesterolemia: Results from the CEPHEUS II Study in Egypt

Abstract

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.

A semi-systematic review on hypertension and dyslipidemia care in Egypt—highlighting evidence gaps and recommendations for better patient outcomes

“…An additional survey-based study on NCDs risk factors in Egypt was supplemented to the shortlisted records for assessment. Finally, 8 articles from the structured searches [ 6 , 8 , 21 – 23 , 26 , 35 , 40 ], 2 nationwide survey reports from the unstructured search [ 41 , 42 ], and 1 additional study was included in the final analysis [ 16 ]. Two of the selected studies were not considered for final analysis because of the availability of the similar data in the STEPS Survey reports.…”

“…The results from both the Centralized Pan-Middle East Survey on the under-treatment of hypercholesterolemia (CEPHEUS) studies in Egypt indicated that most patients were aware of their target cholesterol levels (76%) or bad cholesterol (75%) [ 23 , 40 ]. Although compliance to treatment of dyslipidemia in the CEPHEUS II study was reported at 59% [ 40 ], target LDL-C levels were achieved in only 32.5% and 34.4% of the patients as reported in the CEPHEUS I and CEPHEUS II results, respectively [ 23 , 40 ]. According to the DYSlipidemia International Study (DYSIS)-Egypt, one-third of the patients who received chronic statin treatment had control in LDL-C levels [ 21 ].…”

“…Further, the prevalence of high cholesterol in Egypt was comparatively lower than that reported in the USA (55%) and UK (66%) [ 15 ]. Data from both the CEPHEUS studies indicated a higher level of awareness in patients about their cholesterol levels (≥75%), with a moderate level of adherence to the therapeutic regimen (59%) [ 23 , 40 ]. However, there was a possibility of recall bias, which is commonly seen in survey studies.…”

“…Although the treatment rates of dyslipidemia were higher, the overall control rates were lower in the general population as well as in patients with ACS, ranging from 20 to 34% [ 21 – 23 , 40 ]. These lower control rates could be attributed to a lack of implementation of evidence-based guidelines, clinical inertia, and patients’ non-compliance to the prescribed treatment [ 49 ].…”

Elevated plasma proprotein convertase subtilisin/kexin type-9 is associated with poor prognosis of acute myocardial infarction in hypertension patients

“…4 A meta-analysis of 3,12,175 patients demonstrated that with 1 mmol/L LDL-C reduction in statin therapy the risk of major adverse cardiac events (MACE) risk reduction reduced by 23%. 5 However, according to the clinical studies and metaanalysis, [6][7][8] it seems that statins' effect has a "ceiling effect" on the reduction of LDL-C, that the highest dose of any statin cannot reduce the baseline LDL-C level by more than 55-60%. It is not enough for patients with high or very-high ASCVD risk.…”