1、HYPERLIPIDEMIA,DR L RABANYE,DEFINITION,Major risk factor for atherosclerosis as a result of elevated levels of serum cholesterol Major component of Serum Cholesterol- LDL-C ( Low density level lipoprotein)- HDL-C (High density level lipoprotein)- TG ( Triglycyrides),Objective of Treatment Guidelines
2、,Identify patients at cardiovascular risk In-line with advances in diagnosis Incorporating newly identified/quantified risk factors Metabolic syndrome Diabetes Treatment guidelines based on evidence pool available at the time of publication Can be expected to change with the emergence of new evidenc
3、e As evidence accumulates that greater LDL-C reductions are associated with greater reductions in CVD risk, guidelines are updated to reflect lowered LDL-C goals,TARGET CHOLESTEROL LEVELS: LDL-C 3 mmol/L in asymptomatic patients LDL-C 2.5 mmol/L in established CVD and diabetic patients,Developmental
4、 Process of Atherosclerosis,Burden of Diseases (CV),The three leading causes of disease in 2030HIV/ AIDSUnipolar depressive diseaseIschaemic heart Disease,Prevalence of Chronic Conditions in Registered Schemes,The most prevalent conditions (per 1000 beneficiaries):Hypertension (86)Hyperlipidaemia (4
5、2)Asthma (24)T2DM (19)CAD (17),Multiple Risk Factors Cause Cumulative Increase in Risk for CVD,RISK FACTORS,Obesity Smoking Diabetes Mellitus Lack of physical Exercise Hypertension Genetics,Types Of Lipid Lowering Drugs,Statins Fibrates Niacin Resins Selective cholesterol inhibitor,Primary Preventio
6、n: Are We Identifying the Right Patients?,Economic Burden of Cardiovascular Disease in the US Estimated for 2005,American Heart Association. Heart Disease and Stroke Statistics2005 Update.,Heart disease,Coronary heart disease,Stroke,Hypertensive disease,Congestive heart failure,Total CVD*,Billions o
7、f Dollars,Effect of Long-Term Modest Reductions in CV Risk Factors,Emberson et al. Eur Heart J. 2004;25:484-491.,Effect of Long-Term Modest Reductions in CV Risk Factors,Heart of Soweto Study,Cross-Sectional Study at Chris Hani Baragwanath Objective: Describe recent in ACS among urban black South Af
8、ricans Epidemiological transition due to urbanization adoption of Western lifestyle and diet vs. traditional (cardio-protective) African lifestyle 1950s: average of 3 patients/annum identified with AMI 1975-80: Total of 50 cases average of 8 patients/annum 2004: 64 patients with ACS in one year alon
9、e Annual incidence of ACS (based on population size) 1975-80: 0.5 1 per 100 000 2004: 7 per 100 000,Rule out Secondary Causes,LIFETSYLE FACTORS DIET: Triglycerides ; HDL-C and LDL-C SMOKING: HDL-C ALCOHOL: Triglycerides UNDERLYING DISEASES CHOL: Hypothyroidism, Renal disease, liver disease, DM TRIGS
10、: Truncal Obesity, Diabetes, Cushings Syndrome PREGNANCY Cholesterol Protease inhibitors,Treatment Rates For Dyslipidemia in US Are High but Few Patients Reach Goals,NHANES 1999-2002, Home Unweighted N = 3,655 - Weighted Sample = 211,125,161 (2004 Census),There is more that can be done to improve qu
11、ality of care delivered to patients,Patients with Dyslipidaemia,Patients On Lipid-Lowering Treatment,Treated to Goal, 50% receive treatment,1996 2000 Hypertensive 55% 54% On BP Medication 84% 90% % controlled to 140/90mm Hg 44% 45%Hyperlipidemic 86% 59% On statins 19% 58% % controlled to 5.0 mmol/L
12、21% 49%,CVD Patients in Europe: Fewer than One-Half Reach Goal,Some improvement, but still large gap in treatment,Very little improvement,The South African Not at Goal study (SA-NAG): Evaluation of LDL-C goals achieved in patients with established CVD and/or hyperlipidaemia receiving lipid lowering
13、therapy Pts on therapy 4mnths 1201 pts recruited across SA 41% defined as low risk, 59% defined as high risk SA guidelines used to define risk and evaluate achievement of goal Conclusion Majority fell into “not at goal” category These pts were also far above their LDL-C targets,And in South Africa?,
14、% Achieving Guideline-specified LDL-C Goals,The SA-NAG study. A. Ramjeeth, N. Butkow, F. Raal, M. Maholwana-Mokgatlhe, CVJA, Vol19:2, 88-94,Low Risk vs High Risk Patients,3.0,3.7,2.5,3.6,0.7,1.1,High Risk LDL-C reduction needed (by gender & age group),The SA-NAG study. A. Ramjeeth, N. Butkow, F. Raa
15、l, M. Maholwana-Mokgatlhe, CVJA, Vol19:2, 88-94,Key points SA-NAG Study,Significant treatment gap exists between lipid guidelines and goal attainment in dyslipidaemic patients with or without established CVD All patient were on lipid-lowering therapy deficit still exists Begs the question - how many
16、 events could be averted if patients reached treatment goal? Potential reasons for the study result: Inadequate titration of doses Patient long-term compliance Financial constraints In the entire study (N= 1201) only 45 pts were using the highest doses of statin therapy ( 4 %),Provider awareness doe
17、s not equal successful implementation,CVD Treatment Gap - Community,Dr Awareness of Treatment Guidelines,Patient Treated to Goal,WHAT ARE WE DOING WRONG?,Not identifying patients for treatment interventionIdentifying patients but not providing treatmentLifestyle and/or pharmacological intervention?Identifying patients, initiating treatment, but lost to follow-upNot achieving treatment goalsinadequate dosageadherence/compliance issues,THANK YOU!,
