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)

Aim: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Dyslipidaemia is a major risk factor that leads to the clinical sequelae of CVD. As a result, it has become essential for South Africa to update its guidelines for the management of dyslipidaemia, and the South African scientific community has recently adopted the European guidelines on CVD prevention in clinical practice. The South African Not at Goal study (SA-NAG) was a survey done to determine the percentage of patients on lipid-lowering therapy who were not achieving guideline-specified low-density lipoprotein cholesterol (LDL-C) goals. Methods: In this cross-sectional study, dyslipidaemic and/or CVD patients on lipid-lowering therapy for more than four months were enrolled. Volunteers had their demographic data and previous medical history documented. Blood samples from these patients were analysed (using standardised methods) to obtain fasting blood lipid and glucose levels. Results: In total, 1 201 patients (age 58 +/- 11.4 years) were recruited by physicians and general practitioners from across South Africa. Under the new guidelines, 41% of patients were defined as low risk (LR) and 59% were high risk (HR). Sixty-three per cent of LR patients and 77% of HR patients (71% overall) did not achieve their LDL-C target goals of 2.5 and 3.0 mmol/l, respectively. The LR and HR patients who did not achieve their LDL-C goals were on average 19% (0.7 mmol/l +/- 0.5) and 31% (1.1 mmol/l +/- 1.1) above their LDL-C target levels, respectively. Conclusions: These results suggest that a considerable number of patients fall into the category 'not at goal' LDL-C. Patients who failed to achieve goal were also far above their LDL-C target levels. The adoption of the new guidelines will necessitate enhanced disease management to reduce the disease burden.